Objective To explore the correlation between serum cystatin C (CysC) and cognitive function and executive function in patients with acute cerebral infarction. Methods A total of 103 patients with acute cerebral infarction were selected in clinical research. Based on the Montreal cognitive assessment scale (MoCA), patients were divided into cognitive impairment group and normal cognitive group. The levels of serum CysC and MoCA subtypes were compared between the two groups, and the correlation between cystatin C and cognitive function was analyzed. According to the level of serum CysC, the patients were divided into low-level group and middle-high level group. The relationship between CysC and executive function was further investigated by Stroop test. Results CysC was a risk factor of cognitive impairment in the acute phase after cerebral infarction (OR=8.855, 95%CI=1.674-46.841, P=0.010), and the level of CysC was negatively correlated with MoCA score (r=-0.509, P=0.001). In each of the MoCA subproject, the scores of the cognitive impairment group(clock drawing: 0(0, 1), connection: 0(0, 0), copying the cube: 0(0, 0)) were lower in clock drawing, connection, and copying the cube than that of the normal cognitive group(clock drawing: 3(2, 3), connection: 1(0, 1), copying the cube: 1(1, 1))(P<0.05). The difference of task C between low-level CysC group and middle-high level group was statistically significant(P<0.05). The level of CysC was negatively correlated with amount of interference in correct response(r=-0.471, P<0.05), and positively correlated with amount of interference in reacting time(r=0.796, P<0.05). Conclusion Serum CysC is a risk factor of cognitive impairment in acute cerebral infarction. The higher the level of CysC, the more serious cognitive impairment, and cognitive impairment mainly manifested as executive function impairment. Key words: Cerebral infarction; Cystatin C; Cognitive impairment; Executive function