Cognitive performance was assessed in 107 psychiatric patients whose age exceeded 59 years and who did not carry the diagnosis of organic mental syndrome. In this sample, tardive dyskinesia (TD) was associated with greater impairment in each of the seven cognitive domains assessed. These data do not address the etiology of TD but raise questions regarding the use of antipsychotics in young patients with cognitive impairment. Insofar as TD is an expression of basal ganglia dysfunction, these data also emphasize the critical role of relatively caudal brain structures in cognition and emotional expression.