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.
Some large-scale observational studies have found that people taking PPIs long-term were more likely to develop dementia than people not taking PPIs. However, other large studies subsequently found no increased risk. Due to the type of research conducted (observational), these studies do not enable 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 in some but not all research studies.
If PPIs are truly increasing risk, studies suggest reasons why could include poorer absorption of vitamins and minerals, like B12 and magnesium. Possibilities also include an increase in amyloid production (a sticky protein plaque that is seen in the brains of people with Alzheimer’s) and 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 very good idea to review your medication list with your doctor annually to reduce the number of prescriptions to only those that are truly indicated.