目的·探索高血压和血脂异常对老年人认知功能的影响。方法·采用前瞻性队列研究方法建立动态人群队列，于2019年整群选取上海某社区65岁及以上自愿参与免费体检项目居民建立基线，2022年在队列源社区整群随机抽取2个社区卫生服务站512例67~93岁社区老年人进行随访。采集数据包括居民健康档案、各项体检测量结果、简明精神状态检查（Mini-mental State Examination，MMSE）量表评分。结果·512例随访者中，经数据清洗，有效样本量为495例。根据基线和随访认知判断和变化，分3个认知组：好转组、正常组、下降组。下降组高血压患病率超好转组43.14%，超正常组24.39%（下降组66.67% vs好转组23.53%，P=0.011；下降组66.67% vs正常组42.28%，P=0.040）。好转组总胆固醇（total cholesterol，TC）低于正常组［好转组（4.38±1.04）mmol/L vs正常组（5.11±1.12）mmol/L，P=0.009］，下降组2022年TC高于2019年［成对差值（0.46±0.87）mmol/L，95%CI 0.08~0.84，P=0.021］。好转组低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-Ch）低于正常组［好转组（2.51±0.92）mmol/L vs正常组（3.07±1.00）mmol/L，P=0.024］，且其2022年高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-Ch）高于2019年［成对差值（0.16±0.20）mmol/L，95%CI 0.06~0.26，P=0.005］。多项式Logistic回归分析显示：好转组TC低于正常组［β=4.12，OR=61.64，95%CI 1.52~2 494.07，P=0.029］和下降组［β=5.88，OR=357.35，95%CI 4.54~28 149.75，P=0.008］；下降组三酰甘油（triacylglycerol，TAG）［β=1.85，OR=6.34，95%CI 1.05~38.43，P=0.045］、LDL-Ch［β=5.61，OR=274.06，95%CI 3.65~20 567.57，P=0.011］和高血压［β=1.90，OR=6.69，95%CI 1.53~29.16，P=0.011］均高于好转组；下降组年龄大于正常组［β=0.08，OR=1.08，95%CI 1.00~1.16，P=0.041］，受教育程度低于正常组［β=1.22，OR=3.39，95%CI 1.28~8.94，P=0.014］。结论·低TC和LDL-Ch、高HDL-Ch有利于认知好转；高血压、高TC、高TAG、高LDL-Ch、受教育程度低、高年龄是认知下降的风险因素。

Objective ·To explore the effects of hypertension and dyslipidemia on cognitive function in the elderly. Methods ·A dynamic population cohort was established by using prospective cohort study methods. In 2019, a complete cohort was selected from residents aged 65 and above who voluntarily participated in a free physical examination program in a community in Shanghai, serving as the baseline cohort. In 2022, 512 community-dwelling elderly aged 67 to 93 were randomly selected from the same community as the follow-up cohort for the study. The collected date included residents′ health records, various physical examination measurements, and Mini-mental State Examination (MMSE) scale scores. Results ·Of the 512 cases that were followed up, the valid sample size was reduced to 495 after data cleaning. According to the baseline and follow-up cognitive assessments and changes, the cases were categorized into three cognitive groups: the improvement group, the normal group, and the decline group. The prevalence of hypertension in the decline group was 43.14% higher than that in the improvement group and 24.39% higher than that in the normal group (66.67% in the decline group vs 23.53% in the improvement group, P=0.011; 66.67% in the decline group vs 42.28% in the normal group, P=0.040). Total cholesterol (TC) in the improvement group was lower than that in the normal group [improvement group (4.38±1.04) mmol/L vs normal group (5.11±1.12) mmol/L, P=0.009]. Additionally, TC in the decline group in 2022 was higher than that in 2019 [paired difference (0.46±0.87) mmol/L, 95% CI 0.08?0.84, P=0.021]. LDL-Ch in the improvement group was lower than that in the normal group [improved group (2.51±0.92) mmol/L vs normal group (3.07±1.00) mmol/L, P=0.024], and their HDL-Ch in 2022 was higher than that in 2019 [paired difference (0.16±0.20) mmol/L, 95% CI 0.06?0.26, P=0.005]. The results of multinomial Logistic regression showed: TC in the improved group was lower than that in the normal group [β=4.12, OR=61.64, 95% CI 1.52?2494.07, P=0.029] and the decline group [β=5.88, OR=357.35, 95% CI 4.54?28149.75, P=0.008]; the TAG [β=1.85, OR=6.34, 95% CI 1.05?38.43, P=0.045], LDL-Ch [β=5.61, OR=274.06, 95% CI 3.65?20567.57, P=0.011], and hypertension [β=1.90, OR=6.69, 95% CI 1.53?29.16, P=0.011] in the decline group were higher than those in the improvement group; the age of the decline group was greater than that of the normal group [β=0.08, OR=1.08, 95% CI 1.00?1.16, P=0.041], and the education level was lower than that of the normal group [β=1.22, OR=3.39, 95% CI 1.28?8.94, P=0.014]. Conclusion ·Low TC and LDL-Ch and high HDL-Ch are beneficial to cognitive improvement. Conversely, hypertension, high TC, high TAG, high LDL-Ch, low education level, and advanced ages are risk factors for cognitive decline.