Glioblastoma (GBM) is the most common primary brain tumor in adults, with an increasing incidence in patients aged 75 through 85. Prognosis in these patients is particularly dismal due to more aggressive tumor biology, lower functional reserve and high prevalence of comorbidities. Many studies report cognitive impairment in GBM patients, ranging from 29 to 90%. This study was aimed at evaluating neurocognitive status and comorbidities of an elderly population with high grade glioma and the correlation with clinical and demographical variables. Patients underwent an extended neuropsychological evaluation with a battery of standardized tests on 8 cognitive domains: global function (GF); verbal learning (VL); short and long-term memory (STM); executive functions (EF); abstract reasoning (AR); attention (ATT) and visuo-constructional abilities (CA). Moreover, the Cumulative Illness Rating Scale was administered to each patient for comorbidities evaluation. We assessed 69 patients with median age at diagnosis of 74 years (range 65–85). 43 patients (62%) presented multi-domain cognitive impairment, and only 8 (12%) showed no cognitive impairment. Neuropsychological deficit mainly affected executive functions (n=42), short term memory (n=28), long term memory and attention (n=22). Patients with AR deficit had a poorer PFS and OS (p<0.001%). At the follow up, 7 out of 12 patients showed cognitive improvement, 4 resulted furtherly deteriorated and 1 patient was stable. Attention was the most affected function at follow up, while verbal learning was the most improved one. CONCLUSIONS: Our results highlight the high prevalence of cognitive deficits in patients with Glioma. Moreover, this study underlines the need to include cognitive functioning and comorbidities evaluation in the assessment of elderly neuro-oncological patients.