Objective：To investigate the effect of morphological changes（tortuosity and stenosis） of the internal carotid artery（ICA） on cognition. Methods：A total of 39 patients who visited our hospital from October 2017 to June 2018 and 20 subjects as controls were included in the study. The above 39 patients were subdivided into ICA tortuosity group（23 cases） and ICA stenosis group（16 cases） according to the results of cranial-cervical computed tomography angiography（CTA） and cranio-cervical magnetic resonance angiog－raphy（MRA）. Mini-mental state examination（MMSE） and Montreal cognitive assessment（MOCA） were used to evaluate the cogni－tive function in each group. Cerebral white matter lesions were evaluated by the Fazekas scale，and the number of lacunes was calcu－lated for each group. Results：The MOCA score was 27（24，29） for the ICA tortuosity group，28（25，29） for the ICA stenosis group，and 29（28，30） for the control group，with a significant lower score observed in the ICA tortuosity group than in the control group（P<0.05）. There were no significant differences in MMSE score between the three groups. The ICA tortuosity group and ICA stenosis group had significantly different Fazekas scale scores compared with the control group（P<0.05）；the ICA stenosis group had a signifi－cantly larger number of lacunes than the control group and the ICA tortuosity group（9 cases vs 2 cases/1 case，P<0.05）. Compared with the other two groups，the ICA stenosis group had significantly higher prevalence of smoking，drinking，hypertension，and hyper－lipidemia（P<0.05）. Conclusion：Morphological changes（tortuosity and stenosis） of the ICA are related to cerebral white matter lesions，and can lead to a certain degree of cognitive decline.