Heartburn drugs may be linked to dementia in seniors. The heartburn medications, called proton pump inhibitors (PPIs), includes Prilosec, Nexium and Prevacid, work by lowering the amount of acid produced by the stomach, according to KHOU.
German researchers found that people 75 or older who regularly take the heartburn medications had a 44 percent increased risk of dementia, compared with seniors not using the drugs. The drugs study only found an association, however, and not a cause-and-effect link.
“To evaluate cause-and-effect relationships between long-term PPI use and possible effects on cognition in the elderly, randomized, prospective clinical trials are needed,” said corresponding author Britta Haenisch, from the German Center for Neurodegenerative Diseases in Bonn.
While heartburn drugs are linked to dementia in seniors, “Clinicians should follow guidelines for PPI prescription, to avoid overprescribing PPIs and inappropriate use,” Haenisch said. The report was published Feb. 15 in the journal JAMA Neurology.
The heartburn and dementia results are surprising enough that at least one leading expert on aging, Dr. Malaz Boustani, plans to share the findings with older patients who are using PPIs.
Boustani said earlier studies have linked another type of antacid, H2 blockers, as drugs linked to dementia. Up to now, he’s recommended that patients use PPIs to treat acid reflux and steer clear of H2 blockers like Tagamet, Pepcid and Zantac.
“I’m going to disclose the finding to my patients and then let them decide whether they will take the risk or not,” said Boustani, a professor of medicine with the Indiana University Center for Aging Research and a spokesman for the American Federation for Aging Research. “On Monday I have clinic, and if I have patients taking a PPI or an H2 blocker I will tell them exactly what I’m telling you, and then they can decide.”
More than 15 million Americans used prescription PPIs in 2013, at a total cost of more than $10 billion, according to a report by the IMS Institute for Healthcare Informatics. Several popular PPIs — Prilosec, Prevacid and Zegerid — also are available over-the counter, further boosting their use.
Concern has been increasing that Americans might be overusing PPIs to treat minor cases of heartburn or acid reflux.
As many as 70 percent of PPI prescriptions in the United States have been inappropriately handed out by doctors, and 25 percent of long-term users could stop taking the medication without suffering increased heartburn or acid reflux, according to a study published in January in the journal JAMA Internal Medicine.
Overuse of heartburn drugs could have drastic effects on health, that study found. For example, the medications have been linked to a 20 percent to 50 percent higherrisk of chronic kidney disease.
And now the German researchers report there also is some evidence that PPI use might affect a person’s ability to reason.
Heartburn drugs appear to effect levels of amyloid beta and tau, which are proteins associated with Alzheimer’s disease, the German authors said. PPI use can also lead to vitamin B12 deficiency, which has been associated with cognitive decline.
While the study is intriguing, it’s not enough for doctors to warn patients off PPI use, said Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association.
“It does not tell us anything that should change medical practice right now,” Fargo said. “I don’t think there’s going to be an uprising among doctors telling patients not to take their PPIs. This doesn’t rise anywhere near the level of evidence you would need for that.”
One of the paper’s main flaws in heartburn drugs linked to dementia in seniors is that researchers could not control for diet and body weight as risk factors, Fargo said. “Both of those things, we know, are risk factors for developing cognitive decline and dementia in later life, and both of those are reasons why a person might need to take a proton pump inhibitor,” Fargo explained.