Abstract Background Cognitive impairment (CI) in the elderly is a growing worldwide public health problem. Symptomatic CI is under-diagnosed, even though early detection in dementia care is of great significance and allowing the person to be involved in future care planning. Objectives To measure the prevalence of CI among elderly patients attending primary health care centers in Elsharabya, Egypt and to identify different risk factors associated with CI. Methods A cross-sectional study was performed among 154 elderly using an interview questionnaire including socio-demographic data, Saint – Louis – University – Mental – Status (SLUMS), Test your memory (TYM)) and General practitioner Assessment of Cognition (GPCOG) questionnaires. Results 51.3% of the studied elderly suffered from mild CI compared to 32.5% suffered from marked CI by SLUM. 68.8% suffered from CI by TYM. 83.3% and 13.0% of them were classified as CI by patient assessment and caregiver interview of GPCOG respectively. The most significant factors associated with CI were being older, non-married, and low educational levels. Conclusions and Recommendations The prevalence of CI is high among the studied elderly. Early identification of CI is important to delay the progression to Alzheimer’s disease and achieve a better quality of life.