Association between Lower Extremity Skeletal Muscle Mass and Impaired Cognitive Function in Type 2 Diabetes

Abstract

Lower extremity skeletal muscle mass (LESM) in Type 2 Diabetes (T2D) has been linked to adverse clinical events, but it is not known whether it is associated with cognitive difficulties. We conducted a cross-sectional study on 1,235 people (mean age 61.4 ± 8.0 years) with T2D under primary and secondary care in Singapore. Bioelectrical impedance analyses (BIA) measures of upper extremity skeletal muscle mass (UESM), LESM and appendicular skeletal muscle index (SMI) were related to the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) measures of cognition, in multiple linear regression. In multivariable models, tertile 1 LESM (b = −2.62 (−3.92 to −1.32)) and tertile 2 LESM (b = −1.73 (−2.73 to −0.73)), referenced to tertile 3) were significantly associated with decreased RBANS total score. Significant associations of LESM with cognitive domain performances were observed for tertile 1 (b = −3.75 (−5.98 to −1.52)) and tertile 2 (b = −1.98 (−3.69 to −0.27)) with immediate memory, and for tertile 1 (b = −3.05 (−4.86 to −1.24)) and tertile 2 (b = −1.87 (−3.25 to −0.48)) with delayed memory, and for tertile 1 (b = −2.99 (−5.30 to −0.68)) with visuospatial/ constructional ability. Tertile 1 SMI (b = −1.94 (−3.79 to −0.08) and tertile 2 SMI (b = −1.75 (−3.14 to −0.37)) were also associated with delayed memory. There were no associations between UESM with cognitive performance. Lower LESM may be a useful marker of possible co-occuring cognitive dysfunction. Sarcopenia, the age-related decline in skeletal muscle mass and strength and physical function 1,2 , is linked to adverse events and outcomes including hospitalization, disability and mortality 3-6. Recent studies have also examined the association between sarcopenia and impaired cognitive function as both conditions are highly prevalent in advanced age 2. However, results have been rather divergent 7-12 as some studies reported a link 9-11 while others did not 7,8,12. It is not clear if such a relationship is evident in older individuals with diabetes. Of note, older patients with long-term type 2 diabetes (T2D) typically show accelerated loss of muscle mass and strength. As skeletal muscle plays a key role in glucose storage, absorption and metabolism, diabetic myopathy is an important, but often overlooked condition, that contributes to additional complications and adverse outcomes 13. It is plausible that sarcopenia and cognitive impairment may have a "common soil" known as age-related inflammation (i.e.

Nutritional status mediates the relationship between sarcopenia and cognitive impairment: findings from the WCHAT study

“…Similarly, sarcopenia is common among dementia patients [ 12 ]. The shared pathophysiological mechanisms and pathways between sarcopenia and cognitive impairment involve oxidative stress, chronic inflammation, hormonal changes, insulin resistance, and the gut microbiota [ 11 , 22 , 23 ]. Thus, the relationship between sarcopenia and cognitive impairment is complex and mediated by various internal and external factors, among which nutrition may be a major contributor.…”

Association Between Physical Performance and Cognitive Function in Chinese Community-Dwelling Older Adults: Serial Mediation of Malnutrition and Depression

“…But another study found that there was no significant correlation between upper muscle strength and cognitive function in Type 2 diabetes. 5 The different results may be due to the specificity of the population, the results of our study need to be validated in other populations in the future. Multiple potential explanations for the observed association between poor physical performance and cognitive impairment exist.…”

“…Individuals were included as following criteria: 4 (1) Older adults people ≥65 years old; (2) Have lived in the community for at least one year; (3) Willing to participate in this study. Exclusion criteria: 4 (1) General cognitive function was assessed using the Chinese version of the Matisse Dementia Rating Scale (CDRS), excluding participants who already had severe cognitive impairment and dementia or other neurodegenerative diseases; (2) those who could not take care of themselves and the instrumental activities of daily living scale were more than or equal to three items that could not be completed and could not walk independently; (3) people with hearing impairment, visual impairment and communication difficulties; (4) those who took sedatives in the last one or two months; (5) unable to perform the physical performance test. The methodological sessions were carried out in accordance with the approved guidelines and regulations.…”

Prevalence and Associated Factors of Sarcopenia in Singaporean Adults—The Yishun Study

“…15 Indeed, a recent study reported the association between lower, but not upper, extremity muscle mass and cognitive impairment in persons with type 2 diabetes. 35 More studies can elucidate the relationship between specific cognitive domains and gait. Taken together, lower-extremity strength and cognition, both domains of intrinsic capacity, 36 are important factors in sarcopenia prevention.…”