Millions of Americans take proton pump inhibitors daily to treat indigestion and acid reflux, and these drugs, also known as PPIs, have been linked in recent years to an increased risk of kidney failure, stroke, and premature mortality. In addition, new research suggests that there may be an increased risk of dementia for those who take the medications for an extended period of time.
Those aged 45 and older who took PPIs for more than four years had a 33% greater risk of developing dementia than those who never took the medications, according to a study published in Neurology on Wednesday. Dementia is not a singular disease, but rather an umbrella term for memory loss and cognitive decline resulting from brain cell injury.
PPIs reduce gastric acid by inhibiting the enzymes in the stomach mucosa responsible for acid production. They are frequently used to treat the symptoms of acid reflux and gastroesophageal reflux disease (GERD), a severe form of acid reflux in which food or liquid travels from the stomach to the esophagus. PPIs are commonly used to treat GERD, which is a moderate burning sensation caused by acid reflux.
The occasional use of these medications after a barbecue is not cause for concern, according to experts. “This study does not prove that acid reflux drugs cause dementia,” Dr. Kamakshi Lakshminarayan, a neurologist at the University of Minnesota School of Public Health in Minneapolis and a member of the American Academy of Neurology, told CNN via email. “It only demonstrates a correlation. Further research is required to validate our findings in other large study groups and to investigate the possible association between long-term proton pump inhibitor use and an increased risk of dementia.
Evidence linking PPIs and dementia
Lakshminarayan and her team analyzed a population-based study of 5,712 individuals aged 45 to 64 who did not have dementia at the study’s onset. Almost 1,500 participants, or 26%, utilized PPIs during the study period. After adjusting for age, sex, race, and health conditions such as diabetes and high blood pressure, the researchers discovered that 58 of the 497 individuals who took PPIs for nearly 412 years developed dementia.
415 participants out of 4,222 who did not take the medication developed dementia. Researchers found no increased risk among those who took the drugs for less than 4.40 years. The research had some limitations. During the study period, participants were queried about their medication use only once per year. Inaccurate estimates could result if participants halted and then resumed their PPI use between check-ins. Over-the-counter medications were excluded from the study, as only prescription medicines were examined.
The researchers identified B12 deficiency and impaired amyloid metabolism as potential connections between excessive PPI use and dementia. Some studies have linked the use of acid reflux medications with insufficient B12 levels. And low B12 is associated with impaired cognition and weak memory,” says Lakshminarayan, adding that her team lacked B12 data on the study participants and therefore “could not remark on this theory.”
Dr. Gregory Day, an associate professor in the Department of Neurology at the Mayo Clinic in Jacksonville, Florida, and a fellow of the American Academy of Neurology, concurred that there may be a connection between PPIs and the effects on brain amyloid. Day, who was not involved in the study, stated that proton pump inhibitors can “alter enzymes in the brain” that prevent the accumulation of amyloid, a key factor in Alzheimer’s disease.
PPIs may “decrease the level of the body’s chemical that is there to cut off the amyloid in specific ways,” he explained. Theoretically, these medications increase amyloid in the brain, which increases the risk of Alzheimer’s disease, the leading cause of dementia.
Options to PPI usage
Lakshminarayan advises patients who have been taking proton pump inhibitors for more than four years to consult a physician about alternative treatment options.
“Suddenly stopping these medications may worsen symptoms,” she said. According to specialists, people with frequent acid reflux can develop GERD, which can result in severe gastrointestinal hemorrhage or esophageal cancer.
There are additional treatment options for acid reflux and indigestion, including over-the-counter antacids. Antacids differ from proton pump inhibitors (PPIs) in that they neutralize the acid already present in the stomach, as Lakshminarayan explains. H2 antagonist medications, also known as H2 blockers, can provide longer-lasting relief, but they may take several hours to take effect. Day adds that some individuals may need to reconsider their use of PPIs, which he claims are frequently overused or prescribed for mild symptoms.
“What I would recommend for those taking these medications, regardless of whether they are concerned about their memory or not,” Day says. “I think it’s always reasonable to ask, ‘Why am I taking these medications?'” Dietary changes and avoiding late meals can reduce the need for PPIs. Additionally, being overweight can contribute to acid reflux, so reducing weight can also help alleviate symptoms. Lakshminarayan remarked, however, that these options do not work for everyone. Lakshminarayan stated, “Our recommendation is that patients discuss their medications with their doctors and inform their doctors if they are taking any over-the-counter medications.”
Source: CBS News