Background <p>Vascular cognitive impairment (VCI) is a common cognitive disorder in patients with cerebrovascular disease. The neutrophil percentage-to-albumin ratio (NPAR), a composite marker reflecting inflammatory and nutrition-related status, has attracted increasing attention, but its association with VCI remains unclear.</p> Methods <p>This cross-sectional study included 227 patients with ischemic cerebrovascular disease, including 130 patients with VCI and 97 cognitively normal controls. Logistic regression analyses were performed to examine the association between NPAR and VCI. Quartile-based, standardized, sensitivity, restricted cubic spline, and discrimination analyses were further conducted.</p> Results <p>NPAR levels were higher in the VCI group than in controls. In the fully adjusted model, higher NPAR was associated with the presence of VCI (OR = 4.25, 95% CI: 1.45 ~ 12.45, <i>P</i> = 0.008). Quartile-based and per-1-standard-deviation analyses showed generally consistent findings. Restricted cubic spline analysis suggested an approximately linear association within the observed range. NPAR alone showed moderate discrimination for VCI, whereas its incremental value beyond conventional clinical variables was limited.</p> Conclusions <p>In this cross-sectional study of patients with ischemic cerebrovascular disease, higher NPAR was associated with the presence of VCI. NPAR may provide supplementary information for the evaluation of VCI status; however, these findings should be interpreted cautiously and require confirmation in larger prospective studies.</p> Trial registration <p>ClinicalTrials.gov, NCT04999813. Registered 10 August 2021.</p>