Background: Prevalence of cognitive impairment and dementia has not been studied in Bulgaria up to date. A 2-phase cross-sectional study was designed in order to determine the prevalence of dementia, its subtypes, and mild cognitive impairment in a Bulgarian population. Methods: The study sample consisted of 605 participants over the age of 65, residents of the city of Varna. A total of 540 participants (89%) completed the screening phase of the study. All positive screens and a control group were included in the diagnostic phase of the study, where comprehensive neuropsychological, clinical, and imaging assessments were performed. Results: Dementia was diagnosed in 39 persons (7.2%) and 36 had mild cognitive impairment (6.7%). Alzheimer’s disease was the most frequent type of dementia (3.1%), followed by vascular dementia (2.0%). Discussion: Our results support the hypothesis that prevalence of vascular cognitive impairment may be higher in Bulgaria than in most European countries.