Objective To assess the cognitive impairment in long-term maintenance hemodialysis patients, and to investigate the risk factors relating to the impairment. Method Case control study was performed in the subjects who were on long-term maintenance hemodialysis and without intracranial organic diseases by head CT and MRI examinations, and in the control subjects who were normal community residents without intracranial lesions confirmed by our medical examination center. Performance on a battery of neuropsychological tests was compared between 42 patients and 46 control subjects. The test battery included tests for memory, executive functions, mental speed, visuospatial abilities, visuoconstructive skills and mini-mental state examinations. Results After adjustment for age, sex, years of education, smoking, systolic blood pressure and serum glucose, subjects with long-term maintenance hemodialysis had significantly lower levels of performance tests for acoustic memory, executive functions (including response inhibition, mental flexibility, concept formation and abstract reasoning, plan, sequence and logistical ability), mental processing speed and visuoconstructive skills (P＜0.001), but tests for visual memory (include modified Rey complex figure immediate memory, long-time delay memory and recognition) and visuospatial abilities showed the results similar to control group (P=0.175, P=0.07, P=0.339; P=0.175). Multiple logistic regression analysis showed that hypertension and anemia were the independent risk factors for cognitive impairment in long-term maintenance hemodialysis patients. Conclusion Compared with control subjects, long-term maintenance hemodialysis patients have extensive neuropsychological performance abnormalities that may closely relate to anemia and hypertension.