A cross sectional study was conducted in a group of 317 subjects older than 60 in Malaysia, aimed to determine risk factors associated with cognitive impairment in older adults, focusing on trace elements and DNA damage. Cognitive decline was determined by Montreal Cognitive Assessment (MoCA). Oxidative stress markers (malondialdehyde-MDA and superoxide dismutase-SOD) were determined and DNA damage was assayed using Alkaline Comet Assay. Toenail samples were taken and analyzed using ICP-MS to determine trace element levels. A total of 62.1 % of subjects had cognitive impairment. Subjects with cognitive impairment had significantly higher levels of MDA and DNA damage as compared to the group with normal cognitive function; MDA (2.07 +/- 0.05 nmol/L vs 1.85 +/- 0.06 nmol/L) (p < 0.05) and DNA damage (% Tail Density, 14.52 +/- 0.32 vs 10.31 +/- 0.42; Tail Moment, 1.79 +/- 0.06 vs 1.28 +/- 0.06) (p < 0.05 for all parameters). However, the level of SOD among subjects with cognitive impairment (6.67 +/- 0.33 u.e/min/mg protein) was lower than the level among those with normal cognitive functions (11.36 +/- 0.65 u.e/min/mg protein) (p < 0.05). Multiple logistic regression revealed the predictors for cognitive impairment among the subjects were DNA damage (Adjusted odd ratio [OR], 1.37; 95% confidence interval [CI], 1.18-1.59), level of trace elements in toenails namely, lead (OR, 2.471; CI, 1.535-3.980) and copper (OR, 1.275; CI, 1.047-1.552) (p < 0.05). High levels of lead and copper can lead to increase in oxidative stress levels and are associated with DNA damage that eventually could be associated with cognitive decline.