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Gastric reflux drugs are potentially involved in cognitive decline (2016-02-17)

Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal diseases but have also been shown to be potentially involved in cognitive decline.
To examine the association between the use of PPIs omeprazole, pantoprazole, lansoprazole, esomeprazole, or rabeprazole and the risk of incident dementia in the elderly resarchers conducted a prospective cohort study using observational data from 2004 to 2011, derived from the largest German statutory health insurer, Allgemeine Ortskrankenkassen (AOK).

Data on inpatient and outpatient diagnoses (coded by the German modification of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision) and drug prescriptions (categorized according to the Anatomical Therapeutic Chemical Classification System) were available on a quarterly basis.
Data analysis was performed from August to November 2015.

A total of 73,679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication were 44 percent more likely to develop dementia than those who were not receiving the drugs, the authors reported in JAMA Neurology.

The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.

The current study can only provide a statistical association between PPI prescriptions and occurrence of dementia in the elderly. It canít prove that PPIs actually cause dementia, said senior author Britta Haenisch of the German Center for Neurodegenerative Diseases in Bonn, Germany.

PPIs used for the treatment of gastroesophageal reflux disease and peptic ulcers work by reduction of gastric acid production, Haenisch said. 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, she said.

For more information
JAMA Neurology
Association of Proton Pump Inhibitors With Risk of Dementia
A Pharmacoepidemiological Claims Data Analysis
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