Can Proton Pump Inhibitors Cause Dementia?

You probably shouldn't worry that acid-reducing medicine can cause mental decline; it's unlikely there’s a link between proton pump inhibitors and dementia.

If your elderly mother takes 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 study suggests.

Proton pump inhibitors (PPIs) — omeprazole (Prilosec) or lansoprazole (Prevacid) are two common names — treat gastroesophageal reflux, reducing your body’s production of acid. They have also been prescribed for ulcers, although 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 the suspicion, researchers at Emory University in Atlanta gathered data on 10,486 participants age 50 and up who had either normal or slightly impaired cognitive function. Eighteen percent of them used PPIs occasionally, and eight percent used them regularly.

Compared to the majority of the study participants, who didn’t use PPIs, the people who did were older, and more likely to have other health issues — including heart disease, type 2 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 increase chances of dementia.

The Emory team concluded that PPI users were at higher risk of dementia because of their other illnesses, not the drug. When the researchers 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 German study also showed 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 (FDA) has issued numerous warnings about PPIs: Long-term use and high doses may promote bone fractures or Clostridium difficile infection, a bacterial intestinal problem that is hard to handle, especially for the elderly.

Other studies suggest that long-term PPI use may interfere with the absorption of nutrients and 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. 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. Healthy lifestyle changes can also reduce acid reflux, such as losing weight, quitting smoking, and elevating the head of your bed.

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