Metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition affecting a significant global population. Beyond its primary impact on liver function, MAFLD/MASLD is associated with a range of extrahepatic manifestations, including cognitive impairment. This review highlights the escalating concern over cognitive impairment in individuals with MAFLD/MASLD, which can manifest as compromised executive function and global cognitive decline. The underlying mechanisms involve insulin resistance, lipotoxicity, systemic inflammation, and other factors that contribute to the intricate pathophysiology of MAFLD/MASLD. The review synthesizes available evidence, explores potential mechanisms, and assesses clinical implications to contribute to a more comprehensive understanding of the impact of MAFLD/MASLD on cognitive function. Key risk factors, such as metabolic syndrome, are discussed, along with the interplay between the gut-brain-liver axis and its implications for cognitive health. The review also examines neurological manifestations, challenges in assessment, and potential treatments, emphasizing the need for integrated care approaches to address the complex interplay between metabolic and cognitive health.Metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition affecting a significant global population. Beyond its primary impact on liver function, MAFLD/MASLD is associated with a range of extrahepatic manifestations, including cognitive impairment. This review highlights the escalating concern over cognitive impairment in individuals with MAFLD/MASLD, which can manifest as compromised executive function and global cognitive decline. The underlying mechanisms involve insulin resistance, lipotoxicity, systemic inflammation, and other factors that contribute to the intricate pathophysiology of MAFLD/MASLD. The review synthesizes available evidence, explores potential mechanisms, and assesses clinical implications to contribute to a more comprehensive understanding of the impact of MAFLD/MASLD on cognitive function. Key risk factors, such as metabolic syndrome, are discussed, along with the interplay between the gut-brain-liver axis and its implications for cognitive health. The review also examines neurological manifestations, challenges in assessment, and potential treatments, emphasizing the need for integrated care approaches to address the complex interplay between metabolic and cognitive health.