Objective To investigate the imaging features of subcortical ischemic vascular disease (SIVD) and their correlation with cognitive impairment in the elderly. Methods Clinical data of 99 elderly patients (60 to 75 years old) with SIVD admitted in our department from September 2014 to January 2015 were collected. According to the results of head magnetic resonance imaging (MRI), the patients were divided based on the number of lacunar infarction (LI) lesions in the basal ganglia and thalamus area, and on the severity of white matter lesion (WML) by Cholinergic Pathway High Signal Rating Scale (CHIPS). Montreal Cognitive Assessment (MoCA, Beijing version) and Alzheimer’s Diseases Assessment Scale-Cognitive (ADAS-Cog) were used as assessing tools to analyze the correlation of severity of LI or WML with cognitive function. Results MoCA and ADAS-Cog scale indicated that there was no difference in cognitive function between the moderate and mild LI or WML patients (P＞0.05), but significant difference was seen between the severe and mild patients (P＜0.05). For the patients with mild and moderate WML and severe LI (infarct lesions＜7), no cognitive impairment was observed (P＞0.05). While the number of infarct lesions ≥7, the mild and moderate WML patients suffered from cognitive impairment (P＜0.05). Conclusion Cognitive impairment is found in the elderly patients with severe WML or with multiple LI in the basal ganglia and thalamus area, and in those with mild and moderate WML and coexisting multiple LI.