Objective To determine the effect of affective disorder on recurrence of cerebral infarction in the elderly. Methods A prospective study was carried out on 102 elderly patients with identified affective disorder who hospitalized in our Department of Neurology due to first attack of cerebral infarction from October 2012 to September 2013. They were assigned as the observation group (group A). Another 102 first-attacked cerebral infarction patients without affective disorder admitted during the same period were recruited and assigned as the pair-matched group (group B, without difference with group A in age, gender, severity of infarction, and comorbidity). These patients were followed up for 1 year. Recurrence of cerebral infarction was compared between the 2 groups. The compliance with anti-depressant or/and anti-anxiety agents was recorded in the patients of the group A. Results There were 23 patients suffering from relapsed cerebral infarction in group A, and 11 patients in group B, with the recurrence rate significantly higher in group A than in group B (22.5% vs 10.8%, P＜0.05). In group A, the recurrence rate was 36.8% in those who suffered from both coexisting depression and anxiety, significantly higher than those having depression (17.4%) or anxiety (21.6%) only. What’s more, the recurrence rate (30.4%) was comparatively higher in those with poor compliance with drug therapy. Conclusion Affective disorder is an important risk factor for recurrence of cerebral infarction in the elderly, and poor compliance with drug therapy increases the risk further.