The treatment of silted sediment in the river is a global problem. The accumulation of waste sediment will lead to an adverse impact on the environment. In this paper, the silted sediment was reused to produce geopolymer composite materials via alkali-activated gelling modification. The effects of the modifiers of sodium silicate solution, quicklime, and Na2SO4 admixture, and the dosage of the slag, fly ash, and silica fume admixture, and curing conditions and age, on the compressive strength and microstructure of the geopolymer-modified sediment materials were studied. The crystalline phase and hydration products of the modified sediment geopolymer composites were analyzed by X-ray diffraction (XRD) and scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS), respectively. A compressive strength test was conducted to evaluate the mechanical properties of the composites. The results showed that the type and dosage of modifier, amount of mineral admixture additive, cure conditions, and cure age had significant effects on the mechanical properties of the composites. The effect of the addition of mineral admixture on the compressive strength of the modified sediment specimens was more noticeable than that of the modifier. The compressive strength of the geopolymer-modified specimens was greatly increased by the addition of mineral dopants. When 10 wt.% silica fume is added, the compressive strength reaches a maximum value of 33.25 MPa at 60 days. The SEM-EDS results show that the C-S-H gels and C-A-S-H gels were the main hydration products. The results indicate that river siltation sediment is an excellent raw material for geopolymer-modified materials. It is feasible to produce reliable and sustainable hydraulic engineering materials by using river sediment geopolymer-modified materials.