Long-term use of PPI not linked to impairment of cognition and dementia

In a recent study the use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) were not associated with dementia and cognitive decline in older adults. The findings were published in the Gastroenterology Journal.

Raaj Mehta and team conducted a post-hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) trial, a large randomized study that focused on the effects of aspirin on elderly individuals in the United States and Australia. The study included 18,934 community-based adults aged 65 and older, representing diverse racial and ethnic backgrounds.

During annual in-person study visits, participants' medication use, including PPIs and H2RAs, was assessed. Incident dementia was defined based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Secondary endpoints included cognitive impairment, no dementia (CIND), and changes in cognitive function.

The analysis revealed that baseline PPI use was not associated with an increased risk of incident dementia or CIND compared to non-use of PPIs. The multivariable hazard ratio (HR) for incident dementia was 0.88 (95% CI: 0.72-1.08), indicating no significant difference in risk between the two groups. Similarly, there were no associations observed between H2RA use and any cognitive endpoints.

Furthermore, when examining changes in overall cognitive test scores over time, the researchers found no significant differences between PPI users and non-users. The multivariable beta coefficient (B) was -0.002, with a standard error (SE) of 0.01 and a p-value of 0.85.

These findings provide reassurance about the long-term use of PPIs among older adults, suggesting that PPIs are not associated with an increased risk of incident dementia, cognitive impairment, or decline in cognition over time. The study addresses previous limitations by incorporating comprehensive assessments of medication use and accounting for potential confounders. As with any medication, it is essential to consult with healthcare professionals to evaluate the risks and benefits of long-term PPI use on an individual basis.

Source:

Mehta, R., Kochar, B., Zhou, Z., Broder, J. C., Chung, P., Yang, K., Lockery, J., Fravel, M., Ryan, J., Woods, R. L., Ernst, M. E., & Chan, A. T. (2023). ASSOCIATION OF PROTON PUMP INHIBITOR USE WITH INCIDENT DEMENTIA AND COGNITIVE DECLINE IN OLDER ADULTS: A PROSPECTIVE COHORT STUDY. In Gastroenterology. Elsevier BV. https://doi.org/10.1053/j.gastro.2023.05.052