Objectives - To determine the interrelationships between baseline Mini-Mental State Examination (MMSE) score and overall long-term risk of cerebrovascular disease (CBVD). Materials & methods - This was a prospective cohort study of subjects aged 55 years or more who were enrolled in the Beijing Longitudinal Study of Aging (BLSA) and had a baseline MMSE score available. Baseline MMSE score was divided into four categories: >= 28, 26-27, 23-25, and <= 22. Participants were followed for 23 years. Cox regression models were used to examine the association between MMSE score and CBVD. Results - A total of 2101 participants were included in this analysis, 335 (15.9%) with an MMSE score >= 28, 365 (17.4%) with a score of 26-27, 579 (27.6%) with a score of 23-25, and 822 (7.4%) with a score <= 22. There were 576 cases of CBVD. The overall risk of CBVD increased with decreasing MMSE score. The impact of MMSE score on the risk of CBVD was much stronger in women than in men. The hazard ratio for CBVD risk was 1.76 (95% confidence interval [CI], 1.29-2.39, P < 0.05) for subjects with an MMSE score <= 22, and 1.21 (95% CI, 0.91-1.61, P < 0.05) for those with an MMSE score of 23-25. Higher MMSE scores were less strongly associated with the risk of CBVD. Conclusions - Elderly people with lower MMSE scores, especially women, are at higher long-term risk of CBVD.