Heart and brain disorders more frequently co-exist than by chance alone, due to having common risk factors and a degree of interaction. In the setting of heart failure (HF) in the elderly strokes, ...dementia, and depression are all common and can produce a particularly difficult series of clinical problems to manage. Loss of ability to self-care can lead to very poor quality of life and a dramatic increase in health care expenditure. The Heart Failure Association of the ESC as part of its workshop on physiological monitoring of the complex multi-morbid HF patient reviewed screening, monitoring, prevention, and management of cognitive decline within the setting of HF.
Stroke-related sarcopenia: specific characteristics Scherbakov, Nadja; Sandek, Anja; Doehner, Wolfram
Journal of the American Medical Directors Association,
04/2015, Letnik:
16, Številka:
4
Journal Article
Recenzirano
Sarcopenia is characterized by muscle wasting and is primarily a disease of the elderly. A stroke-specific sarcopenia has been described recently. Stroke-related sarcopenia has a number of features ...that distinguish it from the age-related sarcopenia. The disability from stroke depends on the brain lesion leading to impairment of the efferent neuronal pathways. However, the alterations of structural and functional muscle capacity are secondary and depend rather on complex pathophysiological reactions including imbalanced efferent neurovegetative control, systemic and local metabolic imbalance, feeding difficulties, and inflammation. Muscle structural changes start to develop within hours after stroke, followed by rapid reduction of muscle mass. The pathophysiological mechanisms leading to the muscle mass decline are still not understood in details. This review provides insights into the specific features of the stroke-related sarcopenia. Recent research achievements in this area and clinical implications will be discussed.
Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular ...disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
Abstract Stroke is the second leading cause of death and the leading cause of disability in Western countries. More than 60% of patients remain disabled, 50% of patients suffer from hemiparesis and ...30% remain unable to walk without assistance. The skeletal muscle is the main effector organ accountable for disability in stroke. This disability is primarily attributed to the brain lesion; however less attention is paid to structural, metabolic and functional alterations of muscle tissue after stroke. Hemiparetic stroke leads to various muscle abnormalities: A combination of denervation, disuse, inflammation, remodelling and spasticity accounts for a complex pattern of muscle tissue phenotype change and atrophy. The molecular mechanisms of muscle degradation after stroke are only incompletely understood. Reinnervation, fibre-type shift, disuse atrophy, and local inflammatory activation are only some of the key features yet to be explained. Only limited data is available today on clinical muscle changes after stroke that results from few studies in a mere 500 patients. Despite its importance for optimum post stroke recovery, stroke-related sarcopenia is not considered in current guidelines for stroke therapy or rehabilitation and measurement tools to address sarcopenia are infrequently used. This lack of robust evidence on muscle pathology after stroke and on treatment strategies needs to be addressed in an interdisciplinary integrated approach. This review provides an overview on current pathophysiologic insights and on clinical relevance of sarcopenia in stroke patients and on measurement tools to address the problem in the clinical setting.
The assessment of longitudinal changes of body composition by computed tomography (CT) revealed three phenotypes of body wasting in these patients: patients who lost skeletal muscle and fat tissue, ...patients who only lost fat tissue, and patients without wasting who had a significantly improved survival. Importantly, apart from the assessment of muscle bulk, functional and metabolic characteristics of the skeletal muscle tissue might have a role in the determination of functional capacity and symptomatic severity of muscle wasting and hence may have an impact on clinical outcome. Body weight loss after neurological stroke is frequently observed in clinical and experimental settings and associated with adverse clinical outcome.
Abstract
Aims
The association of body weight and weight change with mortality and cardiovascular (CV) outcome in patients with diabetes mellitus (DM) is not clearly established. We assessed the ...relationship between weight, weight change, and outcomes in patients with established CV risk factors and type 2 DM or pre-diabetes.
Methods and results
A total of 12 521 participants from the ORIGIN trial were grouped in BMI categories of low body weight body mass index (BMI) < 22 kg/m2 normal (22–24.9), overweight (25–29.9), obesity Grades 1–3 (30–34.9, 35–39.9, ≥40 kg/m2, respectively). Outcome variables included total and CV mortality and composite outcomes of CV death, non-fatal stroke, or myocardial infarction plus revascularization or heart failure hospitalization. Follow-up was 6.2 years (interquartile range 5.8–6.7 years). After multivariable adjustment, lowest risks were seen in patients with overweight and mild obesity for total mortality overweight: hazard ratio (HR) 0.80 (95% confidence interval (CI) 0.69–0.91); obesity Grade 1: HR 0.82 (0.71–0.95), both P < 0.01) and CV mortality overweight: HR 0.79 (0.66–0.94); obesity Grade 1: 0.79 (0.65–0.95), all compared to patients with normal BMI, P < 0.05. Obesity of any severity was not associated with higher mortality. Low body weight was related to higher mortality HR 1.28 (1.02–1.61); CV mortality: HR 1.34 (1.01–1.79), P < 0.05. A continued 2-year weight loss was associated with higher risk of mortality HR 1.32 (1.18–1.46), P < 0.0001 and CV mortality HR 1.18 (1.02–1.35), compared to patients without weight loss, P < 0.05. In turn, weight gain was not related to any adverse outcome.
Conclusion
Obesity in patients with DM or pre-diabetes and CV risk profile was not associated with higher mortality or adverse CV outcome. The lowest mortality risk was seen in patients with overweight and moderate obesity (BMI 25–35 kg/m2). Weight loss was an independent risk factor for higher mortality compared to no weight loss.
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise ...training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
Iron deficiency, even in the absence of anemia, can be debilitating, and exacerbate any underlying chronic disease, leading to increased morbidity and mortality. Iron deficiency is frequently ...concomitant with chronic inflammatory disease; however, iron deficiency treatment is often overlooked, partially due to the heterogeneity among clinical practice guidelines. In the absence of consistent guidance across chronic heart failure, chronic kidney disease and inflammatory bowel disease, we provide practical recommendations for iron deficiency to treating physicians: definition, diagnosis, and disease-specific diagnostic algorithms. These recommendations should facilitate appropriate diagnosis and treatment of iron deficiency to improve quality of life and clinical outcomes.
The term sarcopenia was introduced in 1988. The original definition was a “muscle loss” of the appendicular muscle mass in the older people as measured by dual energy x‐ray absorptiometry (DXA). In ...2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC‐F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease‐related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age‐related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age‐related and disease‐related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life‐long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.
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