Background: High plasma total homocysteine has emerged as a new risk for cognitive decline with age. Objectives: The aim of the present study was to examine the association of plasma homocysteine with cognitive performance in normal aged Egyptians. Subject and Methods: Forty five aged Egyptians subjects were included in the study. Their cognitive performance was assessed using Mini-Mental State Examination MMSE, Addenbrooke’s cognitive examination (ACE) and Clinical Dementia Rating (CDR) scale. Total plasma homocysteine level in fasting blood samples was also measured. Results: A statistically significant negative association was detected between plasma homocysteine level and age. A statistically highly significant inverse association was found between plasma tHcy and scores of cognitive assessment in aged subjects after adjustment for age, gender, education years and cardiovascular risk factors. No significant association was detected between total plasma homocysteine level and sex, blood sugar or lipid profile (p≥0.05). Conclusion: Elevated tHcy level is an independent risk factor for the decline of cognitive performance in normal elderly subjects.