Objective To investigate the association between intracranial artery stenosis and cholinergic pathway lesions in the white matter in patients with cognitive impairment.Methods A total of 118 patients who met the inclusion criteria were enrolled. Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function, cranial CT angiography was used to collect the information of intracranial vessels, and cranial magnetic resonance imaging was used to evaluate the lesions in white matter. According to cognitive function, the patients were divided into cognitive impairment group (study group with 85 patients) and normal cognition function group (control group with 33 patients).Results The study group had a significantly higher proportion of patients with intracranial vascular stenosis than the control group (P=0.042). Compared with the control group, the study group had significantly lower total MoCA score and the scores of each sub-item (P<0.01) and a significantly higher CHIPS score (P=0.047). The CHIPS score was negatively correlated with total MoCA score and the scores of some sub-items (all P<0.05). Intracranial arterial stenosis was negatively correlated with MoCA score and the scores of all sub-items except abstract function (all P<0.05), and the CHIPS score was positively correlated with intracranial arterial stenosis (P=0.001).Conclusions Intracranial arterial stenosis plays a role in the process of cognitive impairment caused by cholinergic pathway lesions in the white matter.