Impact of Sarcopenia on Functional and Cognitive Recovery in Caucasian Post-Stroke Patients Following Rehabilitation

Alessandro Guerrini^1,2Mariacristina Siotto^2*Alessio Fasano²Carola Cocco²Marco Germanotta²Valeria Cipollini²Laura Cortellini²Arianna Pavan²Stefania Lattanzi²Sabina Insalaco²Erika Antonacci²Elisabetta Ruco²Yeganeh Manon Khazrai¹Irene Giovanna Aprile²

• ¹Department of Science and Technology for Humans and the Environment, Università Campus Bio-Medico di Roma, Rome, Italy, Universita Campus Bio-Medico di Roma, Rome, Italy
• ²Centro IRCCS Don Gnocchi, Florence, Italy

Background & aims: Sarcopenia, a progressive and generalized skeletal muscle disorder, significantly hinders post-stroke recovery. Existing research has focused exclusively on Asian populations, leaving effects in Caucasian cohorts largely unexplored. This study aims to evaluate the impact of sarcopenia, as defined by the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, on functional and cognitive recovery in subacute post-stroke patients undergoing a rehabilitation program. Methods: 87 subacute post-stroke patients (71 [61–78] years; 42 women) were evaluated at admission (T0) and after six weeks of rehabilitation (T1). At T0, demographic, clinical, and nutritional data were collected, and sarcopenia was diagnosed. Functional and cognitive outcomes—including the modified Barthel Index (mBI), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Motricity Index for upper and lower limbs (MI-UE, MI-LE), Functional Ambulation Category (FAC), and Montreal Cognitive Assessment (MoCA)— were evaluated at both T0 and T1. Functional and cognitive recovery (ΔmBI, ΔFMA-UE, ΔMI-UE, ΔMI-LE, and ΔMoCA) were also assessed. Intra-group (T0 vs T1) and inter-group comparisons (sarcopenic vs nonsarcopenic patients) were then evaluated, and a Propensity Score Matching (PSM) analysis was used to adjust for baseline confounding factors. Results: Sarcopenic patients (n=24; 14 women) showed poorer nutritional status and lower score in all functional and cognitive measurements at T0 compared to non-sarcopenic counterpart. Both groups improved significantly at T1 in mBI, FMA-UE, MI-UE, MI-LE, and FAC. However, even after PSM analysis, the sarcopenic patients exhibited lower FAC (0 [0–1] vs 3 [1–3], p = 0.010) and lower mBI (40 [27–57] vs 57 [47–72], p = 0.044) scores at T1, along with a reduced ΔmBI (6 [0–14] vs 15 [8–21], p= 0.014). Conclusions: Our findings emphasize that sarcopenia negatively affects post-stroke recovery of independence and ambulation, highlighting the importance of early identification and targeted interventions in rehabilitation.