People exposed to the 1944–1945 Dutch famine in early gestation performed worse on a selective attention task at age 58 and reported more cognitive problems at age 72. We here hypothesized that undernutrition in early gestation is associated with poorer cognitive functioning in older age and a higher rate of cognitive decline. We tested this hypothesis in the Dutch famine birth cohort in men and women combined and separately. We assessed cognitive function using a Stroop-like, trail-making and 15-word task (at ages 68 and 74) and the Montreal cognitive assessment as well as self-perceived cognitive problems (at age 74) in 73 men ( n = 34) and women ( n = 39). We compared cognitive function and decline (change in cognitive function between age 68 and 74) between those exposed in early gestation and those not exposed (born before or conceived after the famine). Although in both men and women cognitive function declined from age 68 to 74, cognitive task scores and the rate of decline did not differ between those exposed or unexposed to famine. At age 74, men exposed to famine in early gestation more often reported cognitive problems, although this was not statistically different from unexposed men (OR 3.1 [95%CI 0.7 to 13.0]). We did not find evidence of increased cognitive decline after prenatal undernutrition. Selective participation and mortality may have hampered our ability to detect potential true effects. The self-perceived cognitive problems among men who had been exposed to famine in early gestation might be an indication of future dementia risk.