Sarcopenia na doença de parkinson: análise de prevalência e acurácia dos principais métodos de rastreio de acordo com os critérios diagnósticos do European Working Group on Sarcopenia in Older People 2 (EWGSOP2)

Abstract

Introduction: Sarcopenia and Parkinson's disease (PD) share similar pathophysiological mechanisms, such as inflammation, muscle autophagy, oxidative stress and apoptosis. The present study aimed to estimate the prevalence and explore factors associated with sarcopenia, as well as to validate screening tools for sarcopenia in a sample of patients with mild to moderate PD. Methodology: Cross-sectional study carried out in a tertiary public hospital in Brazil. The following eligibility criteria were adopted: stage 1 to 3 according to the modified Hoehn and Yahr staging scale, age ≥ 40 years and ability to stand and walk without assistance. Sociodemographic and clinical data were collected during medical interview and also through medical records review. The patients' handgrip strength was evaluated, as well as their physical performance and muscle mass using dual-energy xray densitometry (DEXA). The following instruments were assessed as screening tools for sarcopenia: SARC-F, calf circumference, Ishii score and age and BMI as proposed by Goodman et al (2013). Results: The study population was constituted by 124 patients, of which 53 (42.7%) were women. The mean age was 65.8 ± 10.5 years and the mean disease duration was 10.1 ± 5.8 years. The mean hand grip strength was 20.4 ± 6.9 kg and 34.6 ± 8.4 kg in women and men, respectively. Furthermore, 20.2% (n=25) of the patients had probable sarcopenia, 9.7% (n=12) confirmed sarcopenia, and 16.9% (n=21) of the patients had a low muscle mass as measured through DEXA. The prevalence of severe sarcopenia in the sample was 3.2% (n=4). Lower levodopa equivalent dose and decreased calf circumference (CC) were independently associated with confirmed sarcopenia. Lower levodopa equivalent dose, higher MDS-UPDRS part III score, and worse cognitive performance as assessed through MMSE were independently associated with probable sarcopenia. The CC (< 31 cm in women and < 34 cm in men) and the Ishii score (>139 in women and >122 in men) demonstrated good accuracy for identifying patients with confirmed sarcopenia. Conclusions: The present study found a prevalence of confirmed sarcopenia in patients with PD which is similar to that estimated in the general population. Sarcopenia was associated with lower levodopa equivalent dose, decreased CC, higher MDS-UPDRS part III score and worse cognitive performance. Healthcare professionals may consider introducing the measurement of CC, which is a quick and inexpensive method to assess sarcopenia in PD patients.