INTRODUCTION: To examine the longitudinal association between estimated pulse wave velocity (ePWV) and cognitive phenotypes in a rural Chinese older population. METHODS: This population-based study included 1857 dementia-free participants (age ≥60 years) who were examined in 2014 and followed in 2018. ePWV was calculated using age and mean blood pressure (MBP). Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and neuropsychological tests. Dementia was diagnosed following the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Data were analyzed using Cox proportional-hazards models, linear regression models, and restricted cubic spline (RCS) curves. RESULTS: Per 1-m/s increase in ePWV was associated with an adjusted hazard ratio (HR) (95% confidence interval [CI]) of 1.51(1.30-1.75) for dementia and 1.58(1.33-1.89) for Alzheimer's disease (AD), and with an MMSE score decline (adjusted β-coefficient = -0.36
95% CI = -0.52 to -0.21). A nonlinear association was observed between baseline ePWV and follow-up cognitive scores. DISCUSSION: A higher ePWV is associated with an increased risk of dementia, AD, accelerated cognitive decline, and poorer cognitive performance in older adults. HIGHLIGHTS: An increased estimated pulse wave velocity (ePWV) was associated with incident dementia, Alzheimer's disease, and accelerated cognitive decline in a rural Chinese older population. A higher ePWV at baseline was associated with lower scores of global cognition and multiple cognitive domains at the 4-year follow-up. An increased ePWV may be a risk factor for dementia and accelerated cognitive deterioration in aging.