Neurodegeneration caused by aging is an important reason for cognitive dysfunction in the elderly. With a small volume and membrane‑like structure, exosomes can penetrate the blood‑brain barrier and spread to the whole brain or enter the peripheral circulation to transmit material information. This paper focuses on the mechanism of exosomes in regulating the aggregation of amyloid β‑protein (Aβ) and tau proteins, microRNA (miRNA), and neuroinflammation in the aging brain with cognitive dysfunction. The clinical application and prospect of exosomes in geriatric cognitive dysfunction diseases were also elaborated, which provided support for exosomes as a new delivery vector for brain‑targeted nano therapy to provide new ideas for the pathogenesis, prevention, and treatment of geriatric cognitive dysfunction diseases.