Cognitive dysfunction (CD) is pervasive in individuals who have chronic spinal cord injuries (SCI). Although classically associated with concomitant traumatic brain injuries, many other causes have been proposed, including premorbid neuropsychological conditions, mood disorders, substance abuse, polypharmacy, chronic pain and fatigue, sleep apnea, autonomic dysregulation, post-intensive care unit syndrome, cortical reorganizations, and neuroinflammation. The consequences of CD are likely widespread, affecting rehabilitation and function. CD in those with SCI should be recognized, and potentially treated, in order to provide the best patient care.