<p>Emotion regulation is a vital life skill, and cognitive reappraisal (CR) is the most effective emotion regulation strategy, which plays a key role in healthy aging. In memory clinic patients, problems with emotion regulation difficulties and cognitive impairment are very common, often accompanied by signs of cerebral small vessel disease (CSVD) on their magnetic resonance imaging (MRI). Is there a correlation among cognitive reappraisal failure, cognitive impairment, and CSVD in these older adults? This study aims to investigate the question. A standardized emotion regulation task was used to measure CR ability. A total of 170 older adults were included in statistical analysis, of which 78 were considered as cognitive reappraisal failure (CR-Failure). All participants completed the emotion regulation task, neuropsychiatric assessments, and MRI scans, with traditional CSVD markers being evaluated. Our analysis indicated that CR ability is negatively correlated with scores on the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. Additionally, logical memory and executive function are significant factors in CR utilization. A higher burden of CSVD or presence of cognitive impairment is an independent risk factor for cognitive reappraisal failure in memory clinic older adults. Furthermore, cognitive impairment significantly mediates the relationship between greater CSVD burden and CR failure.</p>