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Contrary to prior research, the use of proton pump inhibitors (PPIs) to prevent gastric reflux is not associated with new dementia diagnoses in seniors, new evidence shows. The findings should ease concerns that clinicians and their patients may have about safe use of gastric acid blockers and potential effects on cognition, the researchers said.

In gastric reflux, stomach acid travels back into the esophagus, causing irritation of the esophagus lining and raising the risk of more serious conditions. PPIs relieve symptoms of reflux and are also used to treat stomach ulcers by reducing the amount of acid produced by the stomach. The drugs are widely prescribed, but a potential link between their use and dementia has been an ongoing concern for patients and clinicians.

In the new study, investigators analyzed results from the Aspirin in Reducing Events in the Elderly (ASPREE) study, a randomized trial of aspirin in the United States and Australia. Participants included more than 18,000 community-based adults aged 65 years and older of all races and/or ethnicities. 

Patients’ use of PPIs was determined with annual medication reviews. In addition to PPIs, the researchers also tracked outcomes for people taking histamine-2 receptor antagonists (H2RAs), another commonly used acid controller. Incident dementia was defined according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

There was no link to new dementia diagnoses in patients who used PPIs at baseline, versus those who did not use them, investigators found. There also was no evidence for changes in overall cognitive test scores over time. The results were similar for participants taking H2RAs, lead researcher Raaj Mehta MD, MPH, of Massachusetts General Hospital and Harvard Medical School in Boston reported.

Earlier studies that tied these drugs to dementia risk had significant limitations, which the current study corrected for, Mehta and colleagues wrote. These included incomplete assessment of medication use, failure to account for confounders and reliance on claims-based diagnoses for dementia, which can lead to misclassification, they said.

“These data provide reassurance about the safety of long-term use of PPIs among older adults,” they concluded.

Full findings were published in the journal Gastroenterology.

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