Abstract: Background　Hypertension is one of the risk factors for Alzheimer's disease，whose neuropathological changes associated with memory and cognitive function predate clinical symptoms for many years.Therefore，it is of great significance to effectively identify high-risk groups of dementia in patients with hypertension for its prevention clinically.Objective　To investigate the changes of cognitive function of elderly people in community and analyze the effects of hypertension-related treatment，other combined physical diseases and blood pressure control on the transformation from mind cognitive impairment（MCI） to dementia，so as to provide a basis for preventing and delaying the occurrence of dementia.Methods　From July to December 2017，439 elderly patients with MCI who had been sampled by probability proportional to size（PPS） in 2011 were examined for their simple mental state with the remeasurement by the Montreal Cognitive Assessment Scale，Hamilton Depression Scale，Clinical Dementia Assessment Scale and the criteria for the diagnosis of cognitive impairment.The outcomes of follow-up were divided into the stable type（MCIs），the progressive type（MCIp） for dementia and the reversed type（MCIr） for normal cognitive status.The follow-up outcomes of MCI was compared between different history of hypertension and its related treatment.And Logistic regression was used to analyze the related influencing factors of MCI without deterioration.Results　There were significant differences in the number of children，BMI and hyperlipidemia among the elderly with hypertension history in 2011（P<0.05）.There were no differences in age，gender，single status，monthly income，education level，occupation type，personality tendency，family structure，alcoholism history，smoking history，memory decline and type 2 diabetes history between the two groups（P>0.05）.The age of new-onset and untreated hypertension group was higher than that of non-hypertension group，and the systolic and diastolic blood pressure levels of non-hypertension group were lower than those of new-onset and untreated hypertension group，and the diastolic blood pressure level of persistent hypertension group was lower than that of untreated hypertension group（P<0.05）.The average age of MCIp group was higher than that of MCIs group，and the difference was significant（P<0.05）.Logistic regression analysis showed that old age was a risk factor for MCIp（OR=0.856，P=0.011），while high month income was a protective factor（OR=2.288，P=0.045）.Conclusion　Community untreated and new-onset hypertension may promote the progression of MCI to dementia and old age is a risk factor.Decreasing or increasing blood pressure is the result of compensatory or disease progression accompanied by neurodegenerative changes.

Key words: Mild cognitive impairment, Hypertension, Dementia, Root cause analysis, Community

摘要： 背景　阿尔茨海默病与记忆力和认知功能下降有关的神经病理学改变早于临床症状多年，高血压是其危险因素之一。因此，在临床工作中，能在高血压患者中有效识别出痴呆高危人群，对于预防痴呆意义重大。目的　对社区老年人进行调查，了解其认知功能变化情况，分析高血压有关的治疗情况、合并其他躯体疾病、血压控制状况等对轻度认知功能障碍（MCI）向痴呆转化的影响，为防止和延缓痴呆的发生提供依据。方法　于2017年7—12月，对439例2011年经PPS（probability proportional to size）抽样法调查的MCI老年人进行简易智力状态检查，蒙特利尔认知评估量表、汉密尔顿抑郁量表、临床痴呆评定量表等量表测定，以及认知功能障碍诊断标准的再次测定。随访结局仍为MCI者为稳定型（MCIs），进展为痴呆者为进展型（MCIp），逆转为认知正常者为逆转型（MCIr）。比较不同高血压病史及其相关治疗等情况患者的MCI结局，采用Logistic回归分析MCI不恶化的影响因素。结果　有高血压病史的社区MCI老年人入组时（2011年）的子女人数、BMI、高脂血症情况比较，差异有统计学意义（P<0.05）；两组年龄、性别、单身情况、月收入、受教育年限、职业类型、个性倾向、家庭结构、酗酒史、吸烟史、记忆减退情况、2型糖尿病病史比较，差异无统计学意义（P>0.05）。新发高血压组和不治疗高血压组的年龄高于无高血压组，无高血压组的收缩压水平和舒张压水平低于新发高血压组、不治疗高血压组、持续高血压组，且持续高血压组的舒张压水平低于不治疗高血压组（P<0.05）。MCIp组的平均年龄高于MCIs组，差异有统计学意义（P<0.05）。Logistic回归分析结果显示，高龄是MCIp的危险因素（OR=0.856，P=0.011），月收入高则是保护因素（OR=2.288，P=0.045）。结论　社区不治疗和新发高血压者可能会促进MCI进展为痴呆，高龄是危险因素，血压下降或升高是伴随神经退行性改变而出现的机体代偿或疾病进展结果。

关键词: 轻度认知功能障碍, 高血压, 痴呆, 影响因素分析, 社区