ACE and Alzheimer disease: AD patients with hypertension exhibit worse cognitive function (on the AD assessment scale-cognitive subscale, P = 0.038) and a higher burden of neuropsychiatric symptoms (on the neuropsychiatric inventory questionnaire, P = 0.016) than those without hypertension.228 As an antihypertensive medication, ramipril is a specific angiotensin-converting enzyme inhibitor; however, ramipril was tested and failed in a pilot clinical trial.229