A German research group has found a potential relationship between use of heartburn medications and increased risk of developing dementia, resulting in some alarmist headlines in the media.
The study published in 2015 found that people over age 75 who regularly used proton pump inhibitors (PPIs), a group of drugs used for stomach acid disorders such as peptic ulcers or GERD, had a 44 percent greater risk of developing dementia than people who did not use these drugs.
One major concern is that PPIs are among the most widely used drugs in the world, with long-term use reported in 2–3 percent of older Americans. Putting these numbers in perspective, a 44 percent increased risk among PPI users could translate to 10,000 additional new dementia cases every year in the US among people aged 75 to 84.
However, while this observational study and it’s follow up in 2016 showed evidence of a link between PPIs and dementia, because of the way the studies were designed, we do not yet know if these drugs directly cause dementia or if some other factors are responsible. For example, the study authors point out that PPI use can lead to vitamin B12 deficiency, which has been associated with cognitive decline. According to the senior author, Britta Haenish, Ph.D., of the German Center for Neurodegenerative Diseases, as quoted in the NY Times:
“Our study does not prove that PPIs cause dementia. It can only provide a statistical association. This is just a small part of the puzzle.”
A randomized, placebo-controlled study would be needed to show a causal relationship. A dose-response relationship, where higher doses of the drugs relate to a higher risk, would further support a causal role.
Although we know we need more research, what does this all mean for you and your family? It may mean talking to your doctor about whether these medications are essential to your health. According to Eugenia Shmidt, MD, a GI Fellow at Mount Sinai:
“It is fair to say however, that unnecessary, long-term use of any medications – including PPIs – should be avoided. Until we have further information, prescribers should remain judicious in the use of PPIs and look for inappropriate prescribing, especially in geriatric patients who are at risk for polypharmacy and the negative implications of medication over-prescription.”