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Background: Some variables, such as age, gender, regional and dialectical differences influence speech tempo. Men and younger individuals speak faster than women and the elderly. Therefore, these variations should be considered when assessing speaking rate. Objectives: Since different accents influence speaking rates and there is no previous study investigated speech tempo with respect to regional and accent differences in Iran, and given that the elderly are more prone to problems influencing speaking rate, the present study was done to compare speech tempo and speaking rate in two different accents, namely Tehrani and Semnani, and to investigate some related factors. Methods: This cross-sectional study was performed on 200 elderly women selected via convenience sampling method. Speech tempo, speaking rate, verbal fluency, and cognition scores were compared using an independent-samples t-test. Pearson’s correlation coefficient test was used to assess correlations between speaking rate and level of education, Montreal cognitive assessment (MoCA), and verbal fluency scores. Results: No significant difference was found in speech tempo between the studied accents (P = 0.13). Speaking rate was significantly slower in the Tehrani accent than the Semnani one (P = 0.04). The Tehrani elderly obtained significantly less scores in verbal fluency and MoCA ((P ≤ 0.001) and (P = 0.04), respectively. In both groups, speaking rate had a significant correlation with verbal fluency and MoCA scores but not with level of education. Conclusions: Although, our results showed no difference in speech tempo between the studied accents, the Tehrani elderly unexpectedly spoke more slowly meaning that they paused more while speaking. There was a relationship between faster speaking, better verbal fluency, and cognitive performance.