A new study suggests that seniors who take a popular class of medications to treat gastroesophageal reflux disease (GERD) and peptic ulcers may be at an increased risk for dementia. The research, published online Feb. 15 in JAMA Neurology, found that people 75 or older who used proton pump inhibitors (PPIs) were 44 percent more likely to develop dementia than those who did not take the drugs.
PPIs such as Prilosec (omeprazole), Nexium (esomeprazole) and Prevacid (lansoprazole) work by reducing the amount of acid in the stomach. Available in prescription and over-the-counter doses and linked to a higher risk of chronic kidney disease and bone fracture, the drugs are used by a growing number of older patients.
Because of the increased use of PPIs by the elderly, researchers led by Britta Haenisch, PhD, of the German Center for Neurodegenerative Diseases, Bonn, Germany, examined the association between the use of proton pump inhibitors and the risk of dementia. Using data collected from 2004 to 2011 by a large German insurance company, the researchers analyzed inpatient and outpatient diagnoses and drug prescriptions for 73,679 people aged 75 and older. Regular use of PPIs was defined as at least one prescription in each quarter of an 18-month interval.
Among the patients, Haenisch and her colleagues identified 29,510 people who developed dementia during the study period. Of the 2,950 regular users of PPIs – mostly women with an average age of nearly 84 years – 44 percent had an increased risk of dementia when compared to those who did not take PPIs.
Although there is uncertainty as to how PPIs affect the ability to reason, the researchers suggested that the drugs appear to effect levels of amyloid beta and tau, proteins associated with Alzheimer’s disease. Regular use of PPIs can also lead to a vitamin B12 deficiency, which has been linked to cognitive decline.
Haenisch acknowledged to Reuters Health that the current study can only provide a statistical association between PPIs and the occurrence of dementia in the elderly, and that it does not prove that this class of drugs causes dementia. In addition, the researchers couldn’t know if some of the people were at an increased risk for dementia to begin with.
Haenisch advised against a rush to abandon the medications, saying that patients should take PPIs according to their doctor’s instructions. But she also cautioned doctors to avoid overprescribing the drugs, citing a study that found up to 70 percent of the drugs’ prescriptions were inappropriate for the patient.
For those who want to wean off of PPIs, Malaz Boustani, MD, professor of medicine at Indiana University’s Center for Aging Research, told HealthDay that such steps as consuming smaller meals, avoiding chocolate and caffeine, and remaining upright for a few hours after eating will help reduce excess acid or prevent acid reflux.