Proton Pump Inhibitors May Increase the Risk of Dementia in the Elderly Population

Proton pump inhibitors (PPIs) are a class of medications that are commonly used in the elderly population to remedy gastrointestinal problems. This prospective cohort study in German  looks at the possible association between these medications and dementia. For the study, the inclusion criteria was at least 75 years old and no diagnosis of dementia. They defined the use of a PPI as having one prescription per quarter of the following medications: omeprazole, pantoprazole, lansoprazole, esomeprazole, or rabeprazole. Patients who only used PPIs occasionally were not included in the study.  This study also worked to analyze other factors that could contribute to the risk of dementia. Some of these factors were gender, the use of multiple prescription medications, stroke, and comorbid diagnosis with conditions such as depression, heart disease, or diabetes. The data analyzed was from 2004 – 2011.

A total of 73,679 people who met the inclusion criteria were analyzed in the study. The results of the study shows that the use of PPIs in the elderly is associated with an increased risk of dementia.  77.9% of patients who took PPIs regularly during this study had a “significantly increased risk of incident dementia”.  The study results also show that males had a higher risk of dementia with use of PPIs. The comorbid diagnosis of depression and stroke had a higher risk of dementia with the use of PPIs. Comorbid diagnosis with diabetes and the use of other prescription medication with PPIs showed a very slight increased risk of dementia. Patients using PPIs with heart disease actually had a slight decreased risk in developing dementia.

This study is important because PPIs are such a commonly used medication class, especially in the elderly population. If these medications are contributing to the onset of dementia, consideration should be given to avoid prescribing this medication in the elderly population. Additionally, this study could eventually lead to a clearer understanding of how disease states such as dementia or Alzheimer’s develop in the first place. From there, we could focus on developing medications that could help to prevent and treat these terrible conditions.

Gomm W, von Holt K, Thomé F, et al. Association of Proton Pump Inhibitors With Risk of Dementia. JAMA Neurol. doi:10.1001/jamaneurol.2015.4791. (Published 15 February 2016).

1 thought on “Proton Pump Inhibitors May Increase the Risk of Dementia in the Elderly Population”

  1. This is an interesting and eye-opening article for sure, and I think that you bring up a good thought about how this can be a starting point to see the mechanism of action of this disease. It is possible that the proton pump inhibitors are working elsewhere in the body to allow this process to occur. Further research should be conducted to determine if in fact PPIs are causing this to occur. If so, it would be our job as pharmacists to counsel the patient accordingly about the risks of PPIs if they are over the age of 75, or to determine if there is another drug therapy that could reduce their GI symptoms. It also makes me wonder if long-term use of PPIs would eventually lead to dementia before the age of 75? Physiology changes as one ages, so is it this physiological change that is creating the susceptibility to dementia? I’m intrigued as to what this study will determine in the future for prescribing and the health of older adults taking PPIs.

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