Global prevalence of dementia is increasing. Estimated cost of dementia worldwide in 2010 was US$604 billion. It is thus important to consider all factors (especially those preventable ones) that might be contributing to cause dementia. Proton pump inhibitors (PPIs: Omeprazole and other prazoles) are widely used medications, Many countries record many fold increase in PPI prescription over the last decade. Many such prescriptions are considered inappropriate. PPI can cause Vit B12 deficiency and this may contribute to cognitive decline. They can also affect the brain enzymes like b- and c-secretase which can lead to increased Amyloid beta levels.
Britta Haenisch et al looked at the correlation between PPI use and developing dementia in a German elderly population sample over 6 years.Information from 3,327 participants from German dementia research database were analysed. These were patients 75 or older with no dementia at entry to the study. Potential confounders like age, sex, education, polypharmacy, and the comorbidities depression, diabetes, ischemic heart disease and stroke, and the Apolipoprotein E4 (ApoE4) allele status were also studied. 3,076 subjects were included in this analysis. 713 patients received a PPI during the study period.
Use of PPIs was associated with a significant increased risk of dementia [hazard ratio (HR) 1.38, 95 % confidence interval (CI) 1.04–1.83; p = 0.02). As expected presence of an ApoE4 allele (2.25), depression (HR 2.28), diabetes, and stroke showed a significant increase in risk of incident dementia.
Limitation: whether PPI was taken regularly is known in follow-up 3 and 4 only. Statistical association is shown- biological mechanisms to be understood.
Conclusion: This is the first epidemiological investigation showing evidence that PPI use might have an impact on dementia risk. Among primary care patients aged 75 years and older the use of PPIs was associated with a significant increase in the risk of incident dementia.
Summary of the article:
Haenisch B, von Holt K, Wiese B, Prokein J, Lange C, Ernst A, Brettschneider C, König HH, Werle J, Weyerer S, Luppa M, Riedel-Heller SG, Fuchs A, Pentzek M, Weeg D, Bickel H, Broich K, Jessen F, Maier W, Scherer M. Eur Arch Psychiatry Clin Neurosci. 2014 Oct 24. [Epub)