Frailty, Sarcopenia, Spinach Ice Cream

Frailty  developed in a person living with dementia, or at least recently became more obvious,  which was a surprising and puzzling phenomenon.  The Early Onset Alzheimer’s (AD) was diagnosed in her robust mid- 50’s,  so the “little old lady” scenario didn’t seem to be on the horizon then.  Yet here we are.

Appetite, oral intake and output have not changed. Caregiving Old Guy has had to adapt some routines, but not dramatically.  There is a sense of fragility with care needs.  And simple attempts to improve protein nutrition or passive stretching haven’t really changed things.

Brain damage can affect the vitality and strength of muscles, point to point, as seen in stroke or cerebral palsy.  Since AD progressively affects the entire brain, some effects on muscles were not unexpected,  but still surprising in severity.

Sarcopenia is a medical term for the overall loss of muscle tissue that seems to happen with normal aging, both males and females.  The word is like osteopenia, the loss of bone integrity and strength with increased fracture risk. Lancet Seminar / Review 2019  linked here.

And in frailty  (no medical definition needed, although many are available) the combination of bone , muscle, weight loss and other issues makes a person more vulnerable.  It may just be a part of aging, and may not be accompanied with major cognitive problems at all.

As a subject for medical research, frailty issues have evidently been puzzling academic geriatric doctors for decades. A fundamental question:  can frailty be a risk factor for dementia, or is it the other way around?

One study from Dec 2021,  ~190,000 subjects from the UK Biobank, found that high frailty was associated with developing dementia 4X higher than low frailty. The authors also looked at genetics and lifestyle ratings. The study  was not evidently structured to ask what came first, early dementia or frailty.

Members of the same group looked at the Rush Memory and Aging Project database;  using frailty as a risk factor for dementia over ten year trajectories, they found a similar correlation.  But could it be “reverse causation,” or self-fulfilling prophecy, the notion that frailty exists because subclinical dementia was there first?

Muscle loss might exacerbate weight loss, another frailty characteristic. Some call it UIWL, unintentional weight loss.

So, what to do about it all?  It’s natural to think that exercise, better nutrition or supplements could supercharge a person right back up, right?  Although easily recommended, is there any proof those interventional tactics work?

Well….a study of over 1600 subjects, from 2014, about half given a moderate intensity exercise program almost daily vs “health education,” showed that the exercisers did have a modest reduction of risk for worsening mobility,  about  20-30% , by Hazard Ratios.  The exercise group did have more serious adverse events, 8% by Hazard Ratio.

Some older persons seem to lose their appetites, a kind of anorexia, and they lose weight.  A review last year asked the question about whether dementia made weight loss worse, looking at energy expenditures as documented in two dozen papers, and concluded dementia did not make things worse.

A meta-analysis review from last year, looking at combined nutrition and resistance training interventions over >20 studies, found no differences.

There is an International Conference on Frailty and Sarcopenia Research; their last virtual medical meeting was Oct 2021.  Their symposia and oral presentations (J Frailty Aging 2021;10(S1):S1-S40)  show the breadth and scope of this work, from molecular / hormonal investigations,  the biology of muscle loss,  nutrition and cognitive issues,  even issues for home caregivers’ health.

But there didn’t seem to be any definitive answers for CareGiving Old Guy to implement with any practical, individualized actions.

We are now in the WHO Decade of Aging, until 2030, and they’ve published about frailty; this is one theoretical framework [sorry the image might be blurry]

WHO Clinical Consortium on Healthy Ageing. Report of consortium meeting 1–2 December 2016 in
Geneva, Switzerland. Geneva: World Health Organization; 2017 (WHO/FWC/ALC/17.2). Licence: CC BY-NC-SA 3.0 IGO.

On the other hand, maybe Ice Cream can be part of the solution!  In an international survey of >1000 practicing  geriatric doctors, about UIWL and recommendations, the usual first step is optimizing diet. When folks just won’t eat well, they might try nutritional beverages.

But 50% of geriatric doctors will also recommend ice cream  for their patients, perhaps at lower cost and more palatable, not to mention improving quality of life !

CC0 pixabay.com

Of course, for sarcopenia, who can forget Popeye’s arms?  Well, a group in Spain did do resistance training and placebo controlled spinach supplements (in capsules),  ~ 40 total healthy subjects > age 50, and found improvements in the spinach group, published last month.

Jean Pierre Gallot, CC BY 2.0, flickr.com

Time to try Spinach Ice Cream?  Not sure there’s a commercial product, but there are home recipes on internet food blogs!  To quote the source himself:  “I’m strong to the finich, ’cause I eats me spinach, I’m Popeye the sailor man!”