Kiyoka Kinugawa Bourron

My name is Kiyoka Kinugawa Bourron and I am a doctor in neurogeriatrics. I initially trained in neurology before specialising in geriatrics at Sorbonne University, where I was appointed University Professor - Hospital Practitioner (PU-PH).

My interest in geriatrics began during my residency in neurology, where I became interested in the neurodegenerative diseases that affect the elderly. I was attracted by the global approach of geriatrics, which led me to pursue a double specialisation in neuro-geriatrics.

I currently head the functional explorations unit at Charles-Foix Hospital, where I interpret examinations and provide consultations on sleep disorders, as well as neurogeriatric consultations for patients suffering from Alzheimer's or Parkinson's disease.

Sarcopenia is now recognised as a distinct muscular pathology, rather than a normal process of muscle ageing. It is characterised by a progressive decline in both the quantity and quality of muscle, entailing a loss of muscle mass, strength and physical performance. Research has shown that it is a major risk factor for loss of independence, falls, frailty and even death in the elderly, not to mention the significant socio-economic cost. Yet diagnosing and treating it remain complex.

Given that the ageing of the population is a major public health issue, with a direct impact on quality of life, the concept of 'ageing well' necessarily includes the concept of 'moving well', and therefore gives muscle its full importance. Sarcopenia affects around 23% of geriatric in-patients, which is why its diagnosis and subsequent management are crucial.

On a day-to-day basis in hospital, we use specific diagnostic tools for each aspect of muscle loss. To assess loss of muscle mass, for example, standard techniques rely mainly on imaging, including X-ray absorptiometry, the same device used for bone densitometry, but requiring equipment available in a radiology centre. An alternative is the use of bioelectrical impedance measurements, similar to the way smart scales work to indicate body fat and muscle mass, but their use may be limited, particularly in patients with pacemakers.

When it comes to measuring muscle strength, we can use a dynamometer in clinical practice to measure hand strength, but again its effectiveness may be reduced in certain patients suffering from osteoarthritis, for example. As for assessing physical performance, clinical tests and scores can be used to obtain this quickly.

However, there is currently no single tool that can comprehensively assess both muscle quality and quantity. This is why the development of an integrated diagnostic tool capable of assessing both the qualitative and quantitative aspects of muscle is an important area of research.

This project is the fruit of a collaboration launched a few years ago with the mechanical bioengineering team at the Université Technologique de Compiègne, in partnership with my colleague Sofiane Boudaoud, who is an expert in the analysis of high-definition surface electromyogram (HD-sEMG) signals. The project, funded by AXA Assurances VIE Mutuelle, aims to develop a cohort of elderly people at risk of sarcopenia. I want to collect and analyse their electromyographic signals and correlate them with measurements of muscle mass, strength and physical performance in order to determine whether there are markers or a muscular signature in these signals that would enable patients to be classified as sarcopenic or non-sarcopenic.

Ultimately, we hope to develop software that could be used as a medical device to diagnose sarcopenia.
The benefits of this technology lie in its ability to be used at the patient's bedside. It is a portable, non-invasive device, because surface electromyography simply involves applying a single grid, containing 32 electrodes, to the patient's skin. What's more, the technology is already CE certified. Our aim is therefore to develop software to complement this innovative technology, which would not only be non-invasive but also easy to use anywhere with patients.

The feasibility of this approach has already been tested with the Université Technologique de Compiègne within the framework of a European project, EIT Health, in 2018. This study of muscle ageing demonstrated the sensitivity of HD-sEMG for assessing muscle loss, even in healthy, physically active volunteers aged 25 to 75. We also observed differences in muscle activation patterns between sedentary and active groups, confirming the potential of this technology to detect early muscle ageing induced by a sedentary lifestyle.

We hope that HD-sEMG could also be used to monitor muscle condition as part of nutritional interventions, physical activities or rehabilitation. Although this possibility is not yet part of the project, it represents a long-term objective, as does its use in therapeutic trials developing anti-sarcopenic drugs. In short, our project aims to facilitate the diagnosis of sarcopenia by offering a portable, non-invasive solution, while paving the way for regular monitoring of muscle condition and new therapeutic avenues.

Thanks to generous funding from AXA Assurances VIE Mutuelle , we will be involving 15 geriatric departments at the AP-HP in the Paris region to include over 800 patients in our study, the main objective being to fully validate this technology. One of the main challenges of a project of this scale is multi-center coordination. To achieve this, we plan to recruit staff, in particular clinical study technicians, who will travel to the various centres to collect data. One of my priorities is to train these technicians effectively to guarantee the quality of the data collected and avoid any errors. Another major challenge is to maintain a good rate of patient inclusion, which is why we are working with 15 geriatric services that have agreed to take part. AXA's support means we have the material and human resources we need.

Axa’s support is much more than just a financial contribution. Above all, it means recognition of the value and importance of our project. It shows that our work is considered essential, which is extremely gratifying.

Our project is not just about collecting data. It also provides an opportunity for doctoral and Masters 2 students to get involved in the research program. As such, it has an important educational and intellectual aspect.

What's more, the project is both unifying and collaborative: managing to bring together 15 geriatrics departments in the Paris region is no mean feat! This collaboration is creating a culture of emulation in clinical research in geriatrics, demonstrating our ability to produce high-quality work collectively. I think it's crucial to stimulate research in geriatrics.