The relationship between non-motor symptoms in Parkinson’s Disease and Probable Sarcopenia

The relationship between non-motor symptoms in Parkinson’s Disease and Probable Sarcopenia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between non-motor symptoms in Parkinson’s Disease and Probable Sarcopenia Deniz Kamaci Sener, Olgun Deniz, Emine Gemci, Sinan Gonullu, Suat Kamisli This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6290068/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Parkinson’s Disease (PD) and Probable Sarcopenia (PS) are common diseases for the elderly population. Previous studies mentioned the relationship between motor symptoms and sarcopenia in PD patients, but the data on PS and non-motor symptoms and sarcopenia that can be detected in PD are limited. In the present study, the purpose was to investigate the relationship between non-motor symptoms and PS and the relationship between PS. Methods The study included 93 patients who were aged ≥ 65 years, 50 patients with a diagnosis of PD. Sarcopenia evaluation was performed according to the European Working Group on Sarcopenia in Older People Criteria (EWGSOP2) and all individuals were evaluated for Probable Sarcopenia (PS). Nutrition, frailty, daily living activities and depression were evaluated in all individuals. PD patients were applied the Non-Motor Symptom Questionnaire (NMSQ) and the Fall Efficiency Test. Results The PS rate in Parkinson’s Disease patients was 60%, and was higher in those with high Unified Parkinson’s Disease Rating Scale (UPDRS), UPDRS I-II-III, and Hoen Yahr Stages. The PS rate was also higher in patients with high NMSQ scores, dysphagia, and orthostatic hypotension. In the logistic regression analysis regressin orthostatic hypotension (p: 0.026), SARF-C (p: 0.033), UPDRS score (p: 0.019) and CFS (p: 0.042) were determined as risk factors for PS in PD. Conclusion Patient with PD are at risk for PS. Non-motor symptoms are associated with PS. NMS and PS, which can be overlooked in PD, are findings that clinicians must be careful about. In this respect, early clinical diagnosis and early intervention might allow for the reduction of falls, fracture risk, increased independence and quality of life, and reduced mortality and morbidity. Parkinson disease probable sarcopenia non-motor symptoms fall INTRODUCTION Parkinson’s Disease (PD) has a neurodegenerative characteristic in which motor and non-motor symptoms are detected, the frequency of which increases with aging, and despite treatment approaches, it causes dependency over time ( 1 ). Motor symptoms e.g., bradykinesia, rigidity, static tremor, and gait changes might be detected in PD, as well as non-motor symptoms (NMS) e.g., autonomic symptoms, sleep disorders, neuropsychiatric findings, gastrointestinal system findings, sensory symptoms, hyposmia, and unintentional weight loss, which might occur years before these findings. NMS impairs the quality of life of patients and might cause functional impairment and mortality ( 2 , 3 ). In PD low-calorie intake because of motor impairment, decreased activity, hyposmia, dysphagia, and nausea caused by dopaminergic drugs might accelerate the progression of sarcopenia by leading to a decrease in muscle mass and quality ( 4 , 5 ). Sarcopenia is a complex, multifactorial degenerative disease caused by loss of muscle mass and is often detected in elderly individuals ( 6 ). Sarcopenia is associated with falls, difficulty performing activities of daily living, loss of independence, and reduced quality of life. Groups e.g., the European Working Group on Sarcopenia in Older People (EWGSOP2), the Asian Working Group for Sarcopenia (AWGS), and the International Working Group for Sarcopenia specified different definitions and measurement cutoffs in this respect. New guidelines report that muscle strength is more important in the definition of sarcopenia. Low muscle mass and quality confirm the diagnosis of sarcopenia. In 2019, EWGSOP2 defined PS as only weak muscle strength. Low muscle strength is considered sufficient for PS ( 7 ). Handgrip strength is < 16 kg for women and < 27 kg for men in PS. Even in the absence of low muscle mass and quality, untreated muscle weakness leads to serious problems in terms of patients and healthcare costs ( 8 ). Common pathogenetic mechanisms come into play between PD and sarcopenia. As a neuro-inflammation mediator, Interleukin 6 (IL6) is associated with loss of muscle mass and poor physical performance in elderly patients and PD. Mitochondrial dysfunction was shown in non-neuronal tissues in PD, and mitochondrial dysfunction is also mentioned in sarcopenic muscles compared to healthy muscles ( 9 ). Also, a decrease in motor neurons was shown in PD and sarcopenia ( 5 ). Early recognition, intervention, and treatment of sarcopenia, which has common pathogenetic mechanisms in PD, is important to prevent decreased quality of life, disability, and mortality in PD. In the present study, we aimed to investigate the relationship between non-motor findings, PS, and falls in PD patients and to draw attention to non-motor symptoms, which are neglected findings that might contribute to the development of sarcopenia. METHODS Study protocol The study included 93 patients who were aged ≥ 65 years, 50 patients with a diagnosis of idiopathic Parkinson’s Disease according to the Movement Disorder Society and Parkinson’s Disease Society Brain Bank Diagnostic Criteria, who were followed up in the Movement Disorder Clinic of Bursa City Hospital Neurology Clinic between September 2023 and September 2024, and 43 healthy individuals as a control group. Patients who were aged < 65 years, those who were not using antiparkinsonian treatment regularly, those with parkinsonism findings other than PD, those with advanced dementia, those who are unable to mobilize, those with catabolic diseases (malignancy, chronic liver disease, chronic renal failure), those with additional diseases that might cause malnutrition and falls, and those with hemiparesis or paresis in any extremity were not included in the study. Clinical evaluation The socio-demographic data of the patients who were included in the present study, e.g., age, gender, smoking, alcohol use, the number of medications used (> 5 medications: polypharmacy), Hypertension (HT), Diabetes Mellitus (DM), and the presence of falls were recorded. Neurological examinations of Parkinson’s Disease patients and healthy individuals were performed by the same neurologist. Neurological examinations of Parkinson’s Disease patients were performed in ‘on’ period and the patients’ Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) staging was calculated. The duration of the disease and antiparkinsonian treatment doses were recorded in the patient group and the Levodopa Equivalent Daily Dose (LEDD) was calculated. Non-motor questionnaire (NMSQ) was applied to Parkinson’s patients. NMSQ scores of 0 were grouped as no non-motor findings, 1–5 points as mild, 6–9 as moderate, 10–13 points as severe, and ≥ 14 points as very severe non-motor involvement. Unintentional falls in the last 6 months were questioned in the groups, and the Falls Efficacy Scale (FES) was applied to the Parkinson’s patient group. FES > 70 points were considered as fear of falling. Mini-Mental State Examination (MMSE) was administered to the patients who were included in the study by the same geriatrician. Disability was considered based on impairment in performing the basic activities of daily living. The Katz Index of Independence in Activities of Daily Living (ADL) (which includes bathing, dressing, toileting, transferring, continence, and feeding) and the instrumental activities of daily living (IADL), which include using a telephone, doing shopping, handling medicine, handling finances, mode of transportation, the ability to use telephone, food preparation, housekeeping and laundry. Yesavage Geriatric Depression Scale (GDS), Mini Nutritional Examination Short Form (MNA), Clinical Frailty Scale (CSF), and Sarcopenia Screening Scale (SARF-C) were applied. Probable Sarcopenia evaluation Probable Sarcopenia evaluation was carried out according to the EWGSOP2 Criteria. All individuals were evaluated by the same geriatric specialist in the morning on fasting. The height and weight of the patients were measured and Body Mass Index (BMI) was calculated (kg/m2). The subjects grasped the dynamometer with their arms hanging to the sides while standing using the “Grip Strength Dynamometer, Grip D produced by Takei/Made in Japan” device, which measures handgrip strength for the evaluation of muscle strength and squeezed the dynamometer for 3 seconds with their dominant hand, with their arms in a neutral position. After resting for > 10 seconds in between, 3 consecutive measurements were taken and the highest measurement was accepted as the handgrip strength. For male patients, squeezing less than 27 kg and for female patients, squeezing less than 16 kg was accepted as decreased muscle strength. To evaluate physical activity, the number of seconds it took to walk a distance of 6 m was recorded, and a speed of < 0.8 m/s was considered a decreased walking speed. Statistical analysis The Statistical Package for the Social Sciences (SPSS) version 26.0 was used for the statistical analyses. The categorical variables are presented as frequencies and percentages. The continuous variables were assessed by Kolmogorov-Smirnov test and histograms to find out if their distributions were normal or not. The normally distributed numerical parameters were compared by student’s t-test in two groups, while those with non-normal distributions were analyzed by Mann-Whitney U test. The categorical variables were compared by Chi-squares or Fisher’s Exact tests where appropriate. A p-value < 0.05 was considered as statistically significant. The parameters that were identified and were significantly different between probable sarcopenia and without probable sarcopenia in patients with PD in univariate analyses were put into the equation for logistic regression analysis. Variables eligible for inclusion in the multivariate analysis were tested for collinearity. Additionally, multivariable logistic regression analysis with a stepwise backward approach were performed. Variables that remained significant (p < 0.05) in the multivariate model were considered as independent predictors for probable sarcopenia. Hosmer-Lemeshow goodness of fit statistics were used to assess model fit. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each predictor. RESULTS The median age of the 50 PD patients who were included in the study was 73 (65-82), and the median age of 43 healthy controls was 73 (65-90). Of the patients who were included in the study, 41 were female (44%) and 52 were male (66%). Among the patients in the PD, 18 were female (36%) and 32 were male (64%). No statistical differences were detected between the two groups in terms of age and gender. Of the PD, 29 were tremor dominant (TD) (58%) and 21 were non-tremor dominant (non-TD) (42%). The sociodemographic data of the groups are given in Table 1. Smoking was more common in the control group than in the PD (p: 0.006). BMI, alcohol use, polypharmacy, HT, DM, and calf circumference were significant between the groups. No statistically significant differences were detected in terms of (p: 0.384), (p: 0.095), (p: 0.728), (p: 0.108), (p: 0.166), (p: 0.066). Fall rates were higher in the PD when compared to the control group (p: 0.001), Basic ADL, instrumental ADL, MMSE, CFSC, SARF-C, SMMI were lower (p: 0.049), (p: 0.006), (p: 0.005), (p: 0.004), (p<0.001), (p: 0.014). The rate of PS was 30 patients (60%) in PD and 62.8% in the control group, and no difference was detected in terms of PS between the groups. Total UPDRS, UPDRS I, II and III scores, and (H&Y) were higher in patients with PS Parkinson’s Disease (PSPD) (p:0.003), (p:0.003), (p:0.009). Falls, Basic ADL ,instrumental ADL and MNAwere significantly lower (p: 0.035) (p: 0.001), (p<0.001) (p: 0.002) (p<0.001) and 4 m walking time, time up and go test, five times sit to stand test time (p: 0.038), (p: 0.008), (p: 0.041) FES score, CFS and SARF-C were higher (p: 0.031), (p: 0.003), (p: 0.001) in he PSPD compered to non-PSPD. NMSQ score and grade were higher in the PSPD than in non-PSPD (p:003, p:0.025). In this group, dysphagia and orthostatic hypotension were found to be more common among non-motor symptoms (p:0.035), (p:0.047). No differences were detected between the groups in terms of hyposmia (p:0.355). PS and clinical features are given in Table 2. In the Logistic Regression Analysis, orthostatic hypotension (OR: 32.11, 95% CI 1.53-676.05, p: 0.026), SARF-C (OR: 2.92, 95% CI 1.09-7.82, p: 0.033), UPDRS score (OR: 0.88, 95% CI 0.79-0.98, p: 0.019) and CFS (OR: 7.86, 95% CI 1.07-57.52, p: 0.042) were determined as risk factors for PS in PD (Table 3). DISCUSSİON In the Parkinson’s Disease who were included in the study, the PS (low skeletal muscle strength) rate was 60%, and the PS rate was higher in patients with high UPDRS, UPDRS I-II-III, and H&Y stages. The PS rate was higher in patients with high NMSQ scores, dysphagia, and orthostatic hypotension. In the regression analysis, the main factors that might cause PS in PD patients were found to be UPDRS score, CFSC, SARC-F, and orthostatic hypotension. Studies examining sarcopenia in PD report different rates. According to EWGSOP Criteria, Sarcopenia rates in PD are reported as 2-31.4%, according to EWGSOP2 Criteria as 10.9–22.2%, and according to AWGS criteria as 17.2% ( 10 ). The use of EWGSOP2 Criteria is important as it allows for early detection of Sarcopenia and offers the opportunity for early intervention, as it allows for the evaluation of PS at an earlier stage ( 7 ) ( 11 ). The researchers used EWGSOP2 Criteria in the present study and took < 16 kg for women and < 27 kg for men as the cut-off value in the hand grip test. Hart et al. reported the PS rate as 23.9–66% in PD patients according to EWGSOP2 criteria in their systemic review. The 60% PS rate detected in the patients in the present study is consistent with the literature data ( 12 ). In a previous study that was conducted in Switzerland, PS was reported as 26.3% in women and 28% in men in the normal population ( 13 ). Previously, the PS rate in the elderly in the normal population, whose average age was 74.2, was reported as 27% ( 14 ). In the present study, the average age of the PD and control groups was 73, and the average age of the group with PS was 74. In the literature, some studies, including one study conducted in Turkiye ( 5 , 15 ) reported that sarcopenia is more common in women with PD, but there are also some other studies reporting no difference between the genders ( 16 , 17 ). The researchers found no difference between the genders in terms of PS development. More studies and a larger number of patients are needed to clarify the PS-gender relationship in PD. The risk of sarcopenia varies in different stages of PD ( 18 ). Different studies reported the relationships between UPDRS scores and sarcopenia. It was also reported that sarcopenia is observed at a higher rate in patients with high UPDRS scores. ( 4 , 19 , 20 ). Peball et al. reported that UPDRS I and UPDRS II scores were associated with sarcopenia, but UPDRS IV is not associated with sarcopenia, and another study found that UPDRS I and II are not associated with sarcopenia ( 16 ). In the present study, UPDR I and II scores were found to be higher in PSPD. No relationships were detected between UPDRS IV and PS. It was reported that sarcopenia and PS were more common in PD patients with high UPDRS III (gait, body bradykinesis, motor skills, and extremity movements) and that there was a relationship between low hand grip strength and UPDRS III ( 4 ) ( 21 ). The researchers of the present study found the UPDRS III score to be significantly higher in the group with PS, in line with the literature data. The total UPDRS was found to be 58 on average in the PSPD and was higher than in non-PSPD. Vetrona et al. reported that sarcopenia was more common in patients with UPDRS > 42 in a study that included 210 PD patients. The high UPDRS scores of patients with PS might be associated with the smaller number of patients the researchers evaluated and differences in antiparkinsonian treatment,LEDD ( 18 ). In a previous study conducted by Peball et al. ( 17 ), frailty, recurrent falls, and high SARC-F scores were found in the Non-TD PD. Tan et al. reported no relationship between the motor phenotype of the disease and sarcopenia ( 10 ). SARC-F scores, recurrent falls, and CFS scores were higher in PD when compared to the control group in the present study, but no differences were detected between the TD and Non-TD PD in terms of PS. Considering that Non-TD PD progresses more rapidly and leads to faster cognitive decline and therefore sarcopenia, the lack of difference between the non-TD and TD groups might be associated with the number of patients included, the H&Y stage of the patients included, and LEDD. SARC-F is a 5-item questionnaire and is used in screening for Sarcopenia with strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) as a practical test. SARC-F ≥ 4 is considered the sarcopenia threshold ( 7 ). The specificity of SARC-F is quite high and is used as a screening test to identify patients who need further tests for sarcopenia diagnosis. In the study of Luz et al., sarcopenia was higher in those with high UPDRS II scores and SARF-C. In the present study, SARC-F was found to be higher in PD compared to the control group, and UPDRS II scores and SARF-C were higher in the PSPD. This finding is consistent with the literature. It was reported that SARC-F had lower sensitivity in PD (as walking speed is also included) ( 19 ). For this reason, advanced tests must be performed in PD with high SARC-F to detect PS. Impaired homeostasis and a lack of reserve across several physiological systems result in frailty, a condition marked by increased susceptibility to stresses ( 22 ). Frailty was reported at a rate of 33% in hospitalized PD ( 23 ) and is detected at a rate of 57% higher in PD over the age of 74 when compared to the normal population ( 24 ). It is thought that its increased incidence in PD is because of common pathophysiological mechanisms. In the present study, CFS was also found to be higher in Parkinson’s patients. CFS and SARC-F might help us predict the patient group that should be evaluated for PD. BMI and malnutition are associated with PS in the normal population ( 25 ), but obesity was shown to increase the risk of sarcopenia by 3.2-fold in a small sample of studies ( 26 ). Weight loss is a common non-motor symptomps in PD. Approximately half of patients experience unintentional weight loss throughout the disease and patients are underweight in advanced stages ( 27 , 28 ). Weight loss might lead to malnutrition, increased risk of falls, and cognitive impairment. The risk of malnutrition in PD patients is 3–60%, with undernutrition resulting in loss of muscle mass ( 29 ). Weight loss might be associated with reduced food intake because of factors e.g., hyposmia, dysphagia, taste perversion, depression, and anxiety ( 30 , 31 ). In the present study, no difference was found between the PD and control groups in terms of BMI and MNA, but the MNA score was lower in the PSPD. This finding supports the possibility that malnutrition might cause sarcopenia. Barichella et al. reported that sarcopenia was more common in patients with longer disease duration and advanced stages ( 20 ). The researchers of the present study also found the HY stage higher in the PSPD group, which supports the observation of weight loss and muscle weakness in advanced stages. While some studies have shown that the development of sarcopenia in PD patients is associated with the duration of the disease ( 5 , 17 ), Lee et al. reported no correlation between the duration of the disease and Sarcopenia. In the present study, no relationship was found between the duration of the disease and possible Sarcopenia. We believe that different results could be obtained if a larger number of patients and patients with advanced stages were included in the study. There are studies in the literature examining the relationship between NMS and sarcopenia detected in PD. Weight loss and hyposmia might cause osteosarcopenia ( 32 ). Hyposmia might be detected in approximately 90% of early-stage PD is one of the most common NMS( 33 ). In a previous study conducted in China ( 34 ), NMS scores were found to be high in patients with sarcopenia. In the present study, NMS scores were also high in the PSPD group. Nutrition, fatigue, and sleep quality were reported to be associated with sarcopenia. In present study we found dysphagia and orthostatic hypotension, which are NMS, to be higher in the PSPD. We did not find any difference between the PSPD and non-PSPD in terms of hyposmia. Dysphagia might lead to decreased nutrition, decreased muscle mass, and sarcopenia. Hyposmia was questioned in patients but no smell test was performed. If tests measuring smell function were applied to this patient group, different results might have been obtained. Different results may be found if more patients and advanced stage patients are included in the study. Cai et al. reported in their meta-analysis that falls are more common in PD patients with Sarcopenia and Probable Sarcopenia, and that falls are more common in the patient group with a high HY stage ( 35 ). In the present study, consistent with these findings, falls were found to be more common in PD patients and the PSPPD group. Fear of falling (FES) is higher in the PS group. For this reason, PD patients should be questioned in terms of falling and PS should be kept in mind. Also, falls, fractures, limited movement, and the need for care affect daily living activities in the elderly with sarcopenia ( 7 ). Previous studies reported that the ADL score was lower in the PSPD group, patients used higher doses of LEDD and more medication, and antiparkinsonian medications might cause more falls ( 36 ). Lima et al. ( 5 ) reported that PSPD patients used higher LEDD and had higher ADL scores. In the present study, ADL and instrumental ADL scores were lower in PD compared to healthy controls and in the PSPD when compared to the non-PSPD group. No difference was found between the groups in terms of LEDD and polypharmacy, which situation might differ as LEED and disease stage increase. Clinical implications / future directions PS is common in PD and is associated with NMS. It is understood in recent studies that muscle strength is more important than muscle mass when evaluating sarcopenia, and this has led to a focus on muscle strength and power ( 37 ). A link was found between low handgrip strength and functional, physical, and cognitive impairments ( 11 ). In PD, which is one of the fastest-growing neurological diseases globally ( 38 )muscle strength measurement is a low-cost method that helps detect PS. There are many studies in the literature examining sarcopenia in PD patients, but studies discussing PS and its relationship with NMS are limited. There is not adequate data on the management of sarcopenia with antiparkinsonian treatments, but there is a consensus that it might be managed with resistance exercises ( 39 ). For this reason, screening patients by checking muscle strength, which is a low-cost method in the early stages, might draw attention to PS in PD, and allow for early clinical diagnosis and early intervention, reducing the risk of possible falls and fractures, increasing independence and quality of life, and reducing mortality and morbidity. There were some limitations in the present study. NMS was determined according to the neurologist evaluation and questionnaire forms. No separate diagnostic tests were used for orthostatic hypotension, hyposmia, or dysphagia. We did not include patients with advanced dementia, those living in a nursing home, and those who were not mobile in the present study. In the following years, multicenter studies with larger patient numbers are needed to evaluate the relationship between NMS and PS. Declarations Ethics aprovel and constent to parcipate: The study protocol was approved by Bursa City Hospital Ethics Committee and was prepared in line with the World Medical Association Helsinki Declaration. (Ethics Committee date: 07.07.2023, Ethics Committee no: E-13012450-514.99-218927103). Written informed consent was obtained fromall participants. Clinical trail number: Not applicable Consent to participate/publication : Not applicable Data availability statement: The data supporting the findings of this study is available from the corresponding author upon reasonable request. Authors’ contributions: DKS : major role in data acquisition, writing, OD: data collection, statistical analysis , EG: data collection, SG: data collection, SK: supervisor, conceptualisation Funding Sources and Conflicts of Interest : No specific funding was received for this work. The author declares that there are no conflicts of interest relevant to this work. References Shulman LM. Understanding disability in Parkinson's disease. Movement disorders. 2010;25(S1):S131-S5. Moustafa AA, Chakravarthy S, Phillips JR, Gupta A, Keri S, Polner B, et al. Motor symptoms in Parkinson’s disease: A unified framework. Neuroscience & Biobehavioral Reviews. 2016;68:727-40. Schapira AH, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nature Reviews Neuroscience. 2017;18(7):435-50. Drey M, Hasmann SE, Krenovsky J-P, Hobert MA, Straub S, Elshehabi M, et al. Associations between early markers of Parkinson's disease and sarcopenia. Frontiers in Aging Neuroscience. 2017;9:53. Lima DP, de Almeida SB, Bonfadini JdC, de Luna JRG, de Alencar MS, Pinheiro-Neto EB, et al. Clinical correlates of sarcopenia and falls in Parkinson’s disease. PLoS One. 2020;15(3):e0227238. Xiao Q, Chen S, Le W. Hyposmia: a possible biomarker of Parkinson’s disease. Neuroscience bulletin. 2014;30:134-40. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing. 2019;48(1):16-31. Beaudart C, Zaaria M, Pasleau F, Reginster J-Y, Bruyère O. Health outcomes of sarcopenia: a systematic review and meta-analysis. PloS one. 2017;12(1):e0169548. Ercan A, Kulaksiz G, Dalmizrak O, Muftuoglu M, Ogus H, Cavdar L, et al. Mitochondrial respiratory chain enzyme activities, mtDNA variants and gene expression levels in idiopathic Parkinson's disease. 2009. Tan AH, Hew YC, Lim S-Y, Ramli NM, Kamaruzzaman SB, Tan MP, et al. Altered body composition, sarcopenia, frailty, and their clinico-biological correlates, in Parkinson's disease. Parkinsonism & Related Disorders. 2018;56:58-64. Dodds RM, Roberts HC, Cooper C, Sayer AA. The epidemiology of sarcopenia. Journal of Clinical Densitometry. 2015;18(4):461-6. Hart A, Cordova-Rivera L, Barker F, Sayer AA, Granic A, Yarnall AJ. The prevalence of sarcopenia in Parkinson’s disease and related disorders-a systematic review. Neurological Sciences. 2023;44(12):4205-17. Wearing J, Konings P, de Bie RA, Stokes M, De Bruin ED. Prevalence of probable sarcopenia in community-dwelling older Swiss people–a cross-sectional study. BMC geriatrics. 2020;20:1-8. Trevisan C, Vetrano DL, Calvani R, Picca A, Welmer AK. Twelve‐year sarcopenia trajectories in older adults: results from a population‐based study. Journal of Cachexia, Sarcopenia and Muscle. 2022;13(1):254-63. Ozer FF, Akın S, Gultekin M, Zararsız GE. Sarcopenia, dynapenia, and body composition in Parkinson’s disease: are they good predictors of disability?: a case–control study. Neurological Sciences. 2020;41:313-20. Lee C-Y, Chen H-L, Chen P-C, Chen Y-S, Chiang P-L, Wang C-K, et al. Correlation between executive network integrity and sarcopenia in patients with Parkinson’s disease. International journal of environmental research and public health. 2019;16(24):4884. Peball M, Mahlknecht P, Werkmann M, Marini K, Murr F, Herzmann H, et al. Prevalence and associated factors of sarcopenia and frailty in Parkinson’s disease: a cross-sectional study. Gerontology. 2019;65(3):216-28. Vetrano DL, Pisciotta MS, Laudisio A, Monaco MRL, Onder G, Brandi V, et al. Sarcopenia in Parkinson disease: comparison of different criteria and association with disease severity. Journal of the American Medical Directors Association. 2018;19(6):523-7. da Luz MCL, Bezerra GKA, Asano AGC, Chaves de Lemos MdC, Cabral PC. Determinant factors of sarcopenia in individuals with Parkinson’s disease. Neurological Sciences. 2021;42:979-85. Barichella M, Pinelli G, Iorio L, Cassani E, Valentino A, Pusani C, et al. Sarcopenia and dynapenia in patients with parkinsonism. Journal of the American Medical Directors Association. 2016;17(7):640-6. Roberts HC, Syddall HE, Butchart JW, Stack EL, Cooper C, Sayer AA. The association of grip strength with severity and duration of Parkinson’s: a cross-sectional study. Neurorehabilitation and neural repair. 2015;29(9):889-96. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The lancet. 2013;381(9868):752-62. Wallis S, Wall J, Biram R, Romero-Ortuno R. Association of the clinical frailty scale with hospital outcomes. QJM: An International Journal of Medicine. 2015;108(12):943-9. Torsney K, Romero-Ortuno R. The Clinical Frailty Scale predicts inpatient mortality in older hospitalised patients with idiopathic Parkinson's disease. Journal of the Royal College of Physicians of Edinburgh. 2018;48(2):103-7. Bardon LA, Streicher M, Corish CA, Clarke M, Power LC, Kenny RA, et al. Predictors of incident malnutrition in older Irish adults from the Irish longitudinal study on ageing cohort—A MaNuEL study. The Journals of Gerontology: Series A. 2020;75(2):249-56. de Carvalho DHT, Scholes S, Santos JLF, de Oliveira C, Alexandre TdS. Does abdominal obesity accelerate muscle strength decline in older adults? Evidence from the English Longitudinal Study of Ageing. The Journals of Gerontology: Series A. 2019;74(7):1105-11. Cheshire Jr WP, Wszolek ZK. Body mass index is reduced early in Parkinson's disease. Parkinsonism & related disorders. 2005;11(1):35-8. Chen H, Zhang SM, Hernán MA, Willett WC, Ascherio A. Weight loss in Parkinson's disease. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 2003;53(5):676-9. Sheard JM, Ash S, Silburn PA, Kerr GK. Prevalence of malnutrition in Parkinson's disease: a systematic review. Nutrition reviews. 2011;69(9):520-32. Roos DS, Oranje OJ, Freriksen AF, Berendse HW, Boesveldt S. Flavor perception and the risk of malnutrition in patients with Parkinson’s disease. Journal of Neural Transmission. 2018;125:925-30. Aarsland D. Dementia in Parkinson's disease. Dementia with Lewy Bodies. 2005:221-40. De Rui M, Inelmen EM, Trevisan C, Pigozzo S, Manzato E, Sergi G. Parkinson’s disease and the non-motor symptoms: hyposmia, weight loss, osteosarcopenia. Aging clinical and experimental research. 2020;32:1211-8. Cruz-Jentoft A. et Cruz Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412-23. Liu Q-W, Mao C-J, Lu Z-H, Shi R-F, Zhang Y-C, Zhao P, et al. Sarcopenia is associated with non-motor symptoms in Han Chinese patients with Parkinson's Disease: a cross-sectional study. BMC geriatrics. 2023;23(1):494. Cai Y, Feng F, Wei Q, Jiang Z, Ou R, Shang H. Sarcopenia in patients with Parkinson's disease: a systematic review and meta-analysis. Frontiers in Neurology. 2021;12:598035. Haasum Y, Fastbom J, Johnell K. Use of fall-risk inducing drugs in patients using Anti-Parkinson Drugs (APD): a Swedish Register-Based Study. PloS one. 2016;11(8):e0161246. Ishii H, Tsutsumimoto K, Doi T, Nakakubo S, Kim M, Kurita S, et al. Effects of comorbid physical frailty and low muscle mass on incident disability in community-dwelling older adults: A 24-month follow-up longitudinal study. Maturitas. 2020;139:57-63. Dorsey ER, Sherer T, Okun MS, Bloem BR. The emerging evidence of the Parkinson pandemic. Journal of Parkinson’s disease. 2018;8(s1):S3-S8. Sayer AA, Cruz-Jentoft A. Sarcopenia definition, diagnosis and treatment: consensus is growing. Age and ageing. 2022;51(10):afac220. Tables Table 1. Sociodemographic and clinical characteristics of the participants Control (n=43) Parkinson’s disease (n=50) p Age, median (min-max) 73 (65-90) 73 (65-82) 0.252 Gender Female, n(%) Male, n(%) 23 (53.5) 20 (46.5) 18 (36) 32 (64) 0.090 Smoking No, n(%) Yes, n(%) 33 (76.7) 10 (23.3) 48 (96) 2 (4) 0.006 Alcohol consumption No, n(%) Yes, n(%) 40 (93) 3 (7) 50 (100) 0 (0) 0.095 Polypharmacy No, n(%) Yes, n(%) 19 (46.3) 22 (53.7) 25 (50) 25 (50) 0.728 Hypertension, n(%) 31 (72.1) 28 (56) 0.108 Diabetes Mellitus, n(%) 13 (30.2) 9 (18) 0.166 Fall No, n(%) Yes, n(%) 34 (79.1) 9 (20.9) 22 (44) 28 (56) 0.001 BMI ± SD 26.4 ± 5.7 27.4 ± 4.9 0.384 Calf circumference, median (min-max) 35 (21-46) 36 (29-45) 0.066 Basic ADL, median (min-max) 5 (2-6) 5 (0-6) 0.049 Instrumental ADL, median (min-max) 8 (2-8) 8 (0-8) 0.006 Mini mental state examination score, median (min-max) 28 (18-30) 27 (11-30) 0.005 Mini nutritional examination short form, median (min-max) 13 (4-14) 12 (6-14) 0.258 Clinical frailty scale category, median (min-max) 3 (0-6) 4 (1-6) 0.004 SARC-F, median (min-max) 1 (0-5) 3 (0-8) <0.001 Hand Grip Strength ± SD 19.2 ± 6.8 21.8 ± 7.1 0.081 Skeletel muscle mass index (SMMI), median (min-max) 10.16 (7.76-12.70) 11.05 (4.64-14.06) 0.014 Geriatric Depression Scale Short Form, median (min-max) 2 (0-12) 3 (0-13) 0.059 Probable sarcopenia No, n(%) Yes, n(%) 16 (37.2) 27 (62.8) 20 (40) 30 (60) 0.783 Table 2. Patients characteristics and relation with probable sarcopenia in patients with PD Probable Sarcopenia No (n=20) Yes (n=30) p Age, median (min-max) 71 (65-81) 74 (65-82) 0.089 Gender Female, n(%) Male, n(%) 9 (45) 11 (55) 9 (30) 21 (70) 0.279 Type of the disease Tremor dominant type Non-tremor dominant type 14 (70) 6 (30) 15 (50) 15 (50) 0.160 Duration of illness, median (min-max) 5 (1-13) 5 (1-14) 0.359 Polypharmacy No, n(%) Yes, n(%) 11 (55) 9 (45) 14 (46.7) 16 (53.3) 0.564 Fall No, n(%) Yes, n(%) 12 (60) 8 (40) 9 (30) 21 (70) 0.035 Calf circumference, median (min-max) 36.5 (30-42) 36 (29-45) 0.712 L-dopa, median (min-max) 600 (200-1200) 770 (200-1831) 0.259 Basic ADL, median (min-max) 6 (5-6) 4 (1-6) 0.001 Instrumental ADL, median (min-max) 8 (7-8) 6 (0-8) <0.001 Mini mental state examination score, median (min-max) 28 (20-30) 27 (11-29) 0.105 Mini nutritional assessment short form, median (min-max) 13 (10-14) 11 (6-14) 0.002 Geriatric Depression Scale Short Form, median (min-max) 3 (0-7) 4 (0-13) 0.181 Hand Grip Strength ± SD 26.3 ± 5.8 18.8 ± 6.3 <0.001 Skeletel muscle mass index (SMMI), median (min-max) 11.08 (8.63-13.29) 11.05 (4.64-14.06) 0.953 Non motor score 8.2 ± 4.1 11.8 ± 3.8 0.003 Non motor DERECE Derece 1 Derece 2 Derece 3 Derece 4 5 (25) 8 (40) 5 (25) 2 (10) 1 (3.3) 7 (23.3) 12 (40) 10 (33.3) 0.025 UPDRS, median (min-max) 30 (9-78) 58 (15-98) 0.003 UPDRS I 2 (0-7) 5 (1-9) 0.005 UPDRS II 9 (2-28) 20 (3-39) 0.003 UPDRS III 16 (4-38) 25 (9-41) 0.003 UPDRS IV 2 (0-11) 4 (0-18) 0.117 Hoen-Yahr , median (min-max) 2 (1-4) 3 (2-4) 0.009 Dysphagia No, n(%) Yes, n(%) 18 (90) 2 (10) 19 (63.3) 11 (36.7) 0.035 Orthostatic hypotension No, n(%) Yes, n(%) 15 (75) 5 (25) 14 (46.7) 16 (53.3) 0.047 Hiposmi No, n(%) Yes, n(%) 12 (60) 8 (40) 14 (46.7) 16 (53.3) 0.355 Tinetti FES, median (min-max) 34 (11-92) 72 (8-97) 0.031 4 m walking time, median (min-max) 4.8 (2.84-7) 6 (3.35-14.21) 0.038 Timed up and go test , median (min-max) 11.65 (8-17.30) 14.08 (9.30-29) 0.008 Five times sit to stand test ± SD 13.4 ± 3.2 16.3 ± 4.7 0.041 Clinical frailty scale category, median (min-max) 4 (1-5) 5 (3-6) 0.003 SARC-F, median (min-max) 2 (0-7) 4 (1-8) 0.001 Table 3. Univariable and multivariable logistic regression analysis of factors associated with probable sarcopenia in patients with PD Unadjusted Adjusted Risk Factors OR (95% CI) p OR (95% CI) p Non motor puan 1.26 (1.06-1.48) 0.007 Orthostatic hypotension 3.43 (0.99-11.85) 0.052 32.11 (1.53-676.05) 0.026 SARC-F 1.32 (1.07-1.64) 0.011 2.92 (1.09-7.82) 0.033 Age 1.1 (1.01-1.19) 0.027 UPDRS score 1.05 (1.01-1.08) 0.006 0.88 (0.79-0.98) 0.019 Dysphagia 5.21 (1.01-26.83) 0.048 4 m walking time 1.41 (1.05-1.9) 0.021 Clinical frailty scale category 1.9 (1.24-2.9) 0.003 7.86 (1.07-57.52) 0.042 Mini nutritional assessment short form 0.8 (0.66-0.96) 1.019 0.55 (0.28-1.07) 0.079 Additional Declarations No competing interests reported. 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Motor symptoms e.g., bradykinesia, rigidity, static tremor, and gait changes might be detected in PD, as well as non-motor symptoms (NMS) e.g., autonomic symptoms, sleep disorders, neuropsychiatric findings, gastrointestinal system findings, sensory symptoms, hyposmia, and unintentional weight loss, which might occur years before these findings. NMS impairs the quality of life of patients and might cause functional impairment and mortality (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn PD low-calorie intake because of motor impairment, decreased activity, hyposmia, dysphagia, and nausea caused by dopaminergic drugs might accelerate the progression of sarcopenia by leading to a decrease in muscle mass and quality (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSarcopenia is a complex, multifactorial degenerative disease caused by loss of muscle mass and is often detected in elderly individuals (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Sarcopenia is associated with falls, difficulty performing activities of daily living, loss of independence, and reduced quality of life. Groups e.g., the European Working Group on Sarcopenia in Older People (EWGSOP2), the Asian Working Group for Sarcopenia (AWGS), and the International Working Group for Sarcopenia specified different definitions and measurement cutoffs in this respect. New guidelines report that muscle strength is more important in the definition of sarcopenia. Low muscle mass and quality confirm the diagnosis of sarcopenia. In 2019, EWGSOP2 defined PS as only weak muscle strength. Low muscle strength is considered sufficient for PS (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Handgrip strength is \u0026lt;\u0026thinsp;16 kg for women and \u0026lt;\u0026thinsp;27 kg for men in PS. Even in the absence of low muscle mass and quality, untreated muscle weakness leads to serious problems in terms of patients and healthcare costs (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCommon pathogenetic mechanisms come into play between PD and sarcopenia. As a neuro-inflammation mediator, Interleukin 6 (IL6) is associated with loss of muscle mass and poor physical performance in elderly patients and PD. Mitochondrial dysfunction was shown in non-neuronal tissues in PD, and mitochondrial dysfunction is also mentioned in sarcopenic muscles compared to healthy muscles (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Also, a decrease in motor neurons was shown in PD and sarcopenia (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly recognition, intervention, and treatment of sarcopenia, which has common pathogenetic mechanisms in PD, is important to prevent decreased quality of life, disability, and mortality in PD. In the present study, we aimed to investigate the relationship between non-motor findings, PS, and falls in PD patients and to draw attention to non-motor symptoms, which are neglected findings that might contribute to the development of sarcopenia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy protocol\u003c/h2\u003e \u003cp\u003eThe study included 93 patients who were aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, 50 patients with a diagnosis of idiopathic Parkinson\u0026rsquo;s Disease according to the Movement Disorder Society and Parkinson\u0026rsquo;s Disease Society Brain Bank Diagnostic Criteria, who were followed up in the Movement Disorder Clinic of Bursa City Hospital Neurology Clinic between September 2023 and September 2024, and 43 healthy individuals as a control group.\u003c/p\u003e \u003cp\u003ePatients who were aged\u0026thinsp;\u0026lt;\u0026thinsp;65 years, those who were not using antiparkinsonian treatment regularly, those with parkinsonism findings other than PD, those with advanced dementia, those who are unable to mobilize, those with catabolic diseases (malignancy, chronic liver disease, chronic renal failure), those with additional diseases that might cause malnutrition and falls, and those with hemiparesis or paresis in any extremity were not included in the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical evaluation\u003c/h3\u003e\n\u003cp\u003eThe socio-demographic data of the patients who were included in the present study, e.g., age, gender, smoking, alcohol use, the number of medications used (\u0026gt;\u0026thinsp;5 medications: polypharmacy), Hypertension (HT), Diabetes Mellitus (DM), and the presence of falls were recorded. Neurological examinations of Parkinson\u0026rsquo;s Disease patients and healthy individuals were performed by the same neurologist. Neurological examinations of Parkinson\u0026rsquo;s Disease patients were performed in \u0026lsquo;on\u0026rsquo; period and the patients\u0026rsquo; Unified Parkinson\u0026rsquo;s Disease Rating Scale (UPDRS), Hoehn and Yahr (H\u0026amp;Y) staging was calculated. The duration of the disease and antiparkinsonian treatment doses were recorded in the patient group and the Levodopa Equivalent Daily Dose (LEDD) was calculated. Non-motor questionnaire (NMSQ) was applied to Parkinson\u0026rsquo;s patients. NMSQ scores of 0 were grouped as no non-motor findings, 1\u0026ndash;5 points as mild, 6\u0026ndash;9 as moderate, 10\u0026ndash;13 points as severe, and \u0026ge;\u0026thinsp;14 points as very severe non-motor involvement. Unintentional falls in the last 6 months were questioned in the groups, and the Falls Efficacy Scale (FES) was applied to the Parkinson\u0026rsquo;s patient group. FES\u0026thinsp;\u0026gt;\u0026thinsp;70 points were considered as fear of falling.\u003c/p\u003e \u003cp\u003eMini-Mental State Examination (MMSE) was administered to the patients who were included in the study by the same geriatrician. Disability was considered based on impairment in performing the basic activities of daily living. The Katz Index of Independence in Activities of Daily Living (ADL) (which includes bathing, dressing, toileting, transferring, continence, and feeding) and the instrumental activities of daily living (IADL), which include using a telephone, doing shopping, handling medicine, handling finances, mode of transportation, the ability to use telephone, food preparation, housekeeping and laundry. Yesavage Geriatric Depression Scale (GDS), Mini Nutritional Examination Short Form (MNA), Clinical Frailty Scale (CSF), and Sarcopenia Screening Scale (SARF-C) were applied.\u003c/p\u003e\n\u003ch3\u003eProbable Sarcopenia evaluation\u003c/h3\u003e\n\u003cp\u003eProbable Sarcopenia evaluation was carried out according to the EWGSOP2 Criteria. All individuals were evaluated by the same geriatric specialist in the morning on fasting. The height and weight of the patients were measured and Body Mass Index (BMI) was calculated (kg/m2).\u003c/p\u003e \u003cp\u003eThe subjects grasped the dynamometer with their arms hanging to the sides while standing using the \u0026ldquo;Grip Strength Dynamometer, Grip D produced by Takei/Made in Japan\u0026rdquo; device, which measures handgrip strength for the evaluation of muscle strength and squeezed the dynamometer for 3 seconds with their dominant hand, with their arms in a neutral position. After resting for \u0026gt;\u0026thinsp;10 seconds in between, 3 consecutive measurements were taken and the highest measurement was accepted as the handgrip strength. For male patients, squeezing less than 27 kg and for female patients, squeezing less than 16 kg was accepted as decreased muscle strength.\u003c/p\u003e \u003cp\u003eTo evaluate physical activity, the number of seconds it took to walk a distance of 6 m was recorded, and a speed of \u0026lt;\u0026thinsp;0.8 m/s was considered a decreased walking speed.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe Statistical Package for the Social Sciences (SPSS) version 26.0 was used for the statistical analyses. The categorical variables are presented as frequencies and percentages. The continuous variables were assessed by Kolmogorov-Smirnov test and histograms to find out if their distributions were normal or not. The normally distributed numerical parameters were compared by student\u0026rsquo;s t-test in two groups, while those with non-normal distributions were analyzed by Mann-Whitney U test. The categorical variables were compared by Chi-squares or Fisher\u0026rsquo;s Exact tests where appropriate. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as statistically significant. The parameters that were identified and were significantly different between probable sarcopenia and without probable sarcopenia in patients with PD in univariate analyses were put into the equation for logistic regression analysis. Variables eligible for inclusion in the multivariate analysis were tested for collinearity. Additionally, multivariable logistic regression analysis with a stepwise backward approach were performed. Variables that remained significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the multivariate model were considered as independent predictors for probable sarcopenia. Hosmer-Lemeshow goodness of fit statistics were used to assess model fit. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each predictor.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe median age of the 50 PD patients who were included in the study was 73 (65-82), and the median age of 43 healthy controls was 73 (65-90). Of the patients who were included in the study, 41 were female (44%) and 52 were male (66%). Among the patients in the PD, 18 were female (36%) and 32 were male (64%). No statistical differences were detected between the two groups in terms of age and gender. Of the PD, 29 were tremor dominant (TD) (58%) and 21 were non-tremor dominant (non-TD) (42%). The sociodemographic data of the groups are given in Table 1.\u003c/p\u003e\n\u003cp\u003eSmoking was more common in the control group than in the PD (p: 0.006). BMI, alcohol use, polypharmacy, HT, DM, and calf circumference were significant between the groups. No statistically significant differences were detected in terms of (p: 0.384), (p: 0.095), (p: 0.728), (p: 0.108), (p: 0.166), (p: 0.066).\u003c/p\u003e\n\u003cp\u003eFall rates were higher in the PD when compared to the control group (p: 0.001), Basic ADL, instrumental ADL, MMSE, CFSC, SARF-C, SMMI were lower (p: 0.049), (p: 0.006), (p: 0.005), (p: 0.004), (p\u0026lt;0.001), (p: 0.014). The rate of PS was 30 patients (60%) in PD \u0026nbsp;and 62.8% in the control group, and no difference was detected in terms of PS between the groups.\u003c/p\u003e\n\u003cp\u003eTotal UPDRS, UPDRS I, II and III scores, and (H\u0026amp;Y) were higher in patients with PS \u0026nbsp;Parkinson’s Disease (PSPD) (p:0.003), (p:0.003), (p:0.009).\u003c/p\u003e\n\u003cp\u003eFalls, Basic ADL ,instrumental ADL and MNAwere significantly lower \u0026nbsp;(p: 0.035) (p: 0.001), (p\u0026lt;0.001) (p: 0.002) (p\u0026lt;0.001) and 4 m walking time, time up and go test, five times sit to stand test time (p: 0.038), (p: 0.008), (p: 0.041) FES score, CFS and SARF-C were higher (p: 0.031), (p: 0.003), (p: 0.001) in he PSPD compered to non-PSPD.\u003c/p\u003e\n\u003cp\u003eNMSQ score and grade were higher in the PSPD than in non-PSPD (p:003, p:0.025). In this group, dysphagia and orthostatic hypotension were found to be more common among non-motor symptoms (p:0.035), (p:0.047). No differences were detected between the groups in terms of hyposmia (p:0.355). PS and clinical features are given in Table 2.\u003c/p\u003e\n\u003cp\u003eIn the Logistic Regression Analysis, orthostatic hypotension (OR: 32.11, 95% CI 1.53-676.05, p: 0.026), SARF-C (OR: 2.92, 95% CI 1.09-7.82, p: 0.033), UPDRS score (OR: 0.88, 95% CI 0.79-0.98, p: 0.019) and CFS (OR: 7.86, 95% CI 1.07-57.52, p: 0.042) were determined as risk factors for PS in PD (Table 3).\u003c/p\u003e"},{"header":"DISCUSSİON","content":"\u003cp\u003eIn the Parkinson\u0026rsquo;s Disease who were included in the study, the PS (low skeletal muscle strength) rate was 60%, and the PS rate was higher in patients with high UPDRS, UPDRS I-II-III, and H\u0026amp;Y stages. The PS rate was higher in patients with high NMSQ scores, dysphagia, and orthostatic hypotension. In the regression analysis, the main factors that might cause PS in PD patients were found to be UPDRS score, CFSC, SARC-F, and orthostatic hypotension.\u003c/p\u003e \u003cp\u003eStudies examining sarcopenia in PD report different rates. According to EWGSOP Criteria, Sarcopenia rates in PD are reported as 2-31.4%, according to EWGSOP2 Criteria as 10.9\u0026ndash;22.2%, and according to AWGS criteria as 17.2% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The use of EWGSOP2 Criteria is important as it allows for early detection of Sarcopenia and offers the opportunity for early intervention, as it allows for the evaluation of PS at an earlier stage (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The researchers used EWGSOP2 Criteria in the present study and took\u0026thinsp;\u0026lt;\u0026thinsp;16 kg for women and \u0026lt;\u0026thinsp;27 kg for men as the cut-off value in the hand grip test. Hart et al. reported the PS rate as 23.9\u0026ndash;66% in PD patients according to EWGSOP2 criteria in their systemic review. The 60% PS rate detected in the patients in the present study is consistent with the literature data (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a previous study that was conducted in Switzerland, PS was reported as 26.3% in women and 28% in men in the normal population (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Previously, the PS rate in the elderly in the normal population, whose average age was 74.2, was reported as 27% (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In the present study, the average age of the PD and control groups was 73, and the average age of the group with PS was 74. In the literature, some studies, including one study conducted in Turkiye (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) reported that sarcopenia is more common in women with PD, but there are also some other studies reporting no difference between the genders (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The researchers found no difference between the genders in terms of PS development. More studies and a larger number of patients are needed to clarify the PS-gender relationship in PD.\u003c/p\u003e \u003cp\u003eThe risk of sarcopenia varies in different stages of PD (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Different studies reported the relationships between UPDRS scores and sarcopenia. It was also reported that sarcopenia is observed at a higher rate in patients with high UPDRS scores. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Peball et al. reported that UPDRS I and UPDRS II scores were associated with sarcopenia, but UPDRS IV is not associated with sarcopenia, and another study found that UPDRS I and II are not associated with sarcopenia (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In the present study, UPDR I and II scores were found to be higher in PSPD. No relationships were detected between UPDRS IV and PS. It was reported that sarcopenia and PS were more common in PD patients with high UPDRS III (gait, body bradykinesis, motor skills, and extremity movements) and that there was a relationship between low hand grip strength and UPDRS III (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The researchers of the present study found the UPDRS III score to be significantly higher in the group with PS, in line with the literature data. The total UPDRS was found to be 58 on average in the PSPD and was higher than in non-PSPD. Vetrona et al. reported that sarcopenia was more common in patients with UPDRS\u0026thinsp;\u0026gt;\u0026thinsp;42 in a study that included 210 PD patients. The high UPDRS scores of patients with PS might be associated with the smaller number of patients the researchers evaluated and differences in antiparkinsonian treatment,LEDD (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a previous study conducted by Peball et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), frailty, recurrent falls, and high SARC-F scores were found in the Non-TD PD. Tan et al. reported no relationship between the motor phenotype of the disease and sarcopenia (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). SARC-F scores, recurrent falls, and CFS scores were higher in PD when compared to the control group in the present study, but no differences were detected between the TD and Non-TD PD in terms of PS. Considering that Non-TD PD progresses more rapidly and leads to faster cognitive decline and therefore sarcopenia, the lack of difference between the non-TD and TD groups might be associated with the number of patients included, the H\u0026amp;Y stage of the patients included, and LEDD.\u003c/p\u003e \u003cp\u003eSARC-F is a 5-item questionnaire and is used in screening for Sarcopenia with strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) as a practical test. SARC-F\u0026thinsp;\u0026ge;\u0026thinsp;4 is considered the sarcopenia threshold (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The specificity of SARC-F is quite high and is used as a screening test to identify patients who need further tests for sarcopenia diagnosis. In the study of Luz et al., sarcopenia was higher in those with high UPDRS II scores and SARF-C. In the present study, SARC-F was found to be higher in PD compared to the control group, and UPDRS II scores and SARF-C were higher in the PSPD. This finding is consistent with the literature. It was reported that SARC-F had lower sensitivity in PD (as walking speed is also included) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). For this reason, advanced tests must be performed in PD with high SARC-F to detect PS. Impaired homeostasis and a lack of reserve across several physiological systems result in frailty, a condition marked by increased susceptibility to stresses (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Frailty was reported at a rate of 33% in hospitalized PD (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and is detected at a rate of 57% higher in PD over the age of 74 when compared to the normal population (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). It is thought that its increased incidence in PD is because of common pathophysiological mechanisms. In the present study, CFS was also found to be higher in Parkinson\u0026rsquo;s patients. CFS and SARC-F might help us predict the patient group that should be evaluated for PD.\u003c/p\u003e \u003cp\u003eBMI and malnutition are associated with PS in the normal population (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), but obesity was shown to increase the risk of sarcopenia by 3.2-fold in a small sample of studies (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Weight loss is a common non-motor symptomps in PD. Approximately half of patients experience unintentional weight loss throughout the disease and patients are underweight in advanced stages (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Weight loss might lead to malnutrition, increased risk of falls, and cognitive impairment. The risk of malnutrition in PD patients is 3\u0026ndash;60%, with undernutrition resulting in loss of muscle mass (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Weight loss might be associated with reduced food intake because of factors e.g., hyposmia, dysphagia, taste perversion, depression, and anxiety (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In the present study, no difference was found between the PD and control groups in terms of BMI and MNA, but the MNA score was lower in the PSPD. This finding supports the possibility that malnutrition might cause sarcopenia. Barichella et al. reported that sarcopenia was more common in patients with longer disease duration and advanced stages (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The researchers of the present study also found the HY stage higher in the PSPD group, which supports the observation of weight loss and muscle weakness in advanced stages. While some studies have shown that the development of sarcopenia in PD patients is associated with the duration of the disease (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), Lee et al. reported no correlation between the duration of the disease and Sarcopenia. In the present study, no relationship was found between the duration of the disease and possible Sarcopenia. We believe that different results could be obtained if a larger number of patients and patients with advanced stages were included in the study.\u003c/p\u003e \u003cp\u003eThere are studies in the literature examining the relationship between NMS and sarcopenia detected in PD. Weight loss and hyposmia might cause osteosarcopenia (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Hyposmia might be detected in approximately 90% of early-stage PD is one of the most common NMS(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In a previous study conducted in China (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), NMS scores were found to be high in patients with sarcopenia. In the present study, NMS scores were also high in the PSPD group. Nutrition, fatigue, and sleep quality were reported to be associated with sarcopenia. In present study we found dysphagia and orthostatic hypotension, which are NMS, to be higher in the PSPD. We did not find any difference between the PSPD and non-PSPD in terms of hyposmia. Dysphagia might lead to decreased nutrition, decreased muscle mass, and sarcopenia. Hyposmia was questioned in patients but no smell test was performed. If tests measuring smell function were applied to this patient group, different results might have been obtained. Different results may be found if more patients and advanced stage patients are included in the study.\u003c/p\u003e \u003cp\u003eCai et al. reported in their meta-analysis that falls are more common in PD patients with Sarcopenia and Probable Sarcopenia, and that falls are more common in the patient group with a high HY stage (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). In the present study, consistent with these findings, falls were found to be more common in PD patients and the PSPPD group. Fear of falling (FES) is higher in the PS group. For this reason, PD patients should be questioned in terms of falling and PS should be kept in mind. Also, falls, fractures, limited movement, and the need for care affect daily living activities in the elderly with sarcopenia (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Previous studies reported that the ADL score was lower in the PSPD group, patients used higher doses of LEDD and more medication, and antiparkinsonian medications might cause more falls (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Lima et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) reported that PSPD patients used higher LEDD and had higher ADL scores. In the present study, ADL and instrumental ADL scores were lower in PD compared to healthy controls and in the PSPD when compared to the non-PSPD group. No difference was found between the groups in terms of LEDD and polypharmacy, which situation might differ as LEED and disease stage increase.\u003c/p\u003e\n\u003ch3\u003eClinical implications / future directions\u003c/h3\u003e\n\u003cp\u003ePS is common in PD and is associated with NMS. It is understood in recent studies that muscle strength is more important than muscle mass when evaluating sarcopenia, and this has led to a focus on muscle strength and power (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). A link was found between low handgrip strength and functional, physical, and cognitive impairments (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In PD, which is one of the fastest-growing neurological diseases globally (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)muscle strength measurement is a low-cost method that helps detect PS.\u003c/p\u003e \u003cp\u003eThere are many studies in the literature examining sarcopenia in PD patients, but studies discussing PS and its relationship with NMS are limited. There is not adequate data on the management of sarcopenia with antiparkinsonian treatments, but there is a consensus that it might be managed with resistance exercises (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). For this reason, screening patients by checking muscle strength, which is a low-cost method in the early stages, might draw attention to PS in PD, and allow for early clinical diagnosis and early intervention, reducing the risk of possible falls and fractures, increasing independence and quality of life, and reducing mortality and morbidity.\u003c/p\u003e \u003cp\u003eThere were some limitations in the present study. NMS was determined according to the neurologist evaluation and questionnaire forms. No separate diagnostic tests were used for orthostatic hypotension, hyposmia, or dysphagia. We did not include patients with advanced dementia, those living in a nursing home, and those who were not mobile in the present study. In the following years, multicenter studies with larger patient numbers are needed to evaluate the relationship between NMS and PS.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics aprovel and constent to parcipate:\u0026nbsp;\u003c/em\u003eThe study protocol was approved by Bursa City Hospital Ethics Committee and was prepared in line with the World Medical Association Helsinki Declaration. (Ethics Committee date: 07.07.2023, Ethics Committee no: E-13012450-514.99-218927103).\u0026nbsp;Written informed consent was obtained fromall participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical trail number:\u0026nbsp;\u003c/em\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to participate/publication :\u0026nbsp;\u003c/em\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eData availability statement:\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe data supporting the findings of this study is available from the corresponding author upon reasonable request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/em\u003eDKS : major role in data acquisition, writing, OD: data collection, statistical analysis , EG: data collection, SG: data collection, SK: supervisor, conceptualisation\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding Sources and Conflicts of Interest\u003c/em\u003e: No specific funding was received for this work. The author declares that there are no conflicts of interest relevant to this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShulman LM. Understanding disability in Parkinson\u0026apos;s disease. Movement disorders. 2010;25(S1):S131-S5.\u003c/li\u003e\n\u003cli\u003eMoustafa AA, Chakravarthy S, Phillips JR, Gupta A, Keri S, Polner B, et al. Motor symptoms in Parkinson\u0026rsquo;s disease: A unified framework. Neuroscience \u0026amp; Biobehavioral Reviews. 2016;68:727-40.\u003c/li\u003e\n\u003cli\u003eSchapira AH, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nature Reviews Neuroscience. 2017;18(7):435-50.\u003c/li\u003e\n\u003cli\u003eDrey M, Hasmann SE, Krenovsky J-P, Hobert MA, Straub S, Elshehabi M, et al. Associations between early markers of Parkinson\u0026apos;s disease and sarcopenia. Frontiers in Aging Neuroscience. 2017;9:53.\u003c/li\u003e\n\u003cli\u003eLima DP, de Almeida SB, Bonfadini JdC, de Luna JRG, de Alencar MS, Pinheiro-Neto EB, et al. Clinical correlates of sarcopenia and falls in Parkinson\u0026rsquo;s disease. PLoS One. 2020;15(3):e0227238.\u003c/li\u003e\n\u003cli\u003eXiao Q, Chen S, Le W. Hyposmia: a possible biomarker of Parkinson\u0026rsquo;s disease. Neuroscience bulletin. 2014;30:134-40.\u003c/li\u003e\n\u003cli\u003eCruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruy\u0026egrave;re O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing. 2019;48(1):16-31.\u003c/li\u003e\n\u003cli\u003eBeaudart C, Zaaria M, Pasleau F, Reginster J-Y, Bruy\u0026egrave;re O. Health outcomes of sarcopenia: a systematic review and meta-analysis. PloS one. 2017;12(1):e0169548.\u003c/li\u003e\n\u003cli\u003eErcan A, Kulaksiz G, Dalmizrak O, Muftuoglu M, Ogus H, Cavdar L, et al. Mitochondrial respiratory chain enzyme activities, mtDNA variants and gene expression levels in idiopathic Parkinson\u0026apos;s disease. 2009.\u003c/li\u003e\n\u003cli\u003eTan AH, Hew YC, Lim S-Y, Ramli NM, Kamaruzzaman SB, Tan MP, et al. Altered body composition, sarcopenia, frailty, and their clinico-biological correlates, in Parkinson\u0026apos;s disease. Parkinsonism \u0026amp; Related Disorders. 2018;56:58-64.\u003c/li\u003e\n\u003cli\u003eDodds RM, Roberts HC, Cooper C, Sayer AA. The epidemiology of sarcopenia. Journal of Clinical Densitometry. 2015;18(4):461-6.\u003c/li\u003e\n\u003cli\u003eHart A, Cordova-Rivera L, Barker F, Sayer AA, Granic A, Yarnall AJ. The prevalence of sarcopenia in Parkinson\u0026rsquo;s disease and related disorders-a systematic review. Neurological Sciences. 2023;44(12):4205-17.\u003c/li\u003e\n\u003cli\u003eWearing J, Konings P, de Bie RA, Stokes M, De Bruin ED. Prevalence of probable sarcopenia in community-dwelling older Swiss people\u0026ndash;a cross-sectional study. BMC geriatrics. 2020;20:1-8.\u003c/li\u003e\n\u003cli\u003eTrevisan C, Vetrano DL, Calvani R, Picca A, Welmer AK. Twelve‐year sarcopenia trajectories in older adults: results from a population‐based study. Journal of Cachexia, Sarcopenia and Muscle. 2022;13(1):254-63.\u003c/li\u003e\n\u003cli\u003eOzer FF, Akın S, Gultekin M, Zararsız GE. Sarcopenia, dynapenia, and body composition in Parkinson\u0026rsquo;s disease: are they good predictors of disability?: a case\u0026ndash;control study. Neurological Sciences. 2020;41:313-20.\u003c/li\u003e\n\u003cli\u003eLee C-Y, Chen H-L, Chen P-C, Chen Y-S, Chiang P-L, Wang C-K, et al. Correlation between executive network integrity and sarcopenia in patients with Parkinson\u0026rsquo;s disease. International journal of environmental research and public health. 2019;16(24):4884.\u003c/li\u003e\n\u003cli\u003ePeball M, Mahlknecht P, Werkmann M, Marini K, Murr F, Herzmann H, et al. Prevalence and associated factors of sarcopenia and frailty in Parkinson\u0026rsquo;s disease: a cross-sectional study. Gerontology. 2019;65(3):216-28.\u003c/li\u003e\n\u003cli\u003eVetrano DL, Pisciotta MS, Laudisio A, Monaco MRL, Onder G, Brandi V, et al. Sarcopenia in Parkinson disease: comparison of different criteria and association with disease severity. Journal of the American Medical Directors Association. 2018;19(6):523-7.\u003c/li\u003e\n\u003cli\u003eda Luz MCL, Bezerra GKA, Asano AGC, Chaves de Lemos MdC, Cabral PC. Determinant factors of sarcopenia in individuals with Parkinson\u0026rsquo;s disease. Neurological Sciences. 2021;42:979-85.\u003c/li\u003e\n\u003cli\u003eBarichella M, Pinelli G, Iorio L, Cassani E, Valentino A, Pusani C, et al. Sarcopenia and dynapenia in patients with parkinsonism. Journal of the American Medical Directors Association. 2016;17(7):640-6.\u003c/li\u003e\n\u003cli\u003eRoberts HC, Syddall HE, Butchart JW, Stack EL, Cooper C, Sayer AA. The association of grip strength with severity and duration of Parkinson\u0026rsquo;s: a cross-sectional study. Neurorehabilitation and neural repair. 2015;29(9):889-96.\u003c/li\u003e\n\u003cli\u003eClegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The lancet. 2013;381(9868):752-62.\u003c/li\u003e\n\u003cli\u003eWallis S, Wall J, Biram R, Romero-Ortuno R. Association of the clinical frailty scale with hospital outcomes. QJM: An International Journal of Medicine. 2015;108(12):943-9.\u003c/li\u003e\n\u003cli\u003eTorsney K, Romero-Ortuno R. The Clinical Frailty Scale predicts inpatient mortality in older hospitalised patients with idiopathic Parkinson\u0026apos;s disease. Journal of the Royal College of Physicians of Edinburgh. 2018;48(2):103-7.\u003c/li\u003e\n\u003cli\u003eBardon LA, Streicher M, Corish CA, Clarke M, Power LC, Kenny RA, et al. Predictors of incident malnutrition in older Irish adults from the Irish longitudinal study on ageing cohort\u0026mdash;A MaNuEL study. The Journals of Gerontology: Series A. 2020;75(2):249-56.\u003c/li\u003e\n\u003cli\u003ede Carvalho DHT, Scholes S, Santos JLF, de Oliveira C, Alexandre TdS. Does abdominal obesity accelerate muscle strength decline in older adults? Evidence from the English Longitudinal Study of Ageing. The Journals of Gerontology: Series A. 2019;74(7):1105-11.\u003c/li\u003e\n\u003cli\u003eCheshire Jr WP, Wszolek ZK. Body mass index is reduced early in Parkinson\u0026apos;s disease. Parkinsonism \u0026amp; related disorders. 2005;11(1):35-8.\u003c/li\u003e\n\u003cli\u003eChen H, Zhang SM, Hern\u0026aacute;n MA, Willett WC, Ascherio A. Weight loss in Parkinson\u0026apos;s disease. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 2003;53(5):676-9.\u003c/li\u003e\n\u003cli\u003eSheard JM, Ash S, Silburn PA, Kerr GK. Prevalence of malnutrition in Parkinson\u0026apos;s disease: a systematic review. Nutrition reviews. 2011;69(9):520-32.\u003c/li\u003e\n\u003cli\u003eRoos DS, Oranje OJ, Freriksen AF, Berendse HW, Boesveldt S. Flavor perception and the risk of malnutrition in patients with Parkinson\u0026rsquo;s disease. Journal of Neural Transmission. 2018;125:925-30.\u003c/li\u003e\n\u003cli\u003eAarsland D. Dementia in Parkinson\u0026apos;s disease. Dementia with Lewy Bodies. 2005:221-40.\u003c/li\u003e\n\u003cli\u003eDe Rui M, Inelmen EM, Trevisan C, Pigozzo S, Manzato E, Sergi G. Parkinson\u0026rsquo;s disease and the non-motor symptoms: hyposmia, weight loss, osteosarcopenia. Aging clinical and experimental research. 2020;32:1211-8.\u003c/li\u003e\n\u003cli\u003eCruz-Jentoft A. et Cruz Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412-23.\u003c/li\u003e\n\u003cli\u003eLiu Q-W, Mao C-J, Lu Z-H, Shi R-F, Zhang Y-C, Zhao P, et al. Sarcopenia is associated with non-motor symptoms in Han Chinese patients with Parkinson\u0026apos;s Disease: a cross-sectional study. BMC geriatrics. 2023;23(1):494.\u003c/li\u003e\n\u003cli\u003eCai Y, Feng F, Wei Q, Jiang Z, Ou R, Shang H. Sarcopenia in patients with Parkinson\u0026apos;s disease: a systematic review and meta-analysis. Frontiers in Neurology. 2021;12:598035.\u003c/li\u003e\n\u003cli\u003eHaasum Y, Fastbom J, Johnell K. Use of fall-risk inducing drugs in patients using Anti-Parkinson Drugs (APD): a Swedish Register-Based Study. PloS one. 2016;11(8):e0161246.\u003c/li\u003e\n\u003cli\u003eIshii H, Tsutsumimoto K, Doi T, Nakakubo S, Kim M, Kurita S, et al. Effects of comorbid physical frailty and low muscle mass on incident disability in community-dwelling older adults: A 24-month follow-up longitudinal study. Maturitas. 2020;139:57-63.\u003c/li\u003e\n\u003cli\u003eDorsey ER, Sherer T, Okun MS, Bloem BR. The emerging evidence of the Parkinson pandemic. Journal of Parkinson\u0026rsquo;s disease. 2018;8(s1):S3-S8.\u003c/li\u003e\n\u003cli\u003eSayer AA, Cruz-Jentoft A. Sarcopenia definition, diagnosis and treatment: consensus is growing. Age and ageing. 2022;51(10):afac220.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Sociodemographic and clinical characteristics of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eControl (n=43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eParkinson\u0026rsquo;s disease (n=50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eAge, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e73 (65-90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e73 (65-82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eFemale, n(%)\u003c/p\u003e\n \u003cp\u003eMale, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (53.5)\u003c/p\u003e\n \u003cp\u003e20 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (36)\u003c/p\u003e\n \u003cp\u003e32 (64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (76.7)\u003c/p\u003e\n \u003cp\u003e10 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 (96)\u003c/p\u003e\n \u003cp\u003e2 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eAlcohol consumption\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No, n(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (93)\u003c/p\u003e\n \u003cp\u003e3 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50 (100)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003ePolypharmacy\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (46.3)\u003c/p\u003e\n \u003cp\u003e22 (53.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 (50)\u003c/p\u003e\n \u003cp\u003e25 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eHypertension, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e31 (72.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e28 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eDiabetes Mellitus, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e13 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 (79.1)\u003c/p\u003e\n \u003cp\u003e9 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 (44)\u003c/p\u003e\n \u003cp\u003e28 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eBMI \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e26.4 \u0026plusmn; 5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e27.4 \u0026plusmn; 4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eCalf circumference, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e35 (21-46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e36 (29-45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eBasic ADL, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e5 (2-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5 (0-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.049\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eInstrumental ADL, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e8 (2-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eMini mental state examination score, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e28 (18-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e27 (11-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eMini nutritional examination short form, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e13 (4-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e12 (6-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eClinical frailty scale category, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e3 (0-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e4 (1-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eSARC-F, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e1 (0-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eHand Grip Strength \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e19.2 \u0026plusmn; 6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e21.8 \u0026plusmn; 7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eSkeletel muscle mass index (SMMI), median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e10.16 (7.76-12.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e11.05 (4.64-14.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eGeriatric Depression Scale Short Form, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e2 (0-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3 (0-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 354px;\"\u003e\n \u003cp\u003eProbable sarcopenia\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (37.2)\u003c/p\u003e\n \u003cp\u003e27 (62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (40)\u003c/p\u003e\n \u003cp\u003e30 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Patients characteristics and relation with probable sarcopenia in patients with PD\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 296px;\"\u003e\n \u003cp\u003eProbable Sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNo (n=20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eYes (n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAge, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e71 (65-81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e74 (65-82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eFemale, n(%)\u003c/p\u003e\n \u003cp\u003eMale, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (45)\u003c/p\u003e\n \u003cp\u003e11 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (30)\u003c/p\u003e\n \u003cp\u003e21 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eType of the disease\u003c/p\u003e\n \u003cp\u003eTremor dominant type\u003c/p\u003e\n \u003cp\u003eNon-tremor dominant type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (70)\u003c/p\u003e\n \u003cp\u003e6 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (50)\u003c/p\u003e\n \u003cp\u003e15 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eDuration of illness, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e5 (1-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5 (1-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003ePolypharmacy\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (55)\u003c/p\u003e\n \u003cp\u003e9 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (46.7)\u003c/p\u003e\n \u003cp\u003e16 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.564\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eFall\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (60)\u003c/p\u003e\n \u003cp\u003e8 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (30)\u003c/p\u003e\n \u003cp\u003e21 (70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eCalf circumference, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e36.5 (30-42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e36 (29-45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eL-dopa, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e600 (200-1200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e770 (200-1831)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eBasic ADL, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e6 (5-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (1-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eInstrumental ADL, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e8 (7-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (0-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eMini mental state examination score, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e28 (20-30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e27 (11-29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eMini nutritional assessment short form, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e13 (10-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e11 (6-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eGeriatric Depression Scale Short Form, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e3 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (0-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHand Grip Strength \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e26.3 \u0026plusmn; 5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e18.8 \u0026plusmn; 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eSkeletel muscle mass index (SMMI), median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e11.08 (8.63-13.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e11.05 (4.64-14.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eNon motor score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e8.2 \u0026plusmn; 4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e11.8 \u0026plusmn; 3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eNon motor DERECE\u003c/p\u003e\n \u003cp\u003eDerece 1\u003c/p\u003e\n \u003cp\u003eDerece 2\u003c/p\u003e\n \u003cp\u003eDerece 3\u003c/p\u003e\n \u003cp\u003eDerece 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (25)\u003c/p\u003e\n \u003cp\u003e8 (40)\u003c/p\u003e\n \u003cp\u003e5 (25)\u003c/p\u003e\n \u003cp\u003e2 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (3.3)\u003c/p\u003e\n \u003cp\u003e7 (23.3)\u003c/p\u003e\n \u003cp\u003e12 (40)\u003c/p\u003e\n \u003cp\u003e10 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eUPDRS, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e30 (9-78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e58 (15-98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eUPDRS I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5 (1-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eUPDRS II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e9 (2-28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e20 (3-39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eUPDRS III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e16 (4-38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e25 (9-41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eUPDRS IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (0-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (0-18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHoen-Yahr , median (min-max)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e3 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eDysphagia\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (90)\u003c/p\u003e\n \u003cp\u003e2 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (63.3)\u003c/p\u003e\n \u003cp\u003e11 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eOrthostatic hypotension\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (75)\u003c/p\u003e\n \u003cp\u003e5 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (46.7)\u003c/p\u003e\n \u003cp\u003e16 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.047\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHiposmi\u003c/p\u003e\n \u003cp\u003eNo, n(%)\u003c/p\u003e\n \u003cp\u003eYes, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (60)\u003c/p\u003e\n \u003cp\u003e8 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (46.7)\u003c/p\u003e\n \u003cp\u003e16 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.355\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eTinetti FES, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e34 (11-92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e72 (8-97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e4 m walking time, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4.8 (2.84-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (3.35-14.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eTimed up and go test , median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e11.65 (8-17.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e14.08 (9.30-29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eFive times sit to stand test \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e13.4 \u0026plusmn; 3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e16.3 \u0026plusmn; 4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.041\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eClinical frailty scale category, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4 (1-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5 (3-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eSARC-F, median (min-max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (1-8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Univariable and multivariable logistic regression analysis of factors associated with probable sarcopenia\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ein patients with PD\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eUnadjusted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003eAdjusted\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eRisk Factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eOR (95% CI)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNon motor puan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.26 (1.06-1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eOrthostatic hypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e3.43 (0.99-11.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e32.11 (1.53-676.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.026\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eSARC-F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.32 (1.07-1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2.92 (1.09-7.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.1 (1.01-1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUPDRS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.05 (1.01-1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.88 (0.79-0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eDysphagia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e5.21 (1.01-26.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e4 m walking time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.41 (1.05-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eClinical frailty scale category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.9 (1.24-2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e7.86 (1.07-57.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMini nutritional assessment short form\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e0.8 (0.66-0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0.55 (0.28-1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Parkinson disease, probable sarcopenia, non-motor symptoms, fall","lastPublishedDoi":"10.21203/rs.3.rs-6290068/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6290068/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eParkinson\u0026rsquo;s Disease (PD) and Probable Sarcopenia (PS) are common diseases for the elderly population. Previous studies mentioned the relationship between motor symptoms and sarcopenia in PD patients, but the data on PS and non-motor symptoms and sarcopenia that can be detected in PD are limited. In the present study, the purpose was to investigate the relationship between non-motor symptoms and PS and the relationship between PS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study included 93 patients who were aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, 50 patients with a diagnosis of PD. Sarcopenia evaluation was performed according to the European Working Group on Sarcopenia in Older People Criteria (EWGSOP2) and all individuals were evaluated for Probable Sarcopenia (PS). Nutrition, frailty, daily living activities and depression were evaluated in all individuals. PD patients were applied the Non-Motor Symptom Questionnaire (NMSQ) and the Fall Efficiency Test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe PS rate in Parkinson\u0026rsquo;s Disease patients was 60%, and was higher in those with high Unified Parkinson\u0026rsquo;s Disease Rating Scale (UPDRS), UPDRS I-II-III, and Hoen Yahr Stages. The PS rate was also higher in patients with high NMSQ scores, dysphagia, and orthostatic hypotension. In the logistic regression analysis regressin orthostatic hypotension (p: 0.026), SARF-C (p: 0.033), UPDRS score (p: 0.019) and CFS (p: 0.042) were determined as risk factors for PS in PD.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatient with PD are at risk for PS. Non-motor symptoms are associated with PS. NMS and PS, which can be overlooked in PD, are findings that clinicians must be careful about. In this respect, early clinical diagnosis and early intervention might allow for the reduction of falls, fracture risk, increased independence and quality of life, and reduced mortality and morbidity.\u003c/p\u003e","manuscriptTitle":"The relationship between non-motor symptoms in Parkinson’s Disease and Probable Sarcopenia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-22 12:50:02","doi":"10.21203/rs.3.rs-6290068/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"28d97a6d-10aa-4451-bda8-f8dba253cc14","owner":[],"postedDate":"April 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-09T09:24:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-22 12:50:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6290068","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6290068","identity":"rs-6290068","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}