Objective To investigate the effects of ginkgo-damole combined with butylphthalide on cognition and neurological function in patients with post-ischemic stroke cognitive impairment.Methods A total of 146 patients with post-ischemic stroke cognitive impairment admitted to Xingtai Central Hospital from March 2023 to October 2024 were selected and randomly divided into an experimental group (73 cases, treated with ginkgo-damole combined with butylphthalide) and a control group (73 cases, treated with butylphthalide alone) using a random number table method. The therapeutic efficacy, cognitive status, neurological function, hemorheological parameters [plasma viscosity (PV), whole blood viscosity (BV), erythrocyte sedimentation rate (ESR), hematocrit (HCT) ], inflammatory factors [interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) ], and neurotransmitter levels [5-hydroxytryptamine (5-HT), norepinephrine (NE), dopamine (DA) ] were compared between the two groups.Results The overall effective rate in the experimental group was higher than that in the control group (P < 0.05). After treatment, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) scores in the experimental group were higher than those in the control group (P < 0.05), and both scores were significantly improved compared with baseline values in both groups (P < 0.05). After treatment, the National Institutes of Health Stroke Scale (NIHSS) scores, and levels of NSE and S100β in the experimental group were lower than those in the control group (P < 0.05), and all were significantly reduced compared with baseline values in both groups (P < 0.05). After treatment, PV, BV, ESR, and HCT in the experimental group were lower than those in the control group (P < 0.05), and all were significantly decreased compared with baseline values in both groups (P < 0.05). After treatment, IL-1β, IL-6, and TNF-α levels in the experimental group were lower than those in the control group (P < 0.05), and all were significantly reduced compared with baseline values in both groups (P < 0.05). After treatment, 5-HT, NE, and DA levels in the experimental group were higher than those in the control group (P < 0.05), and all were significantly increased compared with baseline values in both groups (P < 0.05).Conclusion Ginkgo-damole combined with butylphthalide can further enhance clinical therapeutic efficacy, promote the recovery of cognitive ability and neurological function, and exert positive regulatory effects on hemorheological parameters, inflammatory factors, and neurotransmitter levels.