<p>Cerebral microbleeds are a common neuroradiological feature among the elderly population. Their contribution to the development of cognitive decline is an ongoing point of discussion. We investigated cognitive deficits and comorbidities of patients with mixed and strictly lobar microbleeds, as well as the presence of other neuroradiological features. The goal was to identify risk factors for cognitive decline. In this exploratory study, imaging markers and clinical data of 37 participants were retrospectively analyzed. Magnetic resonance images were assessed for cerebral microbleeds, lacunar infarctions, white matter hyperintensities, medial temporal lobe&#xa0;atrophy, global brain atrophy, and for “macro” hemorrhage (cortical superficial siderosis and intracerebral hemorrhage). Cognitive functions were assessed by neuropsychological screening examinations (<i>n</i> = 30) or relative’s questionnaire (<i>n</i> = 7). Memory was the cognitive domain most severely affected (mean ± SD, 2.34 ± 1.85) on the cognitive semiquantitative score (ranging from 0 to 6 points), while the other domains attained mean values of at least 4.75 points. Advanced age, intracerebral hemorrhage, male sex, coronary heart disease, and atrial fibrillation were more prevalent in patients with cognitive decline than without. “Macro” hemorrhage was associated with lower scores in executive functions (<i>p</i>-value = 0.001). Brain atrophy and medial temporal atrophy seemed to be associated with cognitive decline. Memory impairment is common in patients with cerebral microbleeds. Patients with “macro” hemorrhage show a greater cognitive decline in executive functions than subjects without. Atrial fibrillation, intracerebral hemorrhage, and coronary heart disease might be comorbidities associated with cognitive decline. Atrophy might be more relevant for cognitive decline than cerebral microbleeds.</p>