Objective To evaluate the features of cognitive impairment in patients with brain magnetic resonance imaging (MRI)-negative medial temporal lobe epilepsy (MTLE).Methods A retrospective analysis was performed on the clinical data of 27 patients with brain MRI-negative MTLE (including 14 patients with left-sided MTLE[L-MTLE group] and 13 patients with right-sided MTLE[R-MTLE group]). A total of 14 healthy controls with well-matched sex, age, and education level were enrolled as control group. Montreal Cognitive Assessment (MoCA) was used to assess general cognitive function and faux pas recognition task was used to evaluate advanced social cognitive function.Results For MoCA scores, both MTLE groups had significantly lower MoCA total score and score of each item than the control group (P<0.05); compared with the L-MTLE group, the R-MTLE group had significantly lower scores in cube copying test and clock drawing test and significantly higher scores in sentence repetition test and verbal fluency test (all P<0.05); the R-MTLE group had a significantly lower score in cube copying test than the control group (P<0.05). For faux pas recognition task score, both MTLE groups had a significantly lower score than the control group (P<0.05), and the L-MTLE group had a significantly lower score than the R-MTLE group (P<0.05).Conclusions The general cognitive function and advanced social cognitive function of MTLE patients with MRI-negative MTLE are impaired.