Association Between Proton-Pump Inhibitors and Dementia?

Summary and Comment |
May 19, 2016

Association Between Proton-Pump Inhibitors and Dementia?

  1. Allan S. Brett, MD

An observational study that suggested this association has considerable limitations.

  1. Allan S. Brett, MD

In February 2016, a study that linked proton-pump inhibitors (PPIs) to dementia was published online and attracted considerable media attention. Because patients who use PPIs continue to ask their physicians about this presumed dementia risk, we thought it worthwhile to revisit the study (the original article now has been published in print).

Drawing from an insurance claims database, researchers compared older (age, ≥75) regular PPI users (≈3000) with older PPI nonusers (≈71,000); patients had no history of dementia at baseline. During about 6 years of follow-up, risk for a new diagnosis of dementia was significantly higher among PPI users than among nonusers (hazard ratio, 1.44).

Comment

Media coverage of this study did not adequately emphasize that most observational studies — including this one — do not establish cause and effect. One problem is that the researchers controlled for only a few potentially confounding variables; they did not control for alcohol use or cigarette smoking, which could be associated with both PPI use and propensity for dementia. Additionally, type of dementia was not specified for most patients. Patients who take PPIs for valid reasons (e.g., those with peptic ulcer or severe reflux symptoms, and those who take PPIs for guideline-recommended ulcer prophylaxis) should not stop taking the drugs because of this study. However, this study — and others that raise concerns about various potential adverse effects — might motivate patients who take PPIs for no good reason to discontinue them.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (4)

AntiMD

It could easily be that it is not the proton pump inhibitors that cause dementia, but rather endoscopy examinations that many people with digestive problems are told to undergo.

Endoscopy / gastroscopy is touted by doctors as a "safe" and "routine" procedure, but in reality it is an extremely invasive and risky ordeal, that often causes major damage to the person's body, health and psychological state. Same goes for the "sedation" concoction the medicos use to keep the patients still, obedient, erase the memory of the procedure and thus avoid any complaints.

Theresa Chinnery, PhD Neuropsychologist Other Healthcare Professional, Other, ThedaCare

for Jerry: study funded by the National Institute on Aging showed that the MIND diet, which combines components of the MED and DASH diets, lowered the risk of AD by as much as 53% in participants who adhered to the diet rigorously, and by about 35% in those who followed it moderately well. Morris’ team followed the food intake of 923 Chicago-area seniors. Over 4.5 years, 144 participants developed Alzheimer’s disease. The longer people had followed the MIND diet patterns, the less risk they appeared to have. (MIND diet associated with reduced incidence of Alzheimer's disease. Morris, Martha Clare et al. (2015) Alzheimer's & Dementia: The Journal of the Alzheimer's Association , Volume 11 , Issue 9 , 1007 - 1014)

victor kantariya Physician, Family Medicine/General Practice

PPIs and risk of Dementia? Decreased acid secretion in the presence of PPI therapy theoretically would decrease vitamin B12, vitamin D absorption. However, laboratory values of biomarkers showed no changes over time( Aliment Pharmacol Ther. 2015). Future work is needed. Victor Kantariya, MD

Jerry Amos Other, Family Medicine/General Practice, Home

Prevention: "..the risk of getting (Alzheimer's) was 330% greater among people whose blood folic acid levels were in the lowest one-third range and 450% greater when blood homocysteine levels were in the highest one third” Folic acid level is an indicator of significant vegetable intake. Homocysteine level is an indicator of significant animal food intake instead of vegetables. There’s a lot more detail and references in The China Study" (2006) p. 217 by Cornell nutritional biochemist prof. T. Colin Campbell. Some people won't change life style example smokers. Please inform the rest of us what can be done for prevention.

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