This common medication may lead to dementia - study

People who take acid reflux medications called proton-pump inhibitors for four-and-a-half years or more could have a higher risk of dementia compared to people who do not take these medications, according to research just published in Neurology, the medical journal of the American Academy of Neurology. 

Acid reflux occurs when stomach acid flows into the esophagus, usually when lying down or after a meal, causing sufferers heartburn and ulcers.

People with frequent acid reflux may develop gastroesophageal reflux disease (GERD). which can lead to cancer of the esophagus. Reflux occurs when the sphincter muscle at the lower end of the esophagus relaxes at the wrong time, allowing stomach acid to back up into the esophagus. 

Proton-pump inhibitors

Proton-pump inhibitors (PPIs) include medications like omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid). They are prescribed to reduce stomach acid by targeting the enzymes in the stomach lining that produce that acid.

“Proton pump inhibitors are a useful tool to help control acid reflux, however long-term use has been linked in previous studies to a higher risk of stroke, bone fractures and chronic kidney disease,” said study author Dr. Kamakshi Lakshminarayan, of the University of Minnesota School of Public Health in Minneapolis. “Still, some people take these drugs regularly, so we examined if they are linked to a higher risk of dementia. While we did not find a link with short-term use, we did find a higher risk of dementia associated with long-term use of these drugs.”

The study included 5,712 people aged 45 and older (with an average age of 75) who did not have dementia at the start of the study. The researchers determined if participants took acid reflux drugs by reviewing their medications during study visits and during yearly phone calls.

Of the participants, 1,490 people – or 26% – had taken the drugs. They were then divided into four groups based on whether they had taken the drugs and for how long – those who did not take the drugs; those who took the drugs for up to 2.8 years; those who took them for 2.8 to 4.4 years; and people who took them for more than 4.4 years.

Participants were then followed for a median duration of 5.5 years. During this time, 585 people – 10% – developed dementia.

Of the 4,222 people who did not take the drugs, 415 people developed dementia or 19 cases per 1,000 person-years. Of the 497 people who took the drugs for more than 4.4 years, 58 people developed dementia or 24 cases per 1,000 person-years.

Acid reflux drugs and dementia risk 

After adjusting for factors such as age, sex, and race, as well as health-related factors such as high blood pressure and diabetes, researchers found people who had been taking acid reflux drugs for more than 4.4 years had a 33% higher risk of developing dementia than people who never took the drugs. The study hasn’t yet proved that acid-reflux drugs cause dementia but just an association.

“More research is needed to confirm our findings and explore reasons for the possible link between long-term proton pump inhibitor use and a higher risk of dementia,” said Lakshminarayan.

“While there are various ways to treat acid reflux like taking antacids, maintaining a healthy weight, and avoiding late meals and certain foods, different approaches may not work for everyone. It is important that people taking these medications speak with their doctor before making any changes, to discuss the best treatment for them, and because stopping these drugs abruptly may result in worse symptoms.”

Ways to avoid reflux without taking PPIs include avoiding foods that trigger your symptoms; not eating too close to bedtime; not eating too much fat or food in general so your stomach can empty more quickly and won’t become too full; and not wearing overly tight belts or waistbands that interfere with your stomach emptying.