Background <p>Cerebral small vascular disease (CSVD) has an insidious onset and progresses slowly, leading to cognitive impairment. Understanding the clinical characteristics of cognitive impairment is crucial for early identification, prevention, and treatment. This study aimed to analyze risk factors associated with cognitive impairment related to CSVD.</p> Methods <p>This retrospective study included 270 patients with CSVD and independent living abilities. Laboratory tests included measurements, such as fasting blood glucose (FBG), glycosylated hemoglobin, and blood creatinine. All patients underwent neuropsychological evaluation, and the main factors influencing cognitive impairment were analyzed using multivariate logistic regression.</p> Results <p>Among the patients, 80% (<i>n</i> = 216) had symptomatic cerebral infarction. Factors such as history of symptomatic cerebral infarction, FBG level, blood fibrinogen level, and CSVD total burden score were significantly different between the normal cognition and cognitive impairment groups (<i>p</i> &lt; 0.001, <i>p</i> = 0.049, <i>p</i> = 0.009, <i>p</i> = 0.001, respectively). Logistic regression analysis revealed that age, FBG level, and number of lacunar cerebral infarctions were the main factors influencing cognitive impairment. Age, education level, fibrinogen and d-dimer levels, and CSVD total burden score significantly correlated with the level of cognitive impairment. Impaired daytime function affected the cognitive levels of patients with CSVD (<i>p</i> = 0.043).</p> Conclusions <p>This study has highlighted the main risk factors for cognitive impairment in patients with CSVD, such as age, FBG levels, and number of lacunar cerebral infarctions. Additionally, education played a significant role in cognitive outcomes. These findings suggest that managing these risk factors and enhancing cognitive reserve can mitigate the cognitive decline associated with CSVD.</p>