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Background: cognitive decline and muscle weakness are prevalent health conditions in elderly people. We hypothesised that cognitive decline precedes muscle weakness.Objective: to analyse the temporal relationship between cognitive performance and handgrip strength in oldest old people.Design: prospective population-based 4-year follow-up study.Subjects: a total of 555 subjects, all aged 85 years at baseline, were included into the study.Methods: handgrip strength measured at age 85 and 89 years. Neuropsychological test battery to assess global cognitive performance, attention, processing speed and memory at baseline and repeated at age 89 years. Associations between handgrip strength and cognitive performance were analysed by repeated linear regression analysis adjusted for common confounders.Results: at age 85 and 89 years, better cognitive performance was associated with higher handgrip strength (all, P < 0.03), except for attention. There was no longitudinal association between baseline handgrip strength and cognitive decline (all, P > 0.10), except for global cognitive performance (P = 0.007). Better cognitive performance at age 85 years was associated with slower decline in handgrip strength (all, P < 0.01) after adjustment for common confounders.Conclusion: baseline cognitive performance was associated with decline in handgrip strength, whereas baseline handgrip strength was not associated with cognitive decline. Our results suggest that cognitive decline precedes the onset of muscle weakness in oldest old people. [ABSTRACT FROM AUTHOR]

Transitions between disability states in older people occur frequently. This study investigated predictors of disability transitions in the oldest old and was performed in the Leiden 85-plus study, a population-based prospective cohort study among 597 participants aged 85 years. At baseline (age 85 years), data on sociodemographic characteristics and chronic diseases were obtained. Disabilities in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured annually for 5 years with the Groningen Activities Restriction Scale (GARS). Mortality data were obtained. A statistical multi-state model was used to assess the risks of transitions between no disabilities, IADL disability, BADL disability, and death. At baseline, 299 participants (50.0 %) were disabled in IADL only, and 155 participants (26.0 %) were disabled in both BADL and IADL. During 5-year follow-up, 374 participants (62.6 %) made >1 transition between disability states, mostly deterioration in disability. Males had a lower risk of deterioration [hazard ratio (HR), 0.75 (95 % CI, 0.58-0.96)] compared to females. No gender differences were observed for improvement [HR, 0.64 (95 % CI, 0.37-1.11)]. Participants with depressive symptoms were less likely to improve [HR, 0.50 (95 % CI, 0.28-0.87)]. Participants with depressive symptoms [HR, 1.46 (95 % CI, 1.12-1.91)], >1 chronic disease [HR, 1.60 (95 % CI, 1.27-2.01)], and with cognitive impairment [HR, 1.60 (95 % CI, 1.20-2.13)] had the highest risk of deteriorating. Disability is a dynamic process in the oldest old. Deterioration is more common than improvement. Older men are less likely to deteriorate than women. The presence of depressive symptoms, chronic disease, and cognitive impairment predicts deterioration.