Early diagnosis and treatment of vascular cognitive impairment (VCI) are of great significance to reduce the occurrence of dementia. White matter lesions (WML) within the cholinergic pathways is quite common in the VCI patients. The WHL damage in the pathways can be directly evaluated by Cholinergic Pathways Hyper-intensities Scale (CHIPS) and diffusion tensor imaging, which is time-consuming, easy to operate and comparatively objective. This article summarized the relationship between WML within the cholinergic pathways and cognitive function in VCI patients. The review displays that there are WML within the cholinergic pathway in all the 3 stages of VCI, brain-at-risk, mild cognitive impairment and dementia. In addition, a negative correlation is seen between the severity of WML in the pathways and cognitive function, which provides a valuable imaging reference for early screening and diagnosis of VCI.