Little is known about which cognitive functions underlie the new Visual Puzzles subtest of the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV). The purpose of this study was to investigate relationships between Visual Puzzles and common neuropsychological measures in a mixed clinical sample. A total of 44 veterans (75% men) were administered the WAIS-IV as part of a neuropsychological evaluation. Average age was 47.4 years (SD = 11.8), and average education was 13.8 years (SD = 2.3). Correlations were conducted to examine relationships between Visual Puzzles, demographic variables, and neuropsychological measures. Hierarchical regression analysis was used to determine which measures contributed the most variance to Visual Puzzles. Visual Puzzles correlated significantly with measures of visuospatial reasoning, verbal learning and recall, mental flexibility, processing speed, and naming, which accounted for 50% of the variance in Visual Puzzles performance. The results indicate that Visual Puzzles is not a pure measure of visuoperceptual reasoning, at least in a mixed clinical sample, because memory, mental flexibility, processing speed, and language abilities also contribute to successful performance of the task. Thus it may be important to consider other aspects of cognitive functioning when interpreting Visual Puzzles performance.