ABSTRACT Background Cerebral microbleeds (CMBs) are subclinical lesions of the brain parenchyma and an important marker for the clinical diagnosis of central nervous system vascular disease. However, the relationship between CMBs and cerebral infarction, cerebral hemorrhage, and cognitive impairment remains unclear. Methods In order to explore the cognitive function and risk factors of patients with acute cerebral infarction (ACI) complicated with cerebral microbleeds, 190 patients with ACI were collected. The patients were divided into groups with CMBs (n = 108) and groups without CMBs (n = 82) according to the presence or absence of CMBs. The general data, various examination indicators, Montreal Cognitive Assessment Scale (MoCA) scores of the two groups of patients were analyzed. Sixty healthy controls who underwent physical examination in our hospital during the same period were included as the healthy control group. Results ACI patients with CMBs had significantly higher rates of leukoaraiosis, hyperhomocysteinemia, hypercholesterolemia, and hypertension. Cognitive function was significantly lower in ACI patients with CMBs. Serum D-dimer, serum high-sensitivity C-reactive protein, serum neuron-specific enolase, and serum S100β of ACI patients with CMBs were all negatively correlated with their MoCA scores. Conclusion ACI patients with CMBs tended to have lower cognitive abilities than ACI patients without CMBs.