To observe Xingnaojing on cognitive function in elderly patients after stroke, and to discuss the effect on PI3K/AKT signal pathway in the cerebrospinal fluid. Methods:A total of 90 cases of elderly patients after stroke in our hospital during January 2016-June 2016 were included into the study. According to the random principle, they were divided to observation group and the control group. On 1 d before, 3 d and 7 d after treatment, through recovery Physician Quality Reporting System (PQRS) the new cognitive evaluation system, cognitive function levels of the patients were accessed. The PI3K, AKT, pAKT, Bcl, and Bax concentration changes were detected by Western blotting before treatment (T0),after treatment 1 mouth(T1), 2 mouth(T2), 3 mouth(T3), 4 mouth(T4), in the different time points in cerebrospinal fluid. Results:1) cognitive function the two groups both reduced, the changes of control group were more obviously than the observation group, MMSE scores went back to normal in both of the two groups 7 d after treatment, while the PQRS scores showed that the patients still had cognitive function defects. 2)PQRS scores showed that the incidence of postoperative OCD was 15 cases(33.3%) in control group and 9 cases(20%)in observation group; MMSE scores showed that the incidence of postoperative OCD was 15 cases(33.3%) in control group and 9 cases(20%)in observation group; PQRS score showed the OCD incidence was significantly higher than MMSE scores.3) Western blotting results showed that the concentration of PI3K, pAKT, Bcl decreased in the two groups of T1, T2, T3, and T4 compared with the T0, while the Bax levels rose. The iconic protein concentration change trend of every time point of the control group was more obviously than the observation group, the differences were statistically significant (P<0.05). Conclusion:The effect of Xingnaojing on cognitive function in elderly patients before or after Stroke is clear, the impact mechanism may be related to the mediation on iconic protein expression levels of PI3K/AKT signal pathway.