In order to study the relationship between VCI (vascular cognitive impairment) and intracranial and extracranial large artery stenosis, cerebral white matter lesions and brain atrophy. By consecutively enrolling 105 patients with VCI, divided into mild group (n = 77) and severe group (n = 28), and at the same time selecting patients with normal cognition as the control group (n = 71). comparing the differences in cerebrovascular disease risk factors, cerebral white matter lesions, ischemic cerebral infarction, and cerebral atrophy among the 3 groups, and analysing the correlation between the degree of stenosis of the intracranial and extracranial large arteries and VCI. The results show that the differences in the history of ischaemic stroke and the proportion of ≥ 2 lacunae were statistically significant among the 3 groups (P < 0.001). The differences in cerebral white matter high signal, paraventricular white matter, deep white matter Fazekas score, and whole-brain cortical atrophy GCA grading were statistically significant among the 3 groups(P < 0.001). In the multivariate ordered logistic regression analysis model, it was found that internal carotid artery segment C1, internal carotid segment C2 ~ C7, and the degree of middle cerebral artery stenosis are the main influencing factors for the severity of VCI. The degree of stenosis of internal carotid artery C1 segment and internal carotid C2 ~ C7 segment is positively correlated with the severity of VCI patients to a low degree, whereas the degree of stenosis of the middle cerebral artery, cerebral white matter lesions, and cerebral atrophy grading are positively correlated with the severity of VCI patients to a moderate degree. It is evident that with increasing cardiovascular risk factors, history of ischaemic stroke and degree of stenosis of the internal carotid and middle cerebral arteries, the risk of VCI in the subjects increased significantly. It suggests that the condition of intracranial and extracranial large arterial lesions can be used as one of the indicators for the detection of VCI, and that there are certain feasible therapeutic directions.