Objective: The aims of our study were to explore the impact of diabetic peripheral (DPN) and cardiac autonomic neuropathy (CAN) on cognitive functions and the association among cognitive and clinical parameters. Materials and methods. 69 T2D patients (65-90 years) were enrolled. All patients performed Michigan Neuropathy Screening Instruments, vibration and thermal perception thresholds, cardiovascular autonomic reflex tests. Patients were divided in DPN+ or DPN-. The DPN+ group was subdivided in CAN- and CAN+. Participants performed the Montreal Cognitive Assessment Test (MoCA) to screen mild cognitive impairment (MCI), and cognitive domains were assessed by Trail Making Test (TMT-A/B), Rey- Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST). Patients with dementia or depression were excluded according to the clinical dementia rating scale and the Geriatric depression scale (Data from RECOGNISED study, NCT04281186) Results: DSST was significantly lower in DPN+ group versus DPN- (27.68 vs 37.31 p=0.03). The prevalence of MCI was significantly higher in DPN+ and CAN+ group versus DPN+ and CAN- (100% vs 82.1% p=0,04), moreover MoCA became smaller in CAN+ group versus CAN- (18.75 vs 22.04 p<0.01). RAVLT (5.36 vs 9.25 p<0.01), TMT A (68.55 vs 45.13 p<0.01) and DSST (20.0 vs 38.88 p<0.01) were significantly lower in CAN+ group versus CAN-. It was observed a negative correlation between SBP delta and RAVLT (r=-0.49; p=0.01), a positive correlation between E/I, 30:15 ratio and RAVLT (r=0.49; p=0.01 and r=0.49; p=0.01) and between 30:15 ratio and DSST (r=0.54; p<0.01). Conclusion: DN have a high impact on cognitive function in T2D patients. Moreover, the association of DPN and CAN is linked with severe cognitive decline. T2D patients with DN, should be assessed for cognitive impairment.