PURPOSE: The aim of this study is to examine the risk factors of cognitive impairment in elderly hip fracture patients with no underlying neurologic disease, and to determine its effect on functional recovery postoperatively. MATERIALS AND METHODS: From August 2012 to August 2013, 39 patients older than 65 years of age, who underwent hip fracture surgery and were followed-up for a minimum of 1 year at Hallym University Sacred Heart Hospital, were enrolled. All patients were assessed using Korean version of Mini-Mental State Examination (MMSE-K) after admission. All patients were divided into cognitive normal group (MMSE-K> or =24) and cognitive impairment group (MMSE-K<24). WOMAC (Western Ontario and McMaster University) score and Harris hip score were used for assessment of functional recovery at 6-month follow-up. RESULTS: Sixteen patients (41.0%) were classified as the cognitive impairment group. The number of underlying diseases was the only statistically different factor between the two groups. In the evaluation of functional outcome, the functional decline was less in the cognitive normal group. Risk factors for cognitive impairment in elderly hip fracture patients were old age, high body mass index, and the number of underlying diseases, particularly an endocrinologic disease like diabetes. CONCLUSION: Cognitive impairment in elderly patients may have a negative effect on functional recovery after hip fracture surgery. Therefore, we recommend routine evaluation of cognitive function in elderly hip fracture patients even with no underlying neurologic disease.