JAMDA xxx (2016) 1.e1e1.

e9

JAMDA
journal homepage: www.jamda.com

Original Study

Association Between Sarcopenia and Cognitive Impairment:

A Systematic Review and Meta-Analysis
Ke-Vin Chang MD, PhD a, b, c, Tsai-Hsuan Hsu MS b, Wei-Ting Wu MD a,
Kuo-Chin Huang MD, PhD b, d, Der-Sheng Han MD, PhD a, b, c, *
a
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
b
Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
c
Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
d
Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

a b s t r a c t

Keywords: Background: Sarcopenia, a gradual loss of muscle mass and function, has been associated with poor
Sarcopenia health outcomes. Its correlation with another age-related degenerative process, impaired cognition,
cognition remains uncertain. This meta-analysis aimed to determine whether there is an association between
dementia
sarcopenia and cognitive impairment.
muscle
Methods: PubMed and Scopus were searched for observational studies that investigated the association
aging
between sarcopenia and cognitive dysfunction. Participants’ demographics and measurements, defini-
tion of sarcopenia, and tools for evaluating cognitive function were retrieved. The correlations between
sarcopenia and cognitive impairment were expressed as crude and adjusted odds ratios with 95% con-
fidence intervals (CIs).
Results: Seven cross-sectional studies comprising 5994 participants were included. The crude and
adjusted odds ratios were 2.926 (95% CI, 2.297e3.728) and 2.246 (95% CI, 1.210e4.168), respectively. The
subgroup analysis showed that different target populations and sex specificity did not significantly
modify the association, whereas the tools for evaluating cognitive function and modalities for measuring
body composition did.
Conclusions: Sarcopenia was independently associated with cognitive impairment. Future cohort studies
are warranted to clarify the causal correlation. The inclusion of relevant biomarkers and functional
measurements is also recommended to elucidate the underlying biological mechanism.
Ó 2016 AMDA e The Society for Post-Acute and Long-Term Care Medicine.

Sarcopenia was originally known as age-related loss of muscle
mass, leading to impaired strength, reduced aerobic activity, and
decreased physical performance.1 Its prevalence varies from 0.9% to
85.4% in the geriatric population based on different measuring tools
and cut-off values for muscle mass and function.2,3 Other than ag-
ing, possible causes of sarcopenia include inadequate nutrition,
disuse atrophy, hormone depletion, and chronic inflammation.4,5 It
has been associated with several worse health outcomes, including
increased mortality, longer hospitalization, and greater need for
rehabilitation care after hospital discharge.6 Sarcopenia has also
The study was funded by the research funding of the Community and Geriatric
Research Center, National Taiwan University Hospital, Bei-Hu Branch.
The authors declare no conflicts of interest.
* Address correspondence to Der-Sheng Han, MD, PhD, Department of Physical
Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch,
No. 87, NeiJiang Rd, WanHwa District, Taipei 108, Taiwan.
E-mail address: dshan1121@yahoo.com.tw (D.-S. Han).
been recognized as a systemic condition that is related to comor-
bidities such as diabetes mellitus, depression, and cardiovascular
events.6 Cognitive impairment, a prognostic factor for disability and
dependence in elderly individuals, is also comorbid with chronic
diseases such as hypertension, diabetes mellitus, thyroid disease,
and heart failure, but its association with sarcopenia remains
uncertain.7
Declines in cognitive function occur as a neurodegenerative process
of aging and can transition to the most severe form, dementia. The most
common subtype of dementia is Alzheimer disease, followed by
vascular dementia, dementia with Lewy bodies, and frontotemporal
dementia.8 The reported prevalence of dementia is 7.1%e16.3% among
people >65 years of age, and it causes a significant health care expen-
diture burden.9 The risk factors for cognitive impairment include
malnutrition, sedentary lifestyle, lack of anabolic hormones, and
persistent inflammatory reactions, all of which are potential causes of
sarcopenia.10 Until now, although sarcopenia and cognitive dysfunction

http://dx.doi.org/10.1016/j.jamda.2016.09.013
1525-8610/Ó 2016 AMDA e The Society for Post-Acute and Long-Term Care Medicine.
1.e2 K.-V. Chang et al. / JAMDA xxx (2016) 1.e1e1.e9

are prevalent features of advanced aging, whether both are indepen-
dently associated appears inconclusive based on the available literature.
Therefore, the present meta-analysis aimed to explore the association
between sarcopenia and impaired cognition, as well as examine
whether the association is modified by other relevant factors.
Methods
Search Strategy and Inclusion Criteria
PubMed and Scopus were searched for observational studies that
investigated the association between sarcopenia and cognitive
impairment published between the earliest record and May 2016.
Sarcopenia was defined as an age-related loss of muscle mass with
reduced muscle strength and/or impaired physical performance.2
Adults who were able to communicate and participate in the sarco-
penia screening program were included in this study. Those who were
institutionalized or unable to walk independently were excluded. The
assessment of cognitive function by a validated scale was required in
each enrolled study. The search keywords consisted of sarcopenia,
dementia, cognition, and cognitive impairment. Related systematic
reviews and reference lists of the retrieved articles were manually
scrutinized for other potentially eligible studies. We also discarded
non-English literature and abstracts that lacked available full texts.
Identification
Study Selection and Data Extraction
Two authors independently scrutinized the retrieved articles and
extracted the data using a standardized form that included study
design, participant demographics, and definition and measurement of
sarcopenia and cognitive impairment. The Newcastle-Ottawa Scale
was used to assess the included studies and evaluate their quality in
terms of study group selection, group comparability, and exposure or
outcome of interest.11e14 The overall maximum score was 9 points for
the case-control and cohort studies but 6 points for the cross-sectional
studies.11e14 Differences in opinions between reviewers were resolved
through discussion or judgment by the corresponding author.
Outcome Measurement and Statistical Analysis
The crude and adjusted associations between sarcopenia and
cognitive impairment are expressed as odds ratios (ORs) and 95%
confidence intervals (CIs). The adjusted confounders might have
differed among studies but generally included sex, age, education,
depression, and physical performance. The DerSimonian and Laird
random effect model was used to pool effect sizes across selected
studies.15 The c2-based Cochran Q statistic test and I2 statistic were
used to quantify heterogeneity for each summary estimate, with
values of I2 > 0.5 indicating moderate heterogeneity.16,17 To identify

Records identified through Additional records identified

database searching through other sources
(n = 202) (n = 3)

Records after duplicates removed

(n = 136)
Screening

Records screened Records excluded by title

(n = 12) and abstract
(n = 124)

Full-text articles assessed Full-text articles excluded:

for eligibility studies enrolling patients
Eligibility

(n = 7) with fragility only (n = 2);

studies not providing the
distribution of sarcopenia
in their population(n = 3)
Studies included in
qualitative synthesis
(n = 7)
Included

Studies included in
quantitative synthesis
(meta-analysis)
(n = 7)

Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for the study selection process.
Table 1
Summary of Study Characteristics and Definition for Sarcopenia and Cognitive Impairment

Author, Year Participant Definition of Sarcopenia Definition of Cognitive Impairment Enrolled Sample Number Average Age, Study Design Adjusted confounders
Characteristics (Female/Male) Years
Sugimoto Outpatients aged 60 years (1) Skeletal muscle mass measured by Criteria for cognitive impairment Sarcopenia: 88 (56/32) Sarcopenia: Cross-sectional Age, education, vitality
et al29 (2016) or older who attended BIA: defined by Petersen et al31 Control: 330 (223/107) 80.0
5.9; study index, depressive
the memory clinic male: <7.0 kg/m2; female: <5.7 kg/ Control: mood, BMI, health
m2 76.9
6.0 behavior, biochemistry,
(2) Hand grip strength comorbidity
male: <26 kg; female: <18 kg
(3) Physical performance:
time up and go test <13.56 seconds
Huang Community-dwelling Asian Working Group for Sarcopenia Mini-Mental State Examination: Sarcopenia: 50 (14/36) Sarcopenia: Cross-sectional Age, gender, education,
et al27 (2016) older adults (AWGS) less than 16 points for the illiterate, less Control: 681 (331/350) 76.7
5.3; study health behavior,
(1) Skeletal muscle measured by DEXA: than 21 points for those had 6 years of Control: comorbidity,
male: education or less, and less than 24 73.1
5.4 depressed mood,
<7.0 kg/m2; female: <5.4 kg/m2 points for those had more than physical activity
(2) Hand grip strength: 6 years of education

K.-V. Chang et al. / JAMDA xxx (2016) 1.e1e1.e9

male <26 kg; female: <18 kg
(3) Slow gait speed <0.8 m/s
Tolea Community-dwelling (1) Skeletal muscle measured by BIA Montreal Cognitive Assessment <26 Total: 223 (145/78); Not mentioned Cross-sectional Age, gender, race,
et al30 (2015) adults aged 40 Male: <7.26 kg/m2; Female: points/Ascertaining Dementia 8 2 sex was not study BMI, depression
years or older <5.45 kg/m2 points mentioned in
(2) Low muscle strength: not clearly each subgroup.
defined
Kim Patients with end-stage Criteria made by European Working Mini-Mental State Examination Sarcopenia: 32 (12/20) Sarcopenia: Cross-sectional Age, gender, BMI,
et al28 (2014) renal disease aged Group on Sarcopenia in Older People <24 points Control: 63 (29/34) 63.4
11.7; study kg status,
over 50 years (EWGSOP): Control: comorbidity,
(1) Skeletal muscle measured by BIA 64.1
9.3 biochemistry,
male: <8.87 kg/m2; female: depression
<6.42 kg/m2
(2) Hand grip strength:
male <30 kg; female: <20 kg
Hsu Men over 65 years (1) Low muscle mass measured by BIA: Mini-Mental State Examination Sarcopenia: 109 (0/109) Sarcopenia: Cross-sectional Age, BMI, physical
et al26 (2014) living in the veteran <8.87 kg/m2 <24 points Control: 244 (0/244) 83.7
5.7; study function, comorbidity,
retirement community (2) Low muscle strength <22.5 kg Control: depressive symptoms
(3) Slow walking speed 0.8 m/s 82.2
5.0
Alexandre Tda Community dwelling (1) Skeletal muscle mass measured by Modified Mini-Mental State Sarcopenia: 266 (163/103) Sarcopenia: Cross-sectional Age, gender, income,
et al25 (2014) older adults formula estimation: male  8.90 kg/ Examination Control:883 (549/334) Male: study married, education,
m2;female 6.37 kg/m2 <12 points 74.8
1.0, health behavior
(2) Hand grip strength: male: <30 kg Female:
female: <20 kg 75.8
1.0;
(3) Gait speed <0.8 m/s Control:
Male:
68.1
0.6,
Female:
68.9
0.6
Abellan van Kan Community-dwelling Skeletal muscle mass measured by Short Portable Mental Status Sarcopenia: 492 (492/0) Not mentioned Cross-sectional Age, education, disability
et al24 (2013) women aged over DEXA: Questionnaire <8 points Control:2533 (2533/0) study of activity of daily life,
75 years Appendicular lean mass (ALM/ physical activity
h2)  5.67 kg/m2

BIA, bioimpedance analysis; DEXA, dual-energy X-ray absorptiometry.

1.e3
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Table 2
Quality Assessment by Using the Newcastle-Ottawa Scale for the Included Studies
Author, Year Selection
Representative Selection
of Patients of Control
with Sarcopenia
Sugimoto et al29 (2016) - +
Huang et al27 (2016) + +
Tolea et al30 (2015) - +
Kim et al28 (2014) - +
Hsu et al26 (2014) + +
Alexandre Tda et al25 (2014) + +
Abellan van Kan et al24 (2013) + +
+
, each star equals one point in the Total Points column, more stars equal better study ranking in the particular methodology listed in the subheading.
potential effect modifiers, we performed a subgroup analysis of tools
used to evaluate cognitive function, modalities for measuring body
composition, different target populations, and sex specificity. We
employed the Egger test and the funnel plot to evaluate potential
publication bias.18 All of the analyses were performed using
Comprehensive Meta-analysis Software v 3 (Biostat, Englewood, NJ). P
values of < .05 were considered significant, except for .10 for deter-
mining publication bias using the Egger test.
Results
Result of Literature Search
The initial literature search yielded 205 articles consisting of 69
duplicates, which were discarded. After screening the titles and ab-
stracts, we reviewed the full texts of 12 citations for eligibility. We
further excluded 5 articles: 2 that evaluated the association between
cognitive dysfunction and fragility but not sarcopenia19,20 and 3 that
did not provide the distribution of sarcopenia in their population.
21e23
Seven observational studies were included in the final quanti-
tative analysis (Figure 1).24e30
Characteristics of Included Studies and Participants
The 7 included studies comprised 5994 participants with the
average age ranging from 63. 4 to 83.7 years. Regarding the target
population, 1 study recruited patients attending the memory clinic,29
1 recruited patients with end-stage renal disease,28 and 5 recruited
community-dwelling adults.24e27,30 Females accounted for 75.8% of all
enrolled participants; 1 study focused on women,24 1 focused on
men,26 and 5 investigated both sexes.25,27e30 With respect to the
measurement of body composition, 2 studies used dual-energy X-ray
absorptiometry,24,27 4 used bioelectrical impedance analysis, 26,28e30
and 1 used a validated equation for the estimation.25 In terms of
evaluation of cognitive function, 4 studies used the Mini-Mental State
Examination, 25e28,31 1 used the criteria developed by Petersen et al,29
1 used the Short Portable Mental Status Questionnaire,24 and 1
employed both Montreal Cognitive Assessment and Ascertaining
Dementia version 8 (Table 1).30 Because all of the studies used a cross-
sectional design, the Newcastle-Ottawa Scale adapted for cross-
sectional studies was used for the quality assessment (Table 2).
Association Between Sarcopenia and Cognitive Impairment
Furthermore, because 2 of our enrolled studies employed multiple
criteria for the diagnoses of sarcopenia and cognitive impairment, we
extracted the minimal values among the reported ORs for the meta-
analysis to prevent overestimation of the effect sizes.24,30 The crude
OR of the association between sarcopenia and cognitive impairment
Comparability Outcome Total Points
Ascertain Comparability Assessment
of Sarcopenia of Cohorts on of Outcome
Measurement Basis of Design
or Analysis
+ ++ + 5
+ ++ + 6
+ + + 4
+ ++ + 5
+ ++ + 6
+ + + 5
+ + + 5
was 2.926 (95% CI, 2.297e3.728), pooled from all the included studies.
The OR of the association adjusted for confounders like age, sex, ed-
ucation, depression, activities of daily life, and physical performance
was 2.246 (95% CI, 1.210e4.168), as derived from 6 retrieved studies
(Figure 2).24e28,30 The I2 was 8.063 with a P value of.367 for pooling
the crude ORs, and was 77.24 with a P value of < .01 after pooling the
adjusted ORs. The subgroup analysis showed difference in the target
population, and sex specification did not significantly modify the
value of the adjusted associations. However, the association in the
group using the Mini-Mental State Examination (OR, 2.672; 95% CI,
1.716e4.159) was higher than that in the group using Short Portable
Mental Status Questionnaire (OR, 0.970; 95% CI, 0.730e1.289).
Furthermore, the group employing bioimpedance for measuring body
composition had a higher association (OR, 3.444; 95% CI, 2.067e5.737)
than that employing dual-energy X-ray absorptiometry (OR, 1.014;
95% CI, 0.774e1.327) (Figure 3). Significant publication bias was
observed in the adjusted association (P ¼ .019), but not in the crude
association (P value ¼ .406) determined using the Egger test. After we
added potentially unpublished studies to enable quantitative analysis
of the adjusted association, the pooled OR decreased from 2.246 (95%
CI, 1.210e4.168) to 1.787 (95% CI, 1.048e3.048) (Figure 4).
Discussion
To our knowledge, the present meta-analysis was the first to
explore whether sarcopenia is associated with cognitive dysfunction.
After adjusting for relevant confounders, we found a positive associ-
ation between sarcopenia and impaired cognition. Our data also
revealed that the associations differ among subgroups using various
tools for evaluating cognitive function or modalities for measuring
body composition.
Although sarcopenia is an important issue in older populations,
limited systemic reviews and meta-analyses have investigated its risk
factors and correlations with common geriatric comorbidities and
functional outcomes. Weinheimer et al32 conducted a systematic re-
view summarizing the effect of energy restriction and exercise on fat
free mass in sarcopenic obesity in 2010. Steffl et al33 performed 2
meta-analyses investigating whether sarcopenia was related to
smoking in 2015 and to alcohol consumption in 2016.34 Chang et al35
explored the correlation between sarcopenia and mortality in 2016,
whereas Shachar et al36 probed the prognostic value of sarcopenia in
adults with solid tumors in the same year. None of them examined
whether sarcopenia was associated with a decline in cognitive func-
tion. Further, because cognitive impairment creates a great health care
burden in elderly individuals, we found it important to clarify its as-
sociation with sarcopenia, which can be treated with resistance ex-
ercise and nutritional supplements.5,6
Our study revealed a positive crude OR with statistical significance
between sarcopenia and cognitive impairment, indicating that the
 K.-V. Chang et al. / JAMDA xxx (2016) 1.e1e1.e9
Fig. 2. Forest plot of the (A) crude and (B) adjusted associations between sarcopenia and cognitive impairment.
concomitant presence of sarcopenia and impaired cognition was
common in our recruited population. The result was not surprising in
older people because aging is known for its crucial role in the devel-
opment of sarcopenia and decline in cognitive function. We were
more interested in whether other confounders mediated the associ-
ation. In addition to older age, decreased physical activity is another
leading cause of sarcopenia and might result in cognitive impairment
because of cerebral hypoperfusion.6,7,37 A lower education level and
depressive mood are known factors that cause poor performance in
cognitive tests and can be associated with sarcopenia secondary to
reduced viability.6,7,38 The cut-off values for sarcopenia and the in-
cidences of dementia vary between the sexes, which might confound
the correlation between sarcopenia and cognitive disorder.3,39
Therefore, the effect size estimated from the adjusted ORs was
required to clarify the true association.
Of the retrieved articles, 6 provided adjusted ORs, and the pooled
effect size indicated an independent positive association between
sarcopenia and cognitive impairment. Although the adjusted vari-
ables might differ among studies, most included factors such as age,
sex, education, depression, functional level, and common comor-
bidities. The findings suggested that a decline in cognitive function in
patients with sarcopenia could not be simply explained by aging and
lower physical activity. The most accepted theory of relating sarco-
penia to cognitive disorders is through a common pathway. The
depletion of testosterone and estrogen in older individuals has been
1.e5
shown to decrease muscle anabolism and relate to the development
of Alzheimer disease.40,41 Increased levels of C-reactive protein and
tumor necrosis factor alpha in chronic inflammation are known to
cause muscle catabolism and be involved in the pathogenesis of
dementia.4,42 However, because all of the included studies in the
present review lacked detailed data about sex hormones and in-
flammatory makers, we were unable to verify the abovementioned
mechanism.
Several potential biological links might exist between sarcopenia
and decline in cognitive function. The causes of cognitive impairment
include cardiovascular disease, chronic kidney disease, insulin insen-
sitivity, sleep disorders, chronic inflammation, immunosenescence,
and obesity.43 The common etiology might explain the association
between sarcopenia and cognitive impairment. Some of the predis-
posing factors underlying sarcopenia (eg, oxidative stress, inflamma-
tion, and insulin resistance) are also associated with cognitive
impairment.44,45 Among them, vascular aging is common to cardio-
vascular and cerebrovascular diseases.46 Dysfunction in blood vessel
dynamics may have a predictive role in both muscle mass decrease
and cognitive function decline. Atherosclerosis leads to an accelerated
loss of muscle units and can be a prime etiologic factor for frail-
tyddecreased availability of oxygen to muscle.47 The therapeutic ef-
fect of those treatments aiming at improving cardiovascular health,
including physical activity, nutrition and risk factor reduction, should
be studied in the future.
1.e6 K.-V. Chang et al. / JAMDA xxx (2016) 1.e1e1.e9

Fig. 3. Forest plot of the subgroup analysis based on (A) tools for evaluating cognitive impairment, (B) measurements for body composition, (C) target population, and (D) sex
specificity. MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment; AD8, Ascertaining Dementia v 8; SPMSQ, Short Portable Mental Status Questionnaire;
BIA, bioimpedance analysis; DEXA, dual-energy X-ray absorptiometry; ESRD, end-stage renal disease.
 K.-V. Chang et al. / JAMDA xxx (2016) 1.e1e1.e9 1.e7

Fig. 4. Funnel plot of log OR for the (A) crude and (B) adjusted associations. The open circles represent the included studies, whereas the black circles represent the potentially
unpublished studies.

The connection between frailty and cognitive impairment is of
clinical interest because sarcopenia is part of the frailty syndrome.
Frailty, defined by unintentional weight loss, muscle weakness,
exhaustion/fatigue, slowness, and less physically active48 is a geriatric
syndrome characterized by reduced homeostatic reserves. It is
obvious that frailty and sarcopenia share lots of phenotype of
musculoskeletal aging. It is reported that 21.8% of old frail cases had
sarcopenia.49 However, sarcopenia stresses more on skeletal muscle
loss, and frailty focuses widely on weight loss, fatigue, and immobility.
Both of them may incur disability, dependency, and even premature
death.45 Frailty is thought to be the risk factor of dementia, and
“cognitive frailty” was coined to emphasize their relationship.43
Cellular and molecular damage accumulates during aging. These
health deficits finally accumulate and contribute to both frailty and
cognitive impairment.
Regarding the heterogeneity of the adjusted ORs, we speculated
that the majority were derived from differences in tools used to assess
cognitive function and body composition. According to a previous
diagnostic performance study, patients with mild cognitive impair-
ment defined by the Mini-Mental State Examination were likely to be
assigned a more severe level than those defined by the Short Portable
Mental Status Questionnaire.50 Although dual-energy X-ray
1.e8 K.-V. Chang et al. / JAMDA xxx (2016) 1.e1e1.e9
absorptiometry is considered the gold standard to measure skeletal
muscle mass, bioimpedance analysis is more accessible in the clinical
setting. A systematic review pointed out that sarcopenia was more
prevalent in studies using bioimpedance analysis than dual-energy X-
ray absorptiometry.51 A study pointed out that skeletal muscle mass
was overestimated by using dual-energy X-ray absorptiometry
because of inclusion of fat-free adipose tissue.52 Therefore, loss of
skeletal muscle mass was underestimated in older people defined by
dual-energy X-ray absorptiometry, leading to a lower prevalence of
sarcopenia in the target population. The potential misclassification
bias of participants with sarcopenia could explain partially why sar-
copenia defined by dual-energy X-ray absorptiometry was not
significantly associated with cognitive impairment.
Another concern of interpreting our result was asymmetry of the
funnel plot for the adjusted ORs. However, even if potentially un-
published studies were added to the 6 published ones, the lower limit
of the 95% CI of the pooled effect size was still higher than 1 (Figure 4).
This finding further strengthens the fact of an independent positive
association between sarcopenia and cognitive impairment.
We acknowledge several limitations of this meta-analysis. First, all
of the included literature used a cross-sectional design, so causal re-
lationships were vague and required future cohort studies to clarify.
Second, the enrolled studies used different scales to measure cognitive
function and various cut-off points to define sarcopenia, which led to
interstudy heterogeneity. Therefore, we used a random effects model
instead of a fixed effects model for the quantitative analysis under the
assumption that the true effect size followed a nonidentical distri-
bution. Third, the participants in our review comprised community-
dwelling residents and patients recruited from the hospital-based
system, which might limit the generalizability of our findings. How-
ever, we believe that this influence was minimal because we did not
identify significant discrepancies in the effect sizes of the subgroups of
distinct target populations. Finally, in this meta-analysis, we did not
probe any specific cognitive outcome because of data availability. All
included studies provided the over-all scores but not the subdomain of
the cognitive functioning scale. The participants were further
dichotomized into 1 group with cognitive impairment and 1 group
with normal cognitive function based on a predesignated cut-off value
of the cognitive functioning scale. Therefore, which subdomain of
cognitive function, such as orientation, registration, recall, attention,
or calculation, was hampered in patients with sarcopenia could not be
determined in our study.
Conclusions
The present meta-analysis demonstrated that cognitive impair-
ment was significantly more prevalent in participants with sarcopenia
compared with those without sarcopenia. This positive association
was independent of confounders such as age, sex, depression, edu-
cation level, physical performance, and common comorbidities. Future
studies that feature longitudinal tracking of cognitive function in
groups with sarcopenia or vice versa are warranted to clarify the
causal relationship between sarcopenia and cognitive function, while
the inclusion of more relevant biomarkers and functional measure-
ments is also recommended to uncover the underlying biological
mechanism.
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