Association of Dementia With PPIs Disputed

Proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) were not associated with incident dementia; cognitive impairment, no dementia (CIND); or other changes in cognition among adult patients aged 65 years or older, a new study suggests.

“Prior studies have suggested that proton pump inhibitor (PPI) use is associated with increased risk of dementia; however, these have been limited by incomplete assessment of medication use and failure to account for confounders,” the authors wrote in Gastroenterology. “Furthermore, prior studies have relied on claims-based diagnoses for dementia, which can lead to misclassification.”

The investigators conducted a post-hoc analysis of ASPirin in Reducing Events in the Elderly (ASPREE), a randomized trial of aspirin in the United States and Australia, which included 18,934 community-based adults 65 years of age and of all races/ethnicities. The baseline and recent PPI and H2RA use of these patients was determined during a review of medications at yearly in-person study visits.

Incident dementia was defined according to the criteria published in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition. “Secondary endpoints include cognitive impairment, no dementia (CIND) and changes in cognition. Associations of medication use with dementia and CIND outcomes were examined using Cox proportional hazards models,” the authors explained. The study authors examined changes in cognitive test scores using linear mixed-effects models.

“Baseline PPI use vs nonuse was not associated with incident dementia (multivariable hazard ratio, 0.88; 95% confidence interval, 0.72–1.08), CIND (multivariable hazard ratio, 1.00; 95% confidence interval, 0.92–1.09), or with changes in overall cognitive test scores over time (multivariable B, −0.002; standard error, 0.01; P = .85). Similarly, no associations were observed between H2RA use and all cognitive endpoints.

“These data provide reassurance about the safety of long-term use of PPIs among older adults,” they concluded.

Reference:

Mehta RS, Kochar B, Zhou Z.  Association of proton pump inhibitor use with incident dementia and cognitive decline in older adults: a prospective cohort study. Gastroenterology.

Published online June 12, 2023. https://doi.org/10.1053/j.gastro.2023.05.052