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The aim of this study was to investigate the possible interrelation of serum albumin levels and cognitive function of elderly hip fracture patients. The study involved 331 elderly patients with hip fractures, admitted for rehabilitation. Cognition was assessed by Mini-Mental State Examination (MMSE). MMSE scores less than 24 points were considered suggestive of cognitive impairment. Age, serum albumin levels, and previous stroke emerged as the only statistically significant parameters differing between those with MMSE score less than 24 or higher. After adjusting for confounding variables, the middle and lowest tertiles of serum albumin levels were associated with an increased risk of cognitive impairment (odds ratio 1.97, 95% confidence interval 1.15-3.38, P < .01 vs 3.06 and 1.79-5.23, P < .001, respectively). This study shows that lower serum albumin levels are independently associated with lower MMSE scores in hip fractured elderly patients, supporting the possible role of chronic low-grade inflammation in age-related cognitive decline.