Researchers found no association between the use of proton pump inhibitors and the risk for mild cognitive impairment, dementia and Alzheimer’s disease in a recent observational, longitudinal study.
These findings contrast with those from two recent studies that found significant associations between PPI use and dementia and Alzheimer’s disease in older patients.
“The current findings do not support that PPIs are associated with greater risk of dementia despite mechanisms proposed as to why they should be,” including higher beta amyloid levels and vitamin B12 deficiency, Felicia C. Goldstein, PhD, of the department of neurology at Emory University, and colleagues wrote. However, they emphasized that “caution needs to be exercised when speculating about the effect of PPIs on brain functioning until a randomized, prospective clinical trial elucidates the effect of PPIs on cognition.”
PPI use has increased significantly in middle-aged and older adults in the U.S., with the prevalence of prescriptions increasing from 4.9% in 1999 to 8.3% in 2012 in people aged 40 to 64 years, according to the National Health and Nutrition Examination Survey. Understanding the link between PPIs and the risk for mild cognitive impairment and dementia is thus very important, the researchers wrote.
They evaluated 10,486 volunteers within the NIH-supported Alzheimer’s Disease Centers who were aged 50 years and older and had either normal cognition or mild cognitive impairment at baseline. Participants underwent neuropsychological evaluations and self-reported PPI use at two to six annual visits between 2005 and 2015.
Overall, 884 reported they were taking PPIs at every visit, 1,925 reported they took PPIs intermittently, and 7,677 never reported taking PPIs.
Those who reported continuous PPI use showed a lower risk for cognitive function decline compared with those who never reported using PPIs (HR = 0.78; 95% CI, 0.66-0.93) as well as a lower risk for developing mild cognitive impairment or Alzheimer’s disease (HR = 0.82; 95% CI, 0.69-0.98).
Those who reported using PPIs intermittently also showed a lower risk for cognitive function decline (HR = 0.84; 95% CI, 0.76–0.93) and for developing mild cognitive impairment or Alzheimer’s disease (HR = 0.82; 95% CI, 0.74–0.91).
The lower risk applied to individuals with both normal cognition or mild cognitive impairment at baseline.
The researchers acknowledged that the study is limited by the use of patient-reported data on PPI use, but concluded their findings “do not confirm recent reports that the use of PPIs is linked to greater risk of dementia and [Alzheimer’s disease].” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.