Long-term use of acid reflux medications linked to higher dementia risk

Long-term use of certain medications to treat heartburn and acid-related disorders is associated with an increased risk of developing dementia, new research shows.

The research, published Wednesday in the journal Neurology, examined data from more than 5,700 participants who initially did not have dementia and found that those who took proton pump inhibitors for about 4-½ years or more had a 33 percent higher risk of developing dementia than those who did not take the medications.

The study did not say these medications cause dementia, only that there was an association between using the drugs and a higher risk of developing dementia.

The researchers did not find a higher risk of dementia linked to shorter-term use.

“Patients taking these medications should talk to their doctor before making any changes to discuss the best treatment for them,” Kamakshi Lakshminarayan, senior author of the study and a professor of neurology at the University of Minnesota School of Public Health, wrote in an email. “Stopping these drugs abruptly may result in worse symptoms.”

Acid reflux and GERD

Proton pump inhibitors or PPIs, including Prevacid, Prilosec and Nexium, are used to help manage symptoms of acid reflux and a more serious form called gastroesophageal reflux disease, or GERD, in which the stomach contents move back up into the esophagus. The conditions can cause, among other symptoms, heartburn, nausea and regurgitation, which can lead to more serious complications such as trouble swallowing or bleeding in the digestive tract.

People with GERD are also at a slightly increased risk of developing esophageal cancer.

Previous studies have shown a possible link between PPI use and a higher risk of stroke, bone fractures and chronic kidney disease, and the researchers wanted to know whether the medications may also be linked to dementia, which affects about one-third of adults age 85 and older.

Other studies have looked at PPIs and dementia. Some have found similar results. Others have found no association.

In the current observational research, the scientists analyzed data from the Atherosclerosis Risk in Communities Study gathered from 1987 to 1989 through 2017, and adjusted for age, race, sex and chronic conditions such as diabetes and hypertension. The average age of participants was 75.

The study did not identify which specific proton pump inhibitors the participants took.

Participants using over-the-counter medications not prescribed by a health-care provider were excluded.

There are several pathways through which PPIs could impact dementia risk, said Pamela Lutsey, a professor of epidemiology and community health at the University of Minnesota School of Public Health, who is a co-author of the most recent study.

“There is some human evidence that PPI use may predispose to vitamin B12 deficiency, which can be associated with cognitive decline,” she wrote in an email. “Additionally, mice models have suggested that PPI use may impair amyloid metabolism, increasing beta-amyloid levels in the brain. Also, PPI use may result in changes to the gut microbiome that could impact cognitive health.”

Other factors could be contributing to dementia

There may be other variables contributing to dementia risk that were not fully accounted for in the study, research shows.

Poor diet and lack of exercise are associated with both acid reflux and dementia, said Gregory Day, a neurologist at Mayo Clinic in Jacksonville, Fla.

Chronic stress may be linked to dementia, research shows.

GERD also has been shown to interfere with sleep, and poor sleep is associated with a significantly higher risk of dementia.

Studies such as the recent observational study allow us “to have discussions, to be thoughtful about trying to dissect what might be contributing to this risk between a medicine and a cognitive outcome,” Day said. “It doesn’t mean we want all patients throwing these medications in the garbage.”

If you are using these medications for ulcers or gastrointestinal problems and stop using them, you could have potentially life-threatening consequences, Day said.

When to use PPIs

People who have concerns about using prescription or over-the-counter PPIs should speak with their health-care providers before stopping these medications, experts say.

Clinical guidance from the American Gastroenterological Association on best practices for prescribing or deprescribing PPIs state that although the drugs are generally considered safe, “patients should not use any medication when there is not a reasonable expectation of benefit.”

“If taking long term, patients should consult with a primary care physician or gastroenterologist to determine the diagnosis and treatment plan,” Fouad J. Moawad, spokesperson for the American Gastroenterological Association, said in a statement.

Moawad also recommended lifestyle modifications, including reducing intake of foods known to trigger symptoms, not eating three hours before going to sleep, elevating the head of the bed and weight loss.

“For many patients, an on-demand approach to PPIs may work just fine and potentially carry less risk,” he wrote.