Examining the Evidence: Do Drugs Like Nexium Increase Your Risk of Dementia?

A recent study linked some popular drugs used to treat heartburn and peptic ulcers to an increased risk of dementia.  While the study findings are concerning, consumers should be mindful that media reports do not necessarily present the full picture. Here is a breakdown of what the study actually shows:

The Study

Researchers wanted to know if proton pump inhibitors (PPIs), drugs commonly used to treat heartburn and peptic ulcers, were associated with dementia among older adults. Better known by brand names like Nexium, Prilosec, and Prevacid, PPIs reduce the production of gastric acid in the stomach.

The study followed 73,679 German adults aged 75 years and older who had health insurance from Allgemeine Ortskrankenkassen, a large health insurer in Germany, between 2004 and 2011.

New cases of dementia occurred in 40 percent of study participants over the 8-year study period. The risk of dementia was 44 percent higher in participants taking PPIs compared to those who did not. The risk of dementia also differed by type of PPI: Participants taking Nexium were more than twice as likely to develop dementia as those not taking Nexium.

The Limitations

While these results are concerning, it is worth noting that the study has a number of limitations. For example, the study findings suggest an association between PPIs and dementia but do not show PPIs cause dementia. Another factor could be responsible for these results.

It is also possible that cases of early-stage or undiagnosed dementias were not identified. This means that many participants who were considered to be free of dementia at the beginning of the study actually had the disease. If so, the risk of dementia among PPI users reported in this study would be higher than the true risk.

In addition, the researchers were unable to directly measure use of PPIs, instead relying on insurance claims of PPI prescriptions being filled. Over-the-counter use of PPIs was not measured. Finally, the biological mechanism by which PPIs may be related to dementia is not understood.

The Take Away

It is rare for a single study to prove a causal relationship. More studies are needed to determine if and how PPIs cause dementia. Follow-up studies should include a greater number of people taking PPIs and a more reliable way to measure PPI use and dosage.

This study is important because PPIs are among the most commonly prescribed medications in the world. If a causal link between PPIs and dementia is uncovered, tens of millions of people could be at risk for dementia. As with any medical intervention, there are benefits and risks of taking PPIs. PPIs have been associated with deficiencies of certain vitamins and minerals (specifically vitamins B12 and C, calcium, iron and magnesium), which may be of concern for older adults.

Patients may want to discuss the risks and benefits of taking PPIs with their health care providers.

 

Citation

Gomm W, Von Holt K, Thome F, Broich K, Maier W, Fink A, Doblhammer G, Haenisch B. Association of Proton Pump Inhibitors with Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis. JAMA Neurology. February 15, 2016. doi:10.1001/jamaneurol.2015.4791.

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