Clarifying the responses of human activities and climate change to the water cycle under variable environments is crucial for accurately assessing regional water balance. An analysis of the changes in actual evapotranspiration and its driving factors was conducted in the global high-elevation mountains during the period from 2001 to 2022. Utilizing 18 formulas for calculating evapotranspiration, which are based on comprehensive, temperature, radiation, and mass transfer, and then simulated the variations in reference evapotranspiration. Furthermore, we optimized the ET simulation model based on the most effective simulation results and projected future changes using scenario simulation data. Our findings reveal that: 1) ET at high-elevation mountains has significantly decreased at an average rate of 3.923 %/a, with monthly values ranging from 31.179 to 33.652 mm and an average of 32.646 mm; 2) The radiation-based model of Irmark-Allen is particularly well-suited for simulating ET at high-elevation mountains, with precision analysis and the Taylor diagram confirming its superior simulation performance. After optimizing the model using the method of least squares, the value of R2 before and after the optimization were 0.633 and 0.853, respectively. 3) An upward trend in ET under both SSP245 and SSP585 scenario in future simulation projections. Attribution analysis has identified Vapor Pressure Deficit as the key positive driver influencing the change of ET in global high-elevation mountains. Structural equation modeling further reveals that variations in net radiation and precipitation play a significant role in altering evapotranspiration rates. Meanwhile,The water balance analysis reveals that ET has been declining from 2001 to 2022. This phenomenon can be largely attributed to the substantial decline in vapor pressure deficit, the rise in the Normalized Difference Vegetation Index signifying increased vegetation cover, and the reduction in shallow soil moisture during the same period. These factors collectively explain the notable decrease in ET observed in high-elevation mountains.