This study first investigated whether common complex diseases mediate the associations between self-rated health and cognitive abilities. Second, the genetic and environmental mediation of these relationships was explored using bivariate quantitative genetic analyses. Slight evidence was found that associations between self-rated health and cognitive test scores were mediated by chronic diseases. In the younger age group (< 67 years) associations between self-rated health and spatial reasoning and perceptual speed were mediated by both genetic and environmental factors. In the oldest age group (≥ 67 years), associations between self-rated health and verbal ability, spatial reasoning, perceptual speed and visual memory were entirely due to genetic factors.