HMG-CoA reductase inhibitors ("statins") are commonly prescribed for the treatment of dyslipidemia and prevention of any complications arising from this disease. The Food and Drug Administration recently published enhanced warnings for statin use, including the possible relationship between statins and cognitive impairment, especially in the elderly. Significant cognitive decline associated with statin use in elderly patients with Alzheimer's disease has also been reported recently. However, the 2013 American College of Cardiology/American Heart Association blood cholesterol guidelines stated that no evidence is available supporting the conclusion that statins cause an adverse effect on cognition or risk of dementia. Because of the increasing number of elderly patients with dementia, this relationship needs to be examined. This article will review cognitive changes associated with statin use in elderly patients with dementia and offer clinical recommendations.