Dementia affects over 30 million people worldwide and two of the main risk factors for the development of dementia are advancing age and hypertension. Alzheimer’s disease and multi-infarct dementia often co-exist, with hypertension a major risk factor for small–vessel disease in the brain which leads to dementia. In addition, some research shows that hypertensive vasculopathy exacerbates the accumulation of beta-amyloid in the brain, possibly contributing to the development of Alzheimer’s dementia. This review concluded that there was moderately strong evidence that hypertension leads to a decline in function in the areas of the speed of processing and executive function. Hypertension is not consistently associated with a decline in memory, one of the hallmarks of Alzheimer’s. The authors conclude with two important points: 1) “There is substantial evidence that hypertension leads to cognitive impairment, an effect attributed to oxidative stress-driven cerebrovascular dysfunction and damage” and, 2) “It is unclear whether treatment prevents cognitive decline.” —Neil Skolnik, MD