Proton pump inhibitor use and risk of dementia

Abstract

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Clinical Use of Acid Suppressants and Risk of Dementia in the Elderly: A Pharmaco-Epidemiological Cohort Study

“…The findings of the present study are in agreement with prior longitudinal studies that the use of H2RA was a risk factor for subsequent cognitive decline or dementia [10,16,17]. Similarly, the results of epidemiological studies on the association of PPI use with dementia risk have been inconclusive [20][21][22][23][24][25][26][27][28][29][30][31]. Several epidemiological studies reported a detrimental impact of PPIs in increasing the risk of dementia and Alzheimer's disease [20][21][22][23].…”

“…Several epidemiological studies reported a detrimental impact of PPIs in increasing the risk of dementia and Alzheimer's disease [20][21][22][23]. However, a number of epidemiological studies [28,29] and meta-analyses [25,27,30] point toward a null association between PPI use and dementia risk. Of note, a case-control study on risk factors of dementia observed that PPIs were associated with a decreased risk of developing dementia [31].…”

“…Vitamin B 12 deficiency has been shown to be associated with cognitive decline [19]. However, the results of epidemiological studies on the association of PPI use with cognitive impairment, such as dementia, have shown inconsistent conclusions [20][21][22][23][24][25][26][27][28][29][30][31]. Several cohort studies indicated that PPIs were associated with an increased risk of dementia [20][21][22][23], whereas a case-control study reported that PPIs reduced the risk of dementia [31].…”

“…Several cohort studies indicated that PPIs were associated with an increased risk of dementia [20][21][22][23], whereas a case-control study reported that PPIs reduced the risk of dementia [31]. More recent studies point towards a null association between PPI use and dementia risk [25][26][27][28][29][30]. Given these discrepant results and the importance of maintaining adequate cognitive function in elders, the objectives of the present study were to examine the longitudinal associations of the use of acid suppressants, including H2RAs and PPIs, with incident dementia in a cohort of Asian elderly population, given the shared clinical indications between H2RAs and PPIs.…”

Epidemiology of Gastrointestinal Diseases

“…Initially, it was thought that PPIs could inhibit the action of antiplatelet drug clopidogrel and increase cardiovascular events; however, this assertion has not been confirmed in most subsequent observational studies and randomized controlled trials (Laine and Hennekens 2010;Bhatt et al 2010). Moreover, several harms have been linked to the longterm use of PPI therapyenteric infections (e.g., Clostridium difficile) (Leonard et al 2007;Dial et al 2005), micronutrient deficiencies (e.g., vitamin B12, calcium, magnesium) (Liao et al 2019), fractures (Hussain et al 2018), renal dysfunction (Lazarus et al 2016), dementia (Li et al 2019), and pneumonia (Herzig et al 2009). Despite a plausible explanation for each of these health consequences, current epidemiologic evidence is biased and not supportive of causality, including retrospective studies, use of pharmacy claim databases, inconsistent results, weak associations (odds ratios <2), and residual confounding (Kanno and Moayyedi 2019;Vaezi et al 2017).…”