Objective: Relationship between masticatory function and cognitive impairment had been suggested but still understudied. We investigated the association between chewing ability and cognitive impairment among the elderly living in a rural region. Methods: A total of 295 elderly individuals aged >= 70 years in a rural city of Korea participated in a cross-sectional study. Trained nurses conducted interviews and assessed chewing ability using gum that changed color based on chewing performance. Cognitive impairment was assessed using the Mini-Mental State Examination for Dementia Screening (MMSE-DS) of Korean vesrsion. Socio-demographic characteristics, activities of daily living (ADL), Mini-Nutritional Assessment (MNA) were also assessed using questionnaires as potential confounders. Results: The mean age of the participants was 81.4 (ranged 70-102) years and 67.8% of them were female. Participants with low chewing ability were significantly older, dependent, and had lower MNA and MMSE-DS scores. The elderly with middle or low chewing ability had significantly higher risk for having cognitive impairment than those with higher chewing ability. Conclusion: Our findings suggest that poor chewing ability is associated with cognitive impairment or dementia in the elderly living in rural area. (C) 2017 Elsevier B.V. All rights reserved.