Background: The self-perception of health can approach several aspects of physical health, cognition and functional abilities. Objective: To compare elderly subjects wit and without evidence of cognitive decline in relation to health self-perception and socio-demographic variables, highlighting the variables associated with positive or negative health self-perception in these groups. Methods: Ninety eight community-dwelling subjects were assessed in this study. Cognitive and functional abilities were tested using the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), the Blessed Dementia Scale (BDS), and the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE). Self-perception of health evaluation was performed with the use of an adapted questionnaire of the Brazil Old Age Schedule. Results: Twenty-six subjects (26%) had evidence of cognitive decline in this sample. Negative health self-perception and lower levels of physical and leisure activity were significantly associated with cognitive decline in this sample (p = 0.006, p = 0.05, p = 0.03, respectively). In the group of subjects without evidence of dementia, history of cerebrovascular disease was associated with negative health perception. Discussion: Dementia was associated with worse health self-perception evaluation. In addition, elders with evidence of dementia and good health self-perception evaluation had higher IQCODE scores, suggesting lack of judgment regarding health status.