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<b>Background</b>: Frailty, a state of increased vulnerability, could play a role in the progression of vascular dementia. We aim to describe the changes in cerebrovascular reactivity of older adults with frailty and vascular-type mild cognitive impairment (MCIv). <b>Methods</b>: This was a cross-sectional study. A comprehensive geriatric assessment, neuropsychological evaluation, and transcranial Doppler ultrasound (TCD) was performed on 180 participants who were allocated into four groups: healthy (<i>n</i> = 74), frail (<i>n</i> = 40), MCIv (<i>n</i> = 35), and mixed (frail + MCIv) (<i>n</i> = 31). ANOVA and Kruskal&#8722;Wallis tests were used for the analysis of continuous variables with and without normal distribution. Multinomial logistic regression was constructed to identify associated covariates. <b>Results</b>: Subjects in the mixed group, compared to healthy group, were older (75.0 &#177; 5.9 vs 70.3 &#177; 5.9 years; <i>p</i> &lt; 0.001), showed lower education (9.3 &#177; 6.4 vs 12.2 &#177; 4.0 years; <i>p</i> = 0.054), greater frequency of diabetes (42% vs 12%; <i>p</i> = 0.005), worse cognitive performance (z = &#8722;0.81 &#177; 0.94), and reduced left medial-cerebral artery cerebrovascular reactivity (0.43 &#177; 0.42 cm/s). The mixed group was associated with age (odds ratio (OR) 1.16, 95% Confidence Interval (CI) = 1.06&#8722;1.27; <i>p</i> &lt; 0.001), diabetes (OR 6.28, 1.81&#8722;21.84; <i>p</i> = 0.004), and Geriatric Depression Scale (GDS) score (OR 1.34, 95% CI = 1.09&#8722;1.67; <i>p</i> = 0.007). <b>Conclusions</b>: Frailty among older adults was associated with worse cognitive performance, diabetes, and decreased cerebral blood flow.