Sarcopenia y fragilidad en Demencia: Implicaciones para la Evaluación Geriátrica Integral. Revisión sistemática
Palabras clave:
sarcopenia, fragilidad, demencia, evaluación geriátrica integralResumen
DOI: https://doi.org/10.46296/gt.v9i17.0355
Resumen
El envejecimiento poblacional en Ecuador anticipa un incremento de enfermedades neurodegenerativas y síndromes geriátricos, como sarcopenia y fragilidad, que impactan la salud pública. El objetivo de esta revisión sistemática fue analizar la relación entre sarcopenia y/o fragilidad y demencia, contextualizando la evidencia internacional en el escenario nacional. Se realizó una búsqueda exhaustiva en PubMed, EMBASE y Web of Science, seleccionando estudios observacionales en humanos con diagnóstico de demencia, que reportaran prevalencia o asociaciones con sarcopenia y fragilidad. Se incluyeron 27 estudios, que en conjunto abarcaron más de 100 000 participantes, con una edad media de 75 años y predominio femenino. Los hallazgos muestran de forma consistente que las personas con demencia presentan mayor prevalencia de fragilidad y características sarcopénicas, siendo la fragilidad un potencial predictor de demencia y de peores desenlaces clínicos. La asociación es más robusta en demencias no Alzheimer y se ha observado que la fragilidad puede preceder el inicio del deterioro cognitivo. En cuanto a sarcopenia, la evidencia es incipiente, pero su presencia parece correlacionarse con menor masa y fuerza muscular, así como con mayor riesgo de progresión de demencia. Se concluye que fragilidad y sarcopenia podrían actuar como marcadores tempranos de deterioro cognitivo, por lo que su detección en la evaluación geriátrica integral es crucial. Futuros estudios deben estandarizar definiciones y explorar mecanismos biológicos compartidos para optimizar intervenciones preventivas.
Palabras claves: sarcopenia, fragilidad, demencia, evaluación geriátrica integral.
Abstract
Population aging in Ecuador forecasts a rise in neurodegenerative diseases and geriatric syndromes such as sarcopenia and frailty, posing a major public health challenge. This systematic review aimed to examine the relationship between sarcopenia and/or frailty and dementia, contextualizing international findings to the national setting. A comprehensive search was conducted in PubMed, EMBASE, and Web of Science, including observational human studies with a dementia diagnosis that reported prevalence or associations with sarcopenia and frailty. A total of 27 studies were included, encompassing over 100,000 participants, with a mean age of 75 years and a predominance of women. Results consistently indicate that individuals with dementia exhibit higher prevalence of frailty and sarcopenia-related features, with frailty emerging as a potential predictor of dementia and adverse clinical outcomes. The association is stronger for non-Alzheimer dementias, and evidence suggests that frailty may precede cognitive decline. Regarding sarcopenia, current evidence remains limited but points to lower muscle mass and strength in dementia patients and an increased risk of disease progression. In conclusion, frailty and sarcopenia may act as early markers of cognitive impairment, highlighting the importance of their screening in comprehensive geriatric assessment. Future research should standardize diagnostic criteria and investigate shared biological mechanisms to support targeted preventive strategies.
Keywords: sarcopenia, frailty, dementia, comprehensive geriatric assessment.
Información del manuscrito:
Fecha de recepción: 08 de enero de 2026.
Fecha de aceptación: 10 de marzo de 2026.
Fecha de publicación: 09 de abril de 2026.
Descargas
Citas
Albala, C., Lera, L., Sanchez, H., Angel, B., Márquez, C., Arroyo, P., & Fuentes, P. (2017). Frequency of frailty and its association with cognitive status and survival in older Chileans. Clinical Interventions in Aging, Volume 12, 995-1001. https://doi.org/10.2147/CIA.S136906
Allan, L. M., Ballard, C. G., Rowan, E. N., & Kenny, R. A. (2009). Incidence and Prediction of Falls in Dementia: A Prospective Study in Older People. PLoS ONE, 4(5), e5521. https://doi.org/10.1371/journal.pone.0005521
Armstrong, J. J., Stolee, P., Hirdes, J. P., & Poss, J. W. (2010). Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients. Age and Ageing, 39(6), 755-758. https://doi.org/10.1093/ageing/afq121
Avila‐Funes, J. A., Carcaillon, L., Helmer, C., Carrière, I., Ritchie, K., Rouaud, O., Tzourio, C., Dartigues, J., & Amieva, H. (2012). Is Frailty a Prodromal Stage of Vascular Dementia? Results From the T hree‐ C ity S tudy. Journal of the American Geriatrics Society, 60(9), 1708-1712. https://doi.org/10.1111/j.1532-5415.2012.04142.x
Bano, G., Trevisan, C., Carraro, S., Solmi, M., Luchini, C., Stubbs, B., Manzato, E., Sergi, G., & Veronese, N. (2017). Inflammation and sarcopenia: A systematic review and meta-analysis. Maturitas, 96, 10-15. https://doi.org/10.1016/j.maturitas.2016.11.006
Bilotta, C., Nicolini, P., Casè, A., Pina, G., Rossi, S., & Vergani, C. (2012). Frailty syndrome diagnosed according to the Study of Osteoporotic Fractures (SOF) criteria and adverse health outcomes among community-dwelling older outpatients in Italy. A one-year prospective cohort study. Archives of Gerontology and Geriatrics, 54(2), e23-e28. https://doi.org/10.1016/j.archger.2011.06.037
Borda, M. G., Soennesyn, H., Steves, C. J., Osland Vik-Mo, A., Pérez-Zepeda, M. U., & Aarsland, D. (2019). Frailty in Older Adults with Mild Dementia: Dementia with Lewy Bodies and Alzheimer’s Disease. Dementia and Geriatric Cognitive Disorders Extra, 9(1), 176-183. https://doi.org/10.1159/000496537
Boyle, P. A., Buchman, A. S., Wilson, R. S., Leurgans, S. E., & Bennett, D. A. (2009). Association of Muscle Strength With the Risk of Alzheimer Disease and the Rate of Cognitive Decline in Community-Dwelling Older Persons. Archives of Neurology, 66(11). https://doi.org/10.1001/archneurol.2009.240
Buchman, A. S., Schneider, J. A., Leurgans, S., & Bennett, D. A. (2008). Physical frailty in older persons is associated with Alzheimer disease pathology. Neurology, 71(7), 499-504. https://doi.org/10.1212/01.wnl.0000324864.81179.6a
Burns, J. M., Johnson, D. K., Watts, A., Swerdlow, R. H., & Brooks, W. M. (2010). Reduced Lean Mass in Early Alzheimer Disease and Its Association With Brain Atrophy. Archives of Neurology, 67(4). https://doi.org/10.1001/archneurol.2010.38
Cezar, N. O. C., Izbicki, R., Cardoso, D., Almeida, J. G., Valiengo, L., Camargo, M. V. Z., Forlenza, O. V., Yassuda, M. S., & Aprahamian, I. (2017). Frailty in older adults with amnestic mild cognitive impairment as a result of Alzheimer’s disease: A comparison of two models of frailty characterization. Geriatrics & Gerontology International, 17(11), 2096-2102. https://doi.org/10.1111/ggi.13028
Chong, M. S., Tay, L., Chan, M., Lim, W. S., Ye, R., Tan, E. K., & Ding, Y. Y. (2015). Prospective longitudinal study of frailty transitions in a community-dwelling cohort of older adults with cognitive impairment. BMC Geriatrics, 15(1), 175. https://doi.org/10.1186/s12877-015-0174-1
Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., & Rockwood, K. (2013). Frailty in elderly people. The Lancet, 381(9868), 752-762. https://doi.org/10.1016/S0140-6736(12)62167-9
Cruz-Jentoft, A. J., Baeyens, J. P., Bauer, J. M., Boirie, Y., Cederholm, T., Landi, F., Martin, F. C., Michel, J.-P., Rolland, Y., Schneider, S. M., Topinková, E., Vandewoude, M., & Zamboni, M. (2010). Sarcopenia: European consensus on definition and diagnosis. Age and Ageing, 39(4), 412-423. https://doi.org/10.1093/ageing/afq034
Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., Cooper, C., Landi, F., Rolland, Y., Sayer, A. A., Schneider, S. M., Sieber, C. C., Topinkova, E., Vandewoude, M., Visser, M., Zamboni, M., Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2, Bautmans, I., Baeyens,
Evenhuis, H. M., Hermans, H., Hilgenkamp, T. I. M., Bastiaanse, L. P., & Echteld, M. A. (2012). Frailty and Disability in Older Adults with Intellectual Disabilities: Results from the Healthy Ageing and Intellectual Disability Study. Journal of the American Geriatrics Society, 60(5), 934-938. https://doi.org/10.1111/j.1532-5415.2012.03925.x
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., & McBurnie, M. A. (2001). Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146-M157. https://doi.org/10.1093/gerona/56.3.M146
Gray, S. L., Anderson, M. L., Hubbard, R. A., LaCroix, A., Crane, P. K., McCormick, W., Bowen, J. D., McCurry, S. M., & Larson, E. B. (2013). Frailty and Incident Dementia. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68(9), 1083-1090. https://doi.org/10.1093/gerona/glt013
Halloway, S., Arfanakis, K., Wilbur, J., Schoeny, M. E., & Pressler, S. J. (2019). Accelerometer Physical Activity is Associated with Greater Gray Matter Volumes in Older Adults Without Dementia or Mild Cognitive Impairment. The Journals of Gerontology: Series B, 74(7), 1142-1151. https://doi.org/10.1093/geronb/gby010
Hatabe, Y., Shibata, M., Ohara, T., Oishi, E., Yoshida, D., Honda, T., Hata, J., Kanba, S., Kitazono, T., & Ninomiya, T. (2020). Decline in Handgrip Strength From Midlife to Late-Life is Associated With Dementia in a Japanese Community: The Hisayama Study. Journal of Epidemiology, 30(1), 15-23. https://doi.org/10.2188/jea.JE20180137
Hooghiemstra, A. M., Ramakers, I. H. G. B., Sistermans, N., Pijnenburg, Y. A. L., Aalten, P., Hamel, R. E. G., Melis, R. J. F., Verhey, F. R. J., Olde Rikkert, M. G. M., Scheltens, P., Van Der Flier, W. M., & on behalf of the 4C Study Group. (2017). Gait Speed and Grip Strength Reflect Cognitive Impairment and Are Modestly Related to Incident Cognitive Decline in Memory Clinic Patients With Subjective Cognitive Decline and Mild Cognitive Impairment: Findings From the 4C Study. The Journals of Gerontology: Series A, 72(6), 846-854. https://doi.org/10.1093/gerona/glx003
Hsueh, J.-T., Peng, T.-C., Chen, W.-L., Wu, L.-W., Chang, Y.-W., Yang, W.-S., & Kao, T.-W. (2018). Association between frailty and a measure of cognition: A cross-sectional study on community-dwelling older adults. European Geriatric Medicine, 9(1), 39-43. https://doi.org/10.1007/s41999-017-0012-4
Instituto Nacional de Estadística y Censos (INEC). (2020). Proyecciones Poblacionales. https://www.ecuadorencifras.gob.ec/proyecciones-poblacionales/
J.-P., … Schols, J. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16-31. https://doi.org/10.1093/ageing/afy169
Lee, J. E., Shin, D. W., Jeong, S.-M., Son, K. Y., Cho, B., Yoon, J. L., Park, B. J., Kwon, I. S., Lee, J., & Kim, S. (2018). Association Between Timed Up and Go Test and Future Dementia Onset. The Journals of Gerontology: Series A, 73(9), 1238-1243. https://doi.org/10.1093/gerona/glx261
Malmstrom, T. K., & Morley, J. E. (2013). SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia. Journal of the American Medical Directors Association, 14(8), 531-532. https://doi.org/10.1016/j.jamda.2013.05.018
Moon, Y., Moon, W.-J., Kim, J. O., Kwon, K. J., & Han, S.-H. (2019). Role of Muscle Profile in Alzheimer’s Disease: A 3-Year Longitudinal Study. European Neurology, 81(5-6), 209-215. https://doi.org/10.1159/000502176
Namioka, N., Hanyu, H., Hirose, D., Hatanaka, H., Sato, T., & Shimizu, S. (2017). Oxidative stress and inflammation are associated with physical frailty in patients with Alzheimer’s disease. Geriatrics & Gerontology International, 17(6), 913-918. https://doi.org/10.1111/ggi.12804
Ogawa, Y., Kaneko, Y., Sato, T., Shimizu, S., Kanetaka, H., & Hanyu, H. (2018). Sarcopenia and Muscle Functions at Various Stages of Alzheimer Disease. Frontiers in Neurology, 9, 710. https://doi.org/10.3389/fneur.2018.00710
Ohta, Y., Nomura, E., Hatanaka, N., Osakada, Y., Matsumoto, N., Sasaki, R., Tsunoda, K., Takemoto, M., Tadokoro, K., Hishikawa, N., Wakutani, Y., Yamashita, T., Sato, K., Omote, Y., & Abe, K. (2019). Female dominant association of sarcopenia and physical frailty in mild cognitive impairment and Alzheimer’s disease. Journal of Clinical Neuroscience, 70, 96-101. https://doi.org/10.1016/j.jocn.2019.08.062
Peball, M., Mahlknecht, P., Werkmann, M., Marini, K., Murr, F., Herzmann, H., Stockner, H., de Marzi, R., Heim, B., Djamshidian, A., Willeit, P., Willeit, J., Kiechl, S., Valent, D., Krismer, F., Wenning, G. K., Nocker, M., Mair, K., Poewe, W., & Seppi, K. (2019). Prevalence and Associated Factors of Sarcopenia and Frailty in Parkinson’s Disease: A Cross-Sectional Study. Gerontology, 65(3), 216-228. https://doi.org/10.1159/000492572
Rockwood, K. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489-495. https://doi.org/10.1503/cmaj.050051
Rogers, N. T., Steptoe, A., & Cadar, D. (2017). Frailty is an independent predictor of incident dementia: Evidence from the English Longitudinal Study of Ageing. Scientific Reports, 7(1), 15746. https://doi.org/10.1038/s41598-017-16104-y
SABE Ecuador. (2010). Salud, Bienestar y Envejecimiento. Instituto Nacional de Estadística y Censos (INEC). https://www.ecuadorencifras.gob.ec/salud-bienestar-y-envejecimiento/
Sarabia Cobo, C. M., Pérez, V., Hermosilla, C., Nuñez, M. J., & De Lorena, P. (2014). Prevalence of sarcopenia in elderly with dementia institutionalized: a multicenter study. Journal of Aging Research and Lifestyle, 1-4. https://doi.org/10.14283/jarcp.2014.31
Shafiee, G., Keshtkar, A., Soltani, A., Ahadi, Z., Larijani, B., & Heshmat, R. (2017). Prevalence of sarcopenia in the world: A systematic review and meta- analysis of general population studies. Journal of Diabetes & Metabolic Disorders, 16(1), 21. https://doi.org/10.1186/s40200-017-0302-x
Shimada, H., Doi, T., Lee, S., Makizako, H., Chen, L.-K., & Arai, H. (2018). Cognitive Frailty Predicts Incident Dementia among Community-Dwelling Older People. Journal of Clinical Medicine, 7(9), 250. https://doi.org/10.3390/jcm7090250
Shin, H., Kim, S., Kim, J., Shin, I., & Yoon, J. (2012). Association of grip strength with dementia in a Korean older population. International Journal of Geriatric Psychiatry, 27(5), 500-505. https://doi.org/10.1002/gps.2742
Takechi, H., Sugihara, Y., Kokuryu, A., Nishida, M., Yamada, H., Arai, H., & Hamakawa, Y. (2012). Both conventional indices of cognitive function and frailty predict levels of care required in a long‐term care insurance program for memory clinic patients in Japan. Geriatrics & Gerontology International, 12(4), 630-636. https://doi.org/10.1111/j.1447-0594.2011.00828.x
Wallace, L. M. K., Theou, O., Godin, J., Andrew, M. K., Bennett, D. A., & Rockwood, K. (2019). Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer’s disease: A cross-sectional analysis of data from the Rush Memory and Aging Project. The Lancet Neurology, 18(2), 177-184. https://doi.org/10.1016/S1474-4422(18)30371-5
Wang, L., Larson, E. B., Bowen, J. D., & Van Belle, G. (2006). Performance-Based Physical Function and Future Dementia in Older People. Archives of Internal Medicine, 166(10), 1115. https://doi.org/10.1001/archinte.166.10.1115
Publicado
Cómo citar
Número
Sección
Derechos de autor 2026 Revista Científica Arbitrada en Investigaciones de la Salud GESTAR. ISSN: 2737-6273.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
