Prevalência de sarcopenia e associação com comprometimento cognitivo em idosos atendidos em um ambulatório de geriatria e gerontologia do Distrito Federal

Abstract

Introduction: aging brings about several biopsychosocial, cognitive, and morphophysiological alterations and may be associated with a higher prevalence of chronic degenerative diseases, among which sarcopenia and cognitive impairment stand out. The literature is controversial about the association between these two conditions, and it is also notorious the lack of consensus on sarcopenia classification algorithms, which may compromise the comparison between the published works. However, the European Working Group on Sarcopenia in Older People (EWGPSO 2), in 2018, published a new algorithm for diagnosis which aids standardization of papers. Objective: to analyze the association between sarcopenia and cognitive impairment among older adults seen at a geriatrics and gerontology outpatient clinic of the Unified Health System in Brasilia, Brazil. Method: This study was divided into two stages. In the first, an integrative literature review was carried out, the selection of articles occurred between February and March 2021, the searches were conducted in the database platforms: Virtual Health Library, PubMed and Scientific Electronic Library Online. The following Health Sciences Descriptors (DeCS)/(MeSH) were used, with the Boolean combinations AND or OR, ((aged) OR (Elderly)) AND (sarcopenia) AND ((dementia) OR (cognition) OR (cognitive dysfunction)). Original articles were included, available in full, published between 2011 and 2020, in English and Portuguese, and that contemplated the analysis of the relationship between sarcopenia and cognitive impairment in community-dwelling elderly individuals over 60 years of age. Articles that were not in line with the studied theme, that did not present the full text, and articles that evaluated elderly individuals in long-term care facilities and hospitalized individuals were excluded. In the second moment, a cross-sectional, observational and analytical study was carried out with a convenience sample of 36 elderly, aged ≥ 60 years, data collection was carried out between the months of October 2019 to February 2020 and interrupted after the increase in cases of COVID-19 in Brasilia. Sarcopenia was defined with the EWGPSO2 algorithm and cognitive assessment with the MMSE. Pearson's Chi-square and Fisher's Exact tests were applied to assess the association between the pathologies. Results: in the integrative review, a total of 12 articles were included in this review, the articles were categorized between those that showed an association between the two conditions and those that did not. Various approaches to diagnosing sarcopenia were observed in both categories, with a greater predominance of the EWGPSO (2010) and AWGS (2014) algorithms, and cognitive impairment. A higher prevalence of cross-sectional studies was noted, however there were longitudinal studies in both categories. Although the association between the pathologies is controversial among the studies, most articles (67%) showed a statistically significant association in the results and the others, despite not proving a statistically significant relationship, the sarcopenic elderly had worse results in cognitive assessments. Regarding the cross-sectional study developed, a total of 36 elderly individuals were evaluated, with a mean age of 75 years (±8), a higher prevalence of females 28 (78%), most of the participants were white, 19 (52, 78%), married or widowed, 11 (30.56%), with family income between 2 and 5 SM 9 (25%) and with elementary school level 12 (33.22%). The risk of sarcopenia was identified in 22 (61%) of the participants, probable sarcopenia in 20 (55.56%), sarcopenia was confirmed in 11 (30.56%) of the cases, and 100% of the cases evaluated had severe sarcopenia; and 13 (36.11%) had some cognitive impairment, sarcopenia was statistically associated with cognitive decline (p˂0.001) and lower mean thickness of the adductor pollicis muscle (p=0.004). Conclusion: In relation to the review, as the prevalence of sarcopenia increases there is a tendency for cognitive decline, and although some studies did not show a statistically significant association between the conditions, the sarcopenic elderly showed worse results in cognitive assessment tests. However, there was no consensus among the studies on the existence of an association between cognitive impairment and sarcopenia; however, a wide variety of diagnostic algorithms and definitions of the pathology were observed, which may interfere in the prevalence and, consequently, in the evaluation of the cause and effect mechanisms with cognitive decline. In the cross-sectional study, there was a high prevalence of sarcopenia; however, the fact that the field of study was an outpatient clinic specializing in elderly care and that the study used the new diagnostic parameters of the EWGPSO2, which emphasizes muscle strength in the diagnosis, is considered. The results of this article suggest that there is a relationship between sarcopenia and possible cognitive impairment. We also observed the need for further studies on these associations, considering the new diagnostic protocols for sarcopenia proposed by EWGPSO2.