Sarcopenia, but not malnutrition, is associated with fear of falling in older patients with dementia

OBJECTIVE: Fear of falling (FoF) is common in patients with cognitive impairment. However, the role of sarcopenia and malnutrition, which are two important factors that cause falls, on FoF is unknown. The aim of this study was to explore the association between FoF and malnutrition and sarcopenia in older patients with dementia.
METHODS: Two hundred and sixty-six dementia patients underwent comprehensive geriatric assessment. The Falls Efficacy Scale–International (FES-I) was applied to assign and classify FoF. Scores for the FES-I scale were categorized as ≥28, 20–27, or 16–19, representing high concern, moderate, and no or low concern about FoF, respectively. Mini Nutritional Assessment (MNA) scores <17, 17–23.5, or >23.5 were categorized as malnutrition, malnutrition risk, and well-nourished, respectively. Sarcopenia was defined using the SARC-F tool. SARC-F score ≥4 was categorized as sarcopenia. Serum folate, Vitamin B12, and Vitamin D deficiencies were also evaluated. The relationship between FoF groups and nutritional status, presence of sarcopenia, and micronutrient status was evaluated.
RESULTS: The mean age was 80.83±6.61 years. The prevalence of moderate and high FoF in dementia patients was 51%. There was a significant difference in terms of cerebrovascular events, the history of falling, instrumental and basic activities of daily living (IADL and BADL), MNA, and SARC-F scores between the FoF groups (p<0.05). The association between sarcopenia and FoF persisted in multivariable analysis adjusted for MNA scores, cerebrovascular events, falls history, BADL, and IADL (OR=2.67, 95% CI: 1.50–4.50), but there was no significant association between malnutrition/micronutrient deficiencies and FoF (p>0.05).
CONCLUSION: Sarcopenia is associated with the severity of FoF, but malnutrition or micronutrient deficiencies are not associated with the severity of FoF in older patients with dementia.

Malnütrisyon deðil ama sarkopeni yaþlý demans hastalarýnda düþme korkusuyla iliþkilidir

GÝRÝÞ ve AMAÇ: Düþme korkusunun (DK) kognitif bozukluðu olan hastalarda sýk görüldüðü bilinmektedir. Ancak bu hastalarda düþmeye sebep olan iki önemli faktör olan sarkopeni ve malnütrisyonun DK üzerine etkisi bilinmemektedir. Bu çalýþmanýn amacý demansý olan yaþlý hastalarda DK ile malnütrisyon ve sarkopeni arasýndaki iliþkiyi ortaya koymaktýr.
YÖNTEM ve GEREÇLER: 266 demans hastasýna ayrýntýlý geriatrik deðerlendirme yapýldý. DK’yý belirlemek ve sýnýflandýrmak için Düþme Etkinlik Ölçeði–Uluslararasý FES-I kullanýldý. FES-I ölçeði için puanlar, DK hakkýnda sýrasýyla yüksek, orta ve hiç veya düþük endiþeyi temsil eden ≥28, 20-27 veya 16-19 olarak kategorize edildi. Mini Nutritional Assessment (MNA) skorlarý <17, 17-23.5 veya >23.5, sýrasýyla malnütrisyon, malnütrisyon riski ve iyi beslenmiþ olarak sýnýflandý. Sarkopeni, SARC-F aracý kullanýlarak tanýmlandý. SARC-F skoru ≥4 sarkopeni olarak sýnýflandý. Serum folat, B12 vitamini ve D vitamini eksiklikleri de deðerlendirildi. DK gruplarý ile nütrisyonel durum, sarkopeni varlýðý ve mikronutrient durumlarý arasýnda iliþki deðerlendirildi.
BULGULAR: Ortalama yaþ 80.83 ± 6.61 idi. Demans hastalarýnda orta ve yüksek DK prevalansý %51 idi. Serebrovasküler olaylar, düþme öyküsü, Enstrümental ve Temel Günlük Yaþam Aktiviteleri (EGYA ve TGYA), MNA ve SARC-F skorlarý açýsýndan DK gruplarý arasýnda anlamlý farklýlýk bulunmaktaydý (p <0,05). MNA skorlarý, serebrovasküler olaylar, düþme öyküsü, TGYA ve EGYA için düzeltme yapýlarak gerçekleþtirilen çok deðiþkenli analizde, sarkopeni ile DK arasýndaki iliþki devam etti (OR = 2,67, %95 GA: 1,50 ila 4,50), ancak malnütrisyon/mikronutrient eksiklikleri ile DK arasýnda istatistiksel anlamlý iliþki bulunmamaktaydý (p>0.05).
SONUÇ: Sarkopeni, demansý olan yaþlý hastalarda DK’nýn þiddeti ile iliþkilidir, ancak malnütrisyon veya mikronutrient eksiklikleri ile DK iliþkili deðildir. (NCI-2022-11-19)