- A study has found a link between certain acid reflux medications and higher dementia risk.
- People who took proton pump inhibitors longer than four-and-a-half years were at greater risk.
- However, the study could not prove whether PPIs actually cause cognitive decline.
- Experts note that it could simply be a coincidence since older people are more likely to be using PPIs.
- However, they say there are several alternatives to using PPIs for those who are concerned about the risk.
A study published online on August 9, 2023, in the journal Neurology, the medical journal of the American Academy of Neurology, reports that popular acid reflux medications called “proton pump inhibitors” (PPIs) have been linked with a higher risk for dementia.
The association existed in people who took the medication for four-and-a-half years or more.
PPIs include medications like:
These drugs work by causing acid-forming cells in the stomach to reduce the amount of acid they are producing.
Dementia is an umbrella term that refers to conditions like Alzheimer’s disease where abnormal changes occur in the brain that affect people’s ability to think. Dementia can cause serious impairment to people’s day-to-day functioning and behavior.
The authors do note, however, that this study does not prove that PPIs cause dementia. It simply indicates that there may be some sort of relationship between the two.
There were 5,712 people, aged 45 and up, who took part in the study. No one had dementia when the study began.
The researchers reviewed what medications people were taking during study visits and annual phone calls, finding that 26% of them had taken PPIs.
The study participants were divided into the following four groups:
- those who had not taken PPIs
- those who had taken them for up to 2.8 years
- those who had taken them for 2.8 to 4.4 years
- those who had taken them for more than 4.4 years
The groups were then followed for a median of 5.5 years. Over the course of the study, 10% of people developed dementia.
When looking at those who took PPIs for more than 4.4 years, there were 24 cases of dementia per 1,000 person-years among the group who took PPIs. This was in comparison with 19 cases per 1,000 person-years in the group who abstained from PPI use.
After the team adjusted the data for various demographic and health factors, they found PPI users who had taken the drugs for over 4.4 years had a 33% higher risk of developing dementia in comparison to those who never took the drugs.
However, they did not find any association in those people who took PPIs for shorter amounts of time.
Dr. Thanu Jey, Medical Director & Founder at MediBrace, who was not involved in the study, emphasized that the study does not prove cause and effect.
“These results need to be confirmed, and more study is needed to comprehend the underlying mechanisms,” he said.
Jey added, however, that it might have something to do with how PPIs affect how nutrients are absorbed.
“PPIs may alter nutrient absorption, notably by lowering levels of vitamin B12, which is essential for brain health, which could be one explanation for this connection.
“PPIs may also lead to an increase in the formation of the protein beta-amyloid, which is linked to Alzheimer’s disease,” he explained.
But, it could simply be a coincidence, according to Dr. Robert Alesiani, Chief Pharmacotherapy Officer at Tabula Rasa HealthCare.
According to Alesiani, PPIs are quite widely prescribed, especially among older adults. Where about 18% of the general population uses a PPI, this number triples to 55% by the time people reach the age of 65.
“As a majority of all dementia patients are diagnosed after 65 years of age and one can assume that over half of those patients are also taking a PPI, there is a high likelihood that someone diagnosed with dementia, after the age of 65 is also taking a PPI,” Alesiani said. “It doesn’t mean the PPI was responsible.”
Alesiani went on to say that older adults often have comorbidities, like heart, lung, kidney, and metabolic issues.
“Many of these illnesses may require medications for treatment, some of which could increase the risks of dementia,” he said.
In the meantime, if you’d like to decrease your reliance on PPIs, Alesiani said there are alternatives.
Rather than using a PPI, you could use a different type of medication called an “H2 antagonist,” which reduces acid production in a different way.
One example of this type of medication is famotidine (Pepcid), he explained.
You could alternatively use liquid or chewable antacids like Mylanta or Tums.
Alesiani said there are also certain lifestyle modifications that you can make to deal with excess stomach acid, including the following:
- Avoiding foods that trigger your symptoms
- Not eating too close to bedtime
- Not eating too much fat or food in general so your stomach can empty more quickly and won’t become too full
- Staying away from wearing overly tight belts or waistbands that interfere with your stomach emptying
Jey agreed with Alesiani’s suggestions, adding, “It’s critical to balance the hazards and advantages of PPIs when addressing acid reflux. Based on your unique circumstances and medical background, your healthcare professional can help you make an informed choice.”
A study has found a link between certain acid reflux medications and higher dementia risk.
People who took PPIs longer than four-and-a-half years were at greater risk. However, the study could not prove whether PPIs actually cause cognitive decline.
Experts note that it could simply be a coincidence since older people are more likely to be using PPIs. However, they say there are several alternatives to using PPIs for those who are concerned about the risk.