Cognitive impairment is often not properly managed, which may lead to complications such as Alzheimer’s disease, sleep disorders, depression, increased risk of falls, difficulty in decision making, decreased quality of life, and increased mortality risk. This study aimed to identify cognitive impairment among elderly patients undergoing hemodialysis. This study used a descriptive quantitative design. A total of 101 respondents were selected using a total sampling technique. The inclusion criteria were patients who routinely underwent hemodialysis twice a week, were aged ≥55 years, were conscious and oriented, and were able to read and write. Cognitive function was assessed using an electronic-based Mini-Mental State Examination (MMSE). Data were analyzed using univariate analysis and Spearman’s rank correlation test. Spearman’s correlation was selected because the numerical variables were not normally distributed. The mean age of the respondents was 62.11 years, and the mean duration of hemodialysis was 4,252 hours. Most respondents were male (55.4%), had undergone hemodialysis for more than 24 months (49.5%), and had hypertension as the most common underlying disease (55.4%). Most respondents had normal cognitive function (76.2%). Spearman’s rank correlation analysis showed a significant negative correlation between age and MMSE score (rₛ = −0.241, p = 0.015) and between hemodialysis session duration and MMSE score (rₛ = −0.198, p = 0.047). In contrast, the length of undergoing hemodialysis was not significantly correlated with MMSE score (rₛ = 0.123, p = 0.222). Age and hemodialysis session duration were significantly associated with cognitive function, whereas the length of undergoing hemodialysis was not significantly associated with MMSE scores. Periodic cognitive ass essment should therefore be considered, particularly among older patients and those undergoing longer hemodialysis sessions.