PPIs and Dementia: A Tale of Two Studies – Part Two
Prateek Sharma, MD, FASGE, reviewing Northuis C, et al. Neurology 2023 Aug 9.
Previous research has suggested a potential connection between proton pump inhibitors (PPIs) and a higher risk of dementia, causing concern among patients and health care professionals. Many of these studies relied on diagnosis codes to identify cases of dementia and were constrained by incomplete evaluations of PPI usage, as these medications are frequently accessible without a prescription. Two recently published studies have evaluated the association between PPI use and dementia—with divergent conclusions.
This study utilized data from the community-based ARIC (Atherosclerosis Risk in Communities) cohort from 1987 to 2017. The investigators assessed PPI use through medication inventory across clinic visits and annual phone calls. The analysis focused on participants from ARIC visit 5 (2011-2013; visit 1 was 1987-1989) when PPI usage was more common. The investigators used two approaches to examine PPI use: current usage at visit 5 and the duration of usage leading up to visit 5, categorized by exposure periods. The study investigated the development of incident dementia after visit 5, using Cox proportional hazard models, adjusted for various factors.
The analysis comprised 5712 dementia-free participants at visit 5, with a mean age of 75.4 ± 5.1 years, including 22% Black individuals and 58% females. The median follow-up period was 5.5 years, with cumulative PPI use ranging from 112 days to 20.3 years. Throughout the median follow-up duration, there were 585 cases of incident dementia. The findings revealed that participants utilizing PPIs at visit 5 did not face a significantly increased risk of developing dementia during subsequent follow-up, compared with nonusers (hazard ratio [HR], 1.1; 95% confidence interval [CI], 0.9-1.3). However, individuals who had used PPIs for more than 4.4 cumulative years prior to visit 5 exhibited a higher risk of developing dementia during the follow-up period (HR, 1.3; 95% CI, 1.0-1.8) compared with those who reported no PPI use. Notably, the investigators did not observe any significant associations for lesser durations of PPI usage.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Northuis C, Bell E, Lutsey P, et al. Cumulative use of proton pump inhibitors and risk of dementia: the Atherosclerosis Risk in Communities Study. Neurology 2023 Aug 9. (Epub ahead of print) (https://doi.org/10.1212/wnl.0000000000207747)