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目的 了解MMSE阳性人群认知功能损害的危险性及影响因素.方法 2001年9月至2002年2月对广州市5 276名年龄≥55周岁的社区老人采用两阶段法(老年期痴呆初筛调查表和老年期痴呆诊断问卷)进行痴呆患病率(基线)调查,基线筛查出阳性患者917例,并采用诊断问卷进行复查,查出痴呆183例、轻度认知功能损害(mild cognitive impairment,MCI)264例和复查正常老人470名;于2003、2008年采用与基线调查时相同的工具和方法对基线诊断为MCI及复查正常老人进行认知变化的随访.结果 (1)完成随访者(简称完访者,n=303)与失访者(n=332)比较:第2次随访时失访者的年龄大于完访者,差异有统计学意义(t=-5.14,P＜0.05);第2次随访时城镇老人(n=488)的失访率高于农村老人(n=147;x2=21.92,P＜0.05);完访者与失访者的其他个人特征差异均无统计学意义.(2) MCI人群(n=264)中痴呆和阿尔茨海默病(Alzheimer’s disease,AD)的平均年发病率分别为9.42/100人年和7.46/100人年;复查正常老人(n=470)中痴呆和AD、MCI的平均年发病率分别为3.05/100人年、2.21/100人年和6.28/100人年.(3)COX分析显示:复查正常老人中:增龄(RR=1.28,95％ CI 1.09～1.51)、卒中病史(RR=2.23,95％ CI 1.11～4.51)是MCI的影响因素.女性(RR=2.87,95％ CI 1.17～7.04)、增龄(RR=1.70,95％ CI 1.27～2.27)是AD的影响因素.卒中病史(RR=9.15,95％CI2.16～38.74)是血管性痴呆(vascular dementia,VD)的影响因素.MCI人群中:增龄(RR=1.48,95％ CI 1.17～1.86)是AD的影响因素.高血压病史(RR=4.43,95％ CI 1.00～19.53)及卒中病史(RR=7.21,95％ CI 1.88～27.57)是VD的影响因素.结论 MMSE阳性人群患痴呆的危险性较高.增龄、卒中为老年人群患MCI的危险因素;女性、增龄为老年人群患AD的危险因素;高血压、卒中为患VD的危险因素.“,”Objective To explore the cognitive change in lower MMSE scores of the elderly.Methods From Sep 2001 to Feb 2002,5 276 persons aged 55 years or over living in urban and rural areas of Guangzhou were investigated by Senile Dementia Screening Questionaire,Senile Dementia Diagnosis,in which 917 were diagnosed with low MMSE scores (183 dementia patients,264 mild cognitive impairment (MCI) people and 470 normal were differentiated in reexamination).MCI and normal people followed up in 2003 and 2008 with the same tools.Results (1) In comparison between interviewers who finished the interview (n=303) and lost interviews (n=332);the average age in lost interviews were older than the finidhed (t=-5.14,P＜0.05) in second follow-up study.In the second follow-up,urban old people (n=488) had higher lost rate than the rural elderly(n=147;x2=21.92,P＜0.05) and no statistical significant difference were found in the other personal characteristics in both follow-up study.(2) The incidence of dementia and Alzheimer’s disease(AD) among MCI were 9.42/100 person-year and 7.46/100 person-year respectively.The incidence of dementia,AD,MCI among normal were 3.05/100,2.21/100 and 6.28/100 person-year respectively.(3) Those risk factors increased the progression from the normal to MCI were aged(RR=1.28,95％ CI 1.09-1.51),stroke (RR=2.23,95％ CI 1.11-4.51).The risk factors increased the progression from the normal to AD were female (RR=2.87,95％ CI 1.17-7.04),aged (RR=1.70,95％ CI 1.27-2.27).The risk factors increased the progression from the normal to VD were stroke(RR=9.15 95％ CI 2.16-38.74).The risk factors increased the progression from the MCI to AD were aged (RR=1.48,95％ CI 1.17-1.86).Those risk factors increased the progression from the MCI to VD:hypertentsion (RR=4.43,95％ CI 1.00-19.53),stroke (RR=7.21,95％ CI 1.88-27.57).Conclusions The lower MMSE scores of the elderly in community are the risk factor for dementia.The older,stroke in lower MMSE scores elderly may have higher risk progression to MCI.The olderage in lower MMSE scores of the elderly,female could be higher risk progression to AD.The hypertension and stroke in lower MMSE scores of the elderly may have higher risk progression to VD.