Background: Peripheral Artery Disease (PAD), a manifestation of systemic atherosclerosis, has been linked to cognitive impairment. However, evidence within the Indonesian geriatric population remains limited and has yielded conflicting results. This study aimed to determine the association between PAD and cognitive impairment in geriatric patients at a national referral hospital in Indonesia. Methods: A cross-sectional study was conducted involving 130 geriatric patients at Cipto Mangunkusumo National General Hospital from January to March 2025. PAD was diagnosed using the Ankle-Brachial Index (ABI), and cognitive function was assessed with the Mini-Mental State Examination (MMSE). A multivariate logistic regression analysis was performed to evaluate the association between PAD and cognitive impairment after controlling for relevant confounders. Results: Of the 130 participants (52.3% female), 61 (46.9%) were diagnosed with PAD. The prevalence of cognitive impairment was significantly higher in patients with PAD. After adjusting for key confounders, including history of stroke and hypertension, PAD remained a significant and independent predictor of cognitive impairment. Patients with PAD had a 2.69 times greater likelihood of having cognitive impairment compared to those without (adjusted Prevalence Ratio [PR] 2.69; 95% CI 1.28–5.68; p = 0.009). Conclusion: PAD is a significant and independent predictor of cognitive impairment in this cohort of Indonesian geriatric patients. The ABI is a valuable, non-invasive clinical tool that can help identify older adults at an increased risk for cognitive decline, highlighting the importance of integrated vascular and cognitive screening in this population. © The Author(s) 2026.