ScopeDiets rich in polyphenols has been associated with better cognitive performance. The aim of this study is to assess the relationship between microbial phenolic metabolites (MPM) in urine and cognition in the context of an older population at high cardiovascular risk.Methods and resultsA cross‐sectional analysis is conducted in 400 individuals of the PREDIMED‐Plus study. Liquid chromatography coupled to mass spectrometry is used to identify urinary MPM. Mediterranean diet (MedDiet) adherence is estimated with a 17‐item questionnaire and cognitive function is evaluated with a battery of neuropsychological tests. Multivariable‐adjusted linear regression models are fitted to assess the relationship of urinary MPM with the MedDiet and cognitive tests. Protocatechuic acid and enterolactone glucuronide are associated with higher adherence to the MedDiet. Regarding cognitive function, protocatechuic acid, vanillic acid glucuronide, 3‐hydroxybenzoic acid, enterodiol glucuronide, and enterolactone glucuronide are directly associated with a global composite score of all the cognitive tests. Furthermore, protocatechuic acid and enterolactone glucuronide are associated with higher scores in the Mini‐Mental State Examination, whereas enterodiol glucuronide is associated with improved Clock Drawing Test scores.ConclusionsThese results suggest that the MedDiet is linked to MPM associated with better cognitive performance in an older population.