Proton-Pump Inhibitors And Dementia

By Dr. Smita Patel

Proton pump inhibitors or “PPIs” are a class of drugs that treat acid reflux and peptic ulcers. The three most commonly prescribed PPIs are omeprazole, pantoprazole and esomeprazole. In recent years, some studies reported that PPIs increase risk for dementia, including Alzheimer’s disease. We hear patients asking questions about this issue, so I’d like to clarify what we currently know about this risk.

A number of large-scale observational studies have found that people taking PPIs long-term were more likely to develop dementia than people not taking PPIs. Due to the type of research conducted (observational), these studies do not allow us to tease out whether  the PPIs are causal to dementia; we only know that taking PPIs long term and a diagnosis of dementia are associated.

But, if PPIs are causal, studies suggest reasons why could include poorer absorption of vitamins and minerals, like B12 and magnesium, an increase in amyloid production (a sticky protein plaque that is seen in the brains of people with Alzheimer’s) or an altering of the gut’s “microbiome”, which can lead to systemic inflammation, including inflammation in the brain.

We recommend that patients who are prescribed a PPI talk with their primary care physician to see if taking the medication is still necessary. Research has suggested that up to 65 percent of PPI prescriptions may be inappropriate. We do not suggest stopping any medication unless under the guidance of a physician. For some, PPIs will still be necessary, for others, an alternative might work (like an H2 blocker), and for others still, the medication could be ceased all together. In general, it’s a good idea to review your medication list with your doctor annually to reduce the number of prescriptions to only those that are truly indicated.

 

Dr. Smita Patel, DO, is a neurologist at NorthShore University HealthSystem, and an integral part of NorthShore’s Center for Brain Health. Dr. Patel brings expertise in neurology and sleep along with a proficiency in complementary and integrative medicine to develop tailored health plans for her clients. She is board certified in Neurology and Sleep Medicine. Dr. Patel has participated in clinical research studies in the area of sleep medicine and has written book chapters for several academic publications on neurological disorders. She has a strong interest in researching the cause and treatment of neurological diseases as well as supporting and participating in educational programs. Dr. Patel is part of the integrated team at the Center for Brain Health at NorthShore Neurological Institute, working with patients to reduce the risk for Alzheimer’s disease, Parkinson’s disease and other brain disorders, and to improve brain health. For more information, please visit NorthShore