ORIGINAL ARTICLE   Open access

European Journal of Physical and Rehabilitation Medicine 2022 October;58(5):683-92

DOI: 10.23736/S1973-9087.22.07514-1

Copyright © 2022 THE AUTHORS

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language: English

Aging after stroke: how to define post-stroke sarcopenia and what are its risk factors?

Sheng LI ^{1, 2} ✉, Javier GONZALEZ-BUONOMO ³, Jaskiran GHUMAN ⁴, Xinran HUANG ⁵, Aila MALIK ^{1, 2}, Nuray YOZBATIRAN ^{1, 2}, Elaine MAGAT ^{1, 2}, Gerard E. FRANCISCO ^{1, 2}, Hulin WU ⁵, Walter R. FRONTERA ^{6, 7}

¹ Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA; ² NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA; ³ Hospital de la Concepcion San German, Multy Medical Facilities Ponce, San Juan, Puerto Rico; ⁴ Mount Sinai Hospital, New York, NY, USA; ⁵ Department of Biostatistics and Data Science, University of Texas Health Science Center, Houston, TX, USA; ⁶ Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; ⁷ Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico

BACKGROUND: Sarcopenia, generally described as “aging-related loss of skeletal muscle mass and function”, can occur secondary to a systemic disease.
AIM: This project aimed to study the prevalence of sarcopenia in chronic ambulatory stroke survivors and its associated risk factors using the two most recent diagnostic criteria.
DESIGN: A cross-sectional observational study.
SETTING: A scientific laboratory.
POPULATION: Chronic stroke.
METHODS: Twenty-eight ambulatory chronic stroke survivors (12 females; mean age=57.8±11.8 years; time after stroke=76±45 months), hand-grip strength, gait speed, and appendicular skeletal muscle mass (ASM) were measured to define sarcopenia. Risk factors, including motor impairment and spasticity, were identified using regression analysis.
RESULTS: The prevalence of sarcopenia varied between 18% and 25% depending on the diagnostic criteria used. A significant difference was seen in the prevalence of low hand grip strength on the affected side (96%) when compared to the contralateral side (25%). The prevalence of slow gait speed was 86% while low ASM was present in 89% of the subjects. Low ASM was marginally negatively correlated with time since stroke and gait speed, but no correlation was observed with age, motor impairment, or spasticity. ASM loss, bone loss and fat deposition were significantly greater in the affected upper limb than in the affected lower limb. Regression analyses showed that time since stroke was a factor associated with bone and muscle loss in the affected upper limb, spasticity had a protective role for muscle loss in the affected lower limb, and walking had a protective role for bone loss in the lower limb.
CONCLUSIONS: The prevalence of sarcopenia in stroke survivors is high and is a multifactorial process that is not age-related. Different risk factors contribute to muscle loss in the upper and lower limbs after stroke.
CLINICAL REHABILITATION IMPACT: Clinicians need to be aware of high prevalence of sarcopenia in chronic stroke survivors. Sarcopenia is more evident in the upper than lower limbs. Clinicians also need to understand potential protective roles of some factors, such as spasticity and walking for the muscles in the lower limb.

KEY WORDS: Sarcopenia; Stroke; Motor skills disorders; Muscle spasticity