Proton Pump Inhibitors and Dementia

You probably don't have to worry that acid-reducing medicine is causing symptoms of mental decline; it's unlikely there’s a link between proton pump inhibitors and dementia.

If your elderly mother has been taking an acid-reducing proton pump inhibitor and you notice she’s showing some signs of dementia, you’re hardly alone. Both circumstances are common.

But you probably don’t have to worry that the medication is the reason for the decline, a large 2017 study suggests.

Proton pump inhibitors (PPIs) — omeprazole (Prilosec) or lansoprazole (Prevacid) are two common names — treat reflux by cutting your body’s production of acid. They have also been prescribed for ulcers, though there’s less evidence to back up that strategy.

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Prescriptions have soared, prompting research that often found that PPIs had been overprescribed.

Then some studies found a link between proton pump inhibitors and dementia in people age 75 and older. Both omeprazole and lansoprazole cross the blood-brain barrier, which means they could directly affect the brain.

To test this suspicion, researchers at Emory University in Atlanta gathered data on 10,486 participants age 50 and up with either normal or slightly impaired cognitive function. Eighteen percent of them used PPIs occasionally, and eight percent used them regularly.

Compared to the majority, who didn’t use PPIs, the people who did at least occasionally were older, and more likely to have other health issues — including heart disease, diabetes, and depression. They were also more likely to be taking anticholinergic medications — a huge class of sometimes common drugs likeparoxetine (Paxil) and diphenhydramine (Benadryl) — that may up the chance of dementia.

The Emory team concluded that PPI users were at higher risk of dementia because of their other illnesses, not because of the drug. When the team controlled for other risks, the PPI users actually had a lower chance of dementia, possibly because they were getting better healthcare, the authors said.

A large 2016 German study also found that people taking PPIs (and statins) had a lower chance of dementia.

So a link between proton pump inhibitors and dementia shouldn’t be at the top of your worry list, perhaps. But there are other reasons to avoid using the medications regularly. The Food and Drug Administration has issued numerous warnings about PPIs: long-term use and high doses may promote bone fractures or Clostridium difficile infection, an intestinal problem that is hard to handle, especially for the elderly.

Other studies suggest that long-term, PPIs may interfere with the absorption of nutrients, vitamins and minerals, and hamper the action of other medications. The FDA warns, for example, that Prilosec weakens the anticlotting effect of clopidogrel (Plavix).

One small study tied PPIs to weight gain; a majority of the people taking a PPI every day gained weight, by an average of almost eight pounds over a 2- to 5-year period. Each person was matched to a healthy control of the same age and sex who didn’t take the PPI, and the controls didn’t gain weight.

Some people need to take PPIs long-term, but they should discuss the risks with their doctor. If the benefits outweigh the risks, they should keep using PPIs. There are also drug-free ways to reduce reflux, such as losing weight, quitting smoking, and elevating the head of your bed.

Bottom line: take them occasionally, if you must, for as few days as you can, but don’t really worry much about proton pump inhibitors and dementia.

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