Temporal dynamics of blood pressure, functional status and cognitive function in adults aged 85 years and older: a dynamic time warping approach in the Leiden 85-plus study.

Increases in blood pressure over time were associated with later IADL decline, while blood pressure decreases were associated with later IADL improvement.

• Association was statistically significant (P < .05)
• BP changes were associated with subsequent inverse IADL changes over time
• Dynamic time warping (DTW) was used to assess these temporal relationships
• IADL was measured using the Groningen Activity Restriction Scale for Instrumental Activities of Daily Living

Decreases in diastolic blood pressure over time were associated with later decreases in MMSE scores, while increases in diastolic blood pressure were linked to later improvements in MMSE.

• Association was statistically significant (P < .05)
• Changes in diastolic BP preceded concordant changes in cognitive function
• Cognitive function was measured with the Mini-Mental State Examination (MMSE)
• This relationship was directionally concordant (diastolic BP increases linked to MMSE improvements), in contrast to the inverse relationship seen with IADL

The study included 429 of 599 eligible participants from the Leiden 85-plus Study, all aged 85 years at baseline.

• Inclusion criterion was at least three measurements over the study period
• 69% of participants were female
• 39% used antihypertensive medication at baseline
• BP, functional status, and cognitive function were measured at baseline (age 85) and annually over 5 years

Dynamic time warping (DTW) was applied as a method to assess temporal relationships between blood pressure changes and changes in functional or cognitive status.

• DTW was used to explore temporal dynamics in adults aged 85 years and older
• Functional status was assessed using the Groningen Activity Restriction Scale for both ADL and IADL
• Cognitive function was measured with the Mini-Mental State Examination (MMSE)
• The method allowed identification of whether BP changes preceded functional or cognitive changes over the 5-year follow-up period

The direction of the temporal association between blood pressure and functional/cognitive outcomes differed, with BP showing an inverse relationship with IADL but a concordant relationship with cognitive function.

• BP changes were associated with subsequent inverse IADL changes (higher BP preceded IADL decline)
• Diastolic BP changes preceded concordant changes in cognitive function (higher diastolic BP preceded better MMSE scores)
• No statistically significant associations were reported for ADL
• These contrasting directional relationships suggest distinct mechanisms linking BP to functional versus cognitive outcomes in the oldest old