Background: Recent studies suggested that the visceral fat could exert a predictive role in the pathogenesis of dementia. The aims of the present study were to evaluate a) the possible correlation between the epicardial adipose tissue (EAT) thickness and the cognitive impairment; b) the possible predictive role of the EAT levels on cognitive functioning. Methods: 65 community-dwelling subjects were enrolled. The metabolic proﬁle was assessed through the evaluation of the biochemical parameters whereas the EAT thickness was measured through the transthoracic echocardiography. The Mini Mental State Examination (MMSE) was also administered. Results EAT thickness values showed several significant correlations with the variables examined in the study and a strong negative correlation with the MMSE scores (r= -.68; p=.001) was found. The multiple linear regression analysis showed that the EAT thickness levels and the hypertension had a predictive effect on the MMSE scores. Conclusions These preliminary findings support the association between EAT thickness levels and cognitive impairment.