Background: Cognitive impairment is a growing concern in aging populations, particularly in developing countries like India. Early identification is crucial for timely intervention and improved quality of life. The Mini-Mental State Examination (MMSE) is a practical tool for screening cognitive dysfunction in outpatient settings. Objectives: To determine the prevalence of cognitive impairment in elderly patients attending the Neurology Outpatient Department (OPD) at the Atal Institute of Medical Super Specialities (AIMSS), Shimla, using the MMSE and to identify associated demographic and clinical risk factors. Methods: A cross-sectional study was conducted over a 3-month period (January–March 2024) at the Neurology OPD of AIMSS Shimla. A total of 180 patients aged ≥60 years were evaluated using a structured questionnaire and the MMSE. Cognitive impairment was defined as an MMSE score <24. Data was analyzed using SPSS Version 25. Chi-square test and logistic regression were applied to determine associations. Results: Of the 180 participants, 62 (34.4%) exhibited cognitive impairment. Among them, 45 (25%) had mild impairment and 17 (9.4%) had moderate to severe impairment. Significant associations were found between cognitive impairment and advanced age (p<0.01), low education level (p<0.01), hypertension, and past history of stroke (p<0.05). Conclusion: Over one-third of elderly patients attending the Neurology OPD at AIMSS Shimla showed signs of cognitive impairment. Routine screening using MMSE is feasible and essential in outpatient neurology settings to facilitate early detection and intervention.