Cognitive status and associated risk factors in high-risk older adults of China: a population-based cross-sectional study

Older adults at high-risk conditions are particular vulnerable to cognitive impairment; however, population-based assessments targeting this group remain limited. To exam cognitive status and associated risk factors in high-risk older adults in China. This population-based cross-sectional study was conducted across Hainan Province comprising adults aged ≥ 60 years with at least one high-risk condition: physical activity limitations, disability, stroke history, mental health symptoms, or subjective memory concerns, through stratified regional sampling. Pre-mild cognitive impairment (Pre-MCI) and MCI were assessed using the validated BABRI-brain health system. Demographic and health-related data collected from registries and self-reports. The prevalence rates of Pre-MCI and MCI were calculated, and multivariable logistic regression was applied to identify risk factors. Among 228,087 participants (mean age 73.6 ± 8.6 years; 57.6% female; 67.1% with primary education or less), the prevalence of Pre-MCI and MCI was 51.4% and 32.0%, respectively. Significant risk factors for cognitive outcomes included older age (OR range for Pre-MCI: 1.27 [1.24–1.30] to 3.09 [2.77–3.45]; for MCI: 1.04 [1.01–1.07] to 4.28 [3.84–4.78]), unmarried status (OR 1.07 [1.03–1.12] for Pre-MCI; 1.45 [1.39–1.52] for MCI), lower education (OR range for Pre-MCI: 1.37 [1.32–1.41] to 3.74 [3.59–3.89]; for MCI: 1.61 [1.54–1.68] to 6.92 [6.60–7.25]), occupation as farmer/housemaker (OR 1.37 [1.31–1.43] for Pre-MCI; 1.59 [1.51–1.67] for MCI), and residence in medium GDP regions (OR 1.74 [1.66–1.82] for Pre-MCI; 1.38 [1.32–1.45] for MCI). Additional risk factors included hearing impairment, cerebral hemorrhage, family dementia history, and hypertension. Sex-specific differences were observed. The high prevalence of cognitive impairment in high-risk older adults highlights the need for tailored public health strategies. Particular attention should be given to those who are unmarried, with lower education, hearing impairment, and hypertension.