The association of sarcopenia, possible sarcopenia and cognitive impairment: A systematic review and meta-analysis

Objectives: The study aimed to investigate the relationship between sarcopenia, possible sarcopenia, and cognitive impairment, and to analyze the impact of potential moderating factors. Methods: A comprehensive search was conducted on PubMed, EmBase, Web of Science, Cochrane Library, CNKI, Wanfang Databases, VIP and SinoMed from inception until March 2025. The quality of cross-sectional studies was assessed using the Agency for Healthcare Research and Quality Scale, while the Newcastle-Ottawa scale was used to assess the quality of included case-control and cohort studies. Subgroup analyses and meta-regression were employed to explore potential moderating variables and heterogeneity. Results: A total of 31 studies were included in this systematic review, of which 27 studies were quantitatively analyzed. The meta-analysis revealed that both sarcopenia and possible sarcopenia significantly associated with cognitive impairment (OR=1.88, 95%CI = 1.71–2.08), (OR=1.96, 95%CI = 1.50–2.58). Subgroup analyses revealed a stronger association between sarcopenia and cognitive impairment in specific demographics: among females with sarcopenia (OR=3.22, 95%CI = 1.23–8.40), in Asian populations (OR=1.96, 95%CI = 1.76–2.18), and within hospital settings (OR=3.12, 95%CI = 2.18–4.48). These findings underscore the influence of gender, ethnicity, and healthcare environment on the relationship between sarcopenia and cognitive impairment. An assessment of publication bias within studies providing adjusted odds ratios indicated potential bias. However, sensitivity analyses and trim-and-filling analyses confirmed the robustness of our findings, suggesting that the observed associations remain reliable despite the presence of publication bias. Conclusions: Individuals with sarcopenia or possible sarcopenia have approximately twice the odds of developing cognitive impairment compared to those without sarcopenia. Implementing systematic screening and targeted interventions for possible sarcopenia patients is essential to prevent from cognitive decline. Specifically, healthcare professionals should focus on women and inpatients with sarcopenia, employing proactive measures to avert cognitive impairment.