Department of Physical Medicine and Rehabilitation, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby M, Suite 3100, Ann Arbor, MI, 48105, USA.
Research Health Science Specialist, VA Ann Arbor Healthcare System, GRECC, Ann Arbor, USA.
Dig Dis Sci. 2020 Dec;65(12):3734-3743. doi: 10.1007/s10620-020-06099-4. Epub 2020 Jan 25.
Frailty is common in cirrhosis and associated with mortality, hospitalization, and reduced quality of life. Interventions aimed at forestalling frailty are limited by a lack of understanding of underlying physiologic deficits.
This study's aim was to examine contributions of discrete sensorimotor and neurocognitive capacities to conventional frailty measures of unipedal stance time, chair stands, and grip strength.
This cross-sectional study enrolled 119 outpatients with cirrhosis (50% female, aged 62.9 ± 7.3 years). Capacities included sensory (lower limb sensation and visual contrast), neurocognitive (Number Connection Tests A and B, simple and recognition reaction time), and muscular (hip/core strength determined by lateral plank time (LPT)). Bivariate analyses and linear regression models were performed to identify significant contributors to each frailty measure.
The average performance was 9.8 ± 3.9 chair stands, 12.7 s ±9.9 unipedal stance time, and 60.3 ± 25.6 lb grip strength. In multivariate models, factors explained 40% of variance in unipedal stance and 43% of variance in chair stands. The LPT was most strongly associated with unipedal stance and chair stands. Grip strength was associated with LPT, but did not have physiologic predictors.
Clinically useful measures of frailty in adults with cirrhosis can be explained by disease severity but also deficits in strength and neurocognitive function. Recognition reaction time, a novel measure in cirrhosis, had a significant contribution to frailty. These findings have implications for frailty assessment and suggest that the optimal rehabilitation approach to frailty targets neurocognitive function in addition to strengthening.
衰弱在肝硬化中很常见，与死亡率、住院率和生活质量下降有关。由于缺乏对潜在生理缺陷的了解，预防衰弱的干预措施受到限制。
本研究旨在探讨离散感觉运动和神经认知能力对单足站立时间、椅子站立和握力等传统衰弱测量指标的贡献。
这项横断面研究纳入了 119 名肝硬化门诊患者（女性占 50%，年龄 62.9±7.3 岁）。能力包括感觉（下肢感觉和视觉对比度）、神经认知（数字连接测试 A 和 B、简单和识别反应时间）和肌肉（通过侧平板时间（LPT）确定的臀部/核心力量）。进行了双变量分析和线性回归模型，以确定每个衰弱测量指标的显著贡献因素。
平均椅子站立次数为 9.8±3.9 次，单足站立时间为 12.7±9.9 秒，握力为 60.3±25.6 磅。在多变量模型中，因素解释了单足站立和椅子站立的 40%和 43%的方差。LPT 与单足站立和椅子站立的相关性最强。握力与 LPT 相关，但没有生理预测因素。
肝硬化成人中临床有用的衰弱测量指标可以用疾病严重程度来解释，但也可以用力量和神经认知功能缺陷来解释。识别反应时间，肝硬化的一种新测量方法，对衰弱有显著贡献。这些发现对衰弱评估具有影响，并表明针对衰弱的最佳康复方法除了加强外，还应针对神经认知功能。
