New research suggests that the use of certain drugs for gastric reflux or peptic ulcers creates an increased risk for dementia in elderly patients.
The class of drugs—proton pump inhibitors (PPIs)—includes Prevacid (lansoprazole), Nexium (esomeprazole), and Prilosec (omeprazole), HealthDay reports.
German researchers found that people 75 or older who regularly take the medications had a 44 percent increased in the risk of dementia compared with people that age not using the drugs. The study found an association, but not a cause-and-effect link, according to HealthDay. “To evaluate cause-and-effect relationships between long-term PPI use and possible effects on cognition in the elderly, randomized, prospective clinical trials are needed,” said one of the study’s authors, Britta Haenisch, from the German Center for Neurodegenerative Diseases in Bonn.
Haenisch says the study can provide only a statistical association between PPI prescriptions and occurrence of dementia in the elderly, but it cannot prove that PPIs actually cause dementia. The researchers “focused on long-term regular PPI prescription for at least 18 months.” They reviewed medical records from 2004 through 2011 for more than 73,000 patients age 75 and older, most of them women. The researchers classified 2,950 patients as regular PPI users, based on the patient having had at least one prescription for one of the drugs every four or five months over an 18-month period. The researchers looked at prescription PPIs, not the over-the-counter versions.
During the study period, 29,510 people developed dementia. Regular PPI users were 44 percent more likely to develop dementia than those not taking the drugs, according to HealthDay. The study was published online on February 15, 2016 in JAMA Neurology.
In an editorial accompanying the study, Dr. Lewis H. Kuller of the University of Pittsburgh wrote that PPI use and dementia may both be influenced by similar risk factors. Kuller noted that in the Women’s Health Initiative, women who took PPIs were more often obese, had arthritis, and were generally in poorer health than other women in the study, which may increase dementia risk. PPIs are known to carry an increased risk of kidney disease, fracture, low magnesium levels, gastrointestinal infections, Clostridium difficile infection and pneumonia, Reuters Health reports.
“PPIs used for the treatment of gastroesophageal reflux disease and peptic ulcers work by reduction of gastric acid production,” Haenisch explains. “The underlying mechanism by which PPIs might influence cognition is yet to be determined.” Some of the drugs may cross the blood-brain barrier and interact with brain enzymes, or they may be associated with vitamin B12 deficiency, which may promote neurological damage, according to Haenisch.
Haenisch advises patients taking PPIs to follow their doctor’s instructions. And doctors should be careful not to overprescribe PPIs, which is frequently reported, Haenisch said. One study found that up to 70 percent of PPI prescriptions were inappropriate for the patient, according to Reuters Health, and, often, dietary and lifestyle changes can help ease the problems.