Do proton pump inhibitors promote development of dementia?
Use of proton pump inhibitors (PPIs) does not appear to have any effect on cognitive function, with a recent study suggesting that the drugs do not increase the risk of dementia.
Researchers examined data on medication use and other potential risk factors from 13,864 participants in the Nurses’ Health Study II. All participants completed a self-administered computerized neuropsychological test battery.
Multivariable linear regression analysis found a modest association between duration of PPI use and scores for psychomotor speed and attention. The mean score difference for PPI use of 9 to 14 years vs nonuse was –0.06 (95 percent CI, –0.11 to 0.00; p=0.03 for trend). However, the magnitude of this score difference shrank after adjusting for the use of H2 receptor antagonists (H2RAs).
Among individuals who were not regular PPI users, duration of H2RA use was associated with poor cognitive scores, and this relationship was most pronounced for learning and working memory (mean score difference for H2RA users of 9 to 14 years vs nonusers, –0.20; –0.32 to –0.08; p<0.001 for trend).
The present data do not support the suggestion that PPI use increases dementia risk, researchers said, adding that findings for H2RAs should be interpreted with caution as the primary hypothesis was related to PPI use.
While the underlying mechanism by which PPIs might influence the development of dementia is unclear, there are pieces of evidence linking PPI use to cognitive decline. Several studies have shown that some PPIs (eg, lansoprazole and omeprazole) could cross the blood-brain barrier and directly affect the brain. The drugs are also said to be capable of interacting with brain enzymes, as well as inducing increased amyloid beta levels in an amyloid cell model and in the brains of mice. [PLoS One 2013;8:e58837; J Chromatogr A 2002;949:35-42; J Alzheimers Dis 2010;19:573-589]