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The aim of this study was to investigate cognitive performance for the first time in participants with nonalcoholic fatty liver disease (NAFLD) using the Montreal Cognitive Assessment (MoCA).In total, 70 participants with NAFLD and 73 age-matched and sex-matched healthy participants were enrolled in this prospective cross-sectional study. The diagnosis of NAFLD was made on the basis of abdominal ultrasonography findings. Anthropometric indices were calculated, and routine laboratory analyses were carried out for each participant. All participants provided sociodemographic data and completed the Beck Depression Inventory-II. Cognitive functions were evaluated using the Turkish version of the MoCA, with a cut-off score for mild cognitive impairment of less than 21 points.The MoCA scores were significantly lower in participants with NAFLD than in the healthy group (P<0.05). In addition, more NAFLD participants than healthy participants presented with deficits in the visuospatial (P<0.05) and executive function domains (P<0.05). In the multivariate model, education level [2.79 (1.12–6.96); P<0.05] and area of residence [5.68 (2.24–14.38); P<0.001] were associated independently with cognitive dysfunction in both the NAFLD and the healthy groups. The MoCA scores were correlated negatively with fibrosis 4 scores in NAFLD participants (r=−0.359; P<0.05). However, hepatosteatosis grade and the presence of metabolic syndrome were not correlated with MoCA scores in the NAFLD group (P>0.05).Our results show that NAFLD patients may have early or subtle cognitive dysfunction, including in the visuospatial and executive function domains, as indexed by scores on the MoCA test. Further targeted psychometric testing will be required to confirm the presence of cognitive impairment in this population.