Risk of dementia in elderly patients with the use of proton pump inhibitors


Drugs that modify the risk of dementia in the elderly are of potential interest for dementia prevention. Proton pump inhibitors (PPIs) are widely used to reduce gastric acid production, but information on the risk of dementia is lacking. We assessed association between the use of PPIs and the risk of dementia in elderly people. Data were derived from a longitudinal, multicenter cohort study in elderly primary care patients, the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe), including 3,327 community-dwelling persons aged ≥75 years. From follow-up 1 to follow-up 4 (follow-up interval 18 months), we identified a total of 431 patients with incident any dementia, including 260 patients with Alzheimer’s disease. We used time-dependent Cox regression to estimate hazard ratios of incident any dementia and Alzheimer’s disease. Potential confounders included in the analysis comprised age, sex, education, the Apolipoprotein E4 (ApoE4) allele status, polypharmacy, and the comorbidities depression, diabetes, ischemic heart disease, and stroke. Patients receiving PPI medication had a significantly increased risk of any dementia [Hazard ratio (HR) 1.38, 95 % confidence interval (CI) 1.04–1.83] and Alzheimer’s disease (HR 1.44, 95 % CI 1.01–2.06) compared with nonusers. Due to the major burden of dementia on public health and the lack of curative medication, this finding is of high interest to research on dementia and provides indication for dementia prevention.


45 Replies

  • Drugs usually 'inhibit' a natural body process, yep they're just trying to polish us off, slowly but surely of course.....£

    avoid docs & don't do drugs, if humainly possible - the Queen has homeopathic docs & for corgis too.

    I know.... in an ideal world.... hubby pointed to "apple cider vinegar" (cider=apples)

    apologies but I'm reading this just to prop up my beliefs...


    (also read 1984 (1948) in 1976 too) J x

  • According to his bio, Dr. Anthony Toft is physician to the Queen. I wonder if she has a thyroid problem. ;)

  • Gabkad, If she has I expect she'll be using natural dessicated thyroid and not the generic T4. I've had a search but haven't found a member username ElizabethR which is her Twitter monicker.

  • That's because she gets good care and doesn't need to come here and ask for help. (How do I find all the emoticons around here when I need one?)

  • Gabkad, you have to memorise emoticons or snag from someone's post. Yah'd think HU would provide a selection for us brain fogged hypos. I'd like a raised eyebrows smiley.

  • I'll raise you one eyebrow.

  • I'll see your eyebrow and raise you :) :-D :o :x

    If you hover over them you'll see the formulae.

    Off to nod now xx

  • I think Dr Toft is when HM's in Scotland, otherwise it was (is?) Dr Tim Evans.

  • How strange! A while back I read the Jean Plaidy books re Victoria which mentioned the rise to being crowned Queen and the uncles who were around at the time and I thought "thyroid"! I can't remember the specifics though now.

  • Jane, Undiagnosed/untreated B12 deficiency has been misdiagnosed as dementia/Alzheimers. PPI's may be contributing to B12 deficiency.

    I've read Goetze's freebie chapter on SSRIs and antipsychotics. Big Pharma very much a law unto themselves. Roll on publication of All Trials.

  • PPIs also result in low magnesium and thereby cardiac arythmias. ahrythmias. however its spells. arythmia. oh whatever...

  • I take a PPI, Omeprazole, on the advice of my GP but my magnesium is pretty good at 0.89 (0.70-1.00). However this was only the serum magnesium and not the 99% present in bodily tissue. The GP wants to review my Omeprazole dose and if there is no improvement she's referring me to either a gastro or an ENT regarding the digestive problems. I've been using apple cider vinegar though.

  • Ella, PPIs featured on Inside Health a few months ago. Doctors are being encouraged to prescribe less frequently and reduce doses/wean patients off where possible. You're prescribed a PPI to reduce stomach acid but many hypothyroid patients actually have low stomach acid. ACV increases stomach acid as does Betaine Pepsin taken before meals and aids digestion for people with low stomach acid.

  • Years ago, my GP (the same one who hadn't a clue until I had to eventually insist on a thyroid test) told me 'nobody has to get stomach ulcers now, we just prescribe Zantac'. And so on - drugs for high blood pressure, high cholesterol, etc. Good thing I finally became cynically aware of what was happening and joined this forum - I'd be ga ga by now.

    I'd advise everyone to take responsibility as far as possible for their own health and research alternatives.

    But still be careful - reading about the miracle of large doses of Vit. D, I noticed that Metformin (a drug for lowering blood sugar in diabetes) was recommended for living longer! This drug is among others that also deplete B12.

  • Yes Martyn Hooper at the conference spoke about a 79 year old diagnosed PA but 'too old to treat'! - grr! Another thing to watch out for in the elderly is a UTI - my Mum had a wonderful memory but was knocked for 6 by an wee infection, antibiotics - vicious circle really.

    We need stomach acid, it kills the nasties and doesn't let them through to the gut but it depletes as we get older - why vinegar on chips, pickles, apperitifs, wine with meals?

    Hubby was about to go on omeprazole but avoided bread/cakes instead & he's fine, if he accidentally gives in & has indigestion - he has a tiny sip of ACV. J :D

    (Ben Goldacre is very interesting too!)

  • Do you have a particular reference?

  • for Dr Ben Goldacre?

    He advocates that "All trials" should be published - only about half are, possibly the half that disproves the other half - lots on you tube J :D

  • This happened to a family member (vegetarian for many years), who became seriously deficient in B12 but was only tested for Alzheimer's (negative) and then referred to memory clinic and ME clinic, even though unable to walk. It was an uphill and frustrating struggle to get the deficiency recognised by GP (helped by the links below) and we are still fighting for more frequent B12 injections to be given.

    There is a lot of research linking B12 deficiency to dementia but the problem is the narrow range of flawed and unreliable tests, together with GPs refusal to acknowledge that neural symptoms precede anaemia, which is the last stage of PA. If not treated urgently, the neural symptoms can lead to irreversible brain damage, e.g. Altzeimer's etc.

    The BMJ and UKNEQAS have recently issued these recommendations, which will hopefully filter through to surgeries:



    An important summary point:

    "If the clinical features suggest deficiency then it is important to treat patients to avoid neurological impairment even if there may be discordance between the test results and clinical features".

  • "In the elderly, it can cause dementia, says David Smith, Professor Emeritus of Pharmacology at Oxford University.

    ‘B12 deficiency is more common after the age of 60 and, once levels fall below 500 pg/ml (picograms per millilitre — the normal range being 500 to 1,000), the brain starts to deteriorate at twice the usual rate, making memory loss six times more likely,’ he says. "

    Read more: dailymail.co.uk/health/arti...

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  • It could be a lack of vitamin B12 which could occur when there is no acid in the stomach to digest properly. It is funny that the B12 doctor, Dr Chandy, has been instructed not to prescribe B12 shortly before the doctors were offered a bonus payment of £55 for each dementia patient diagnosed. This will ensure that there is no way out for people who have B12 deficiency and they are sitting ducks for dementia and all the misery it will bring families and patients. Margaret Thatcher finally got dementia, but I read somewhere that when she was in office she was getting B12 jabs daily.

  • I believe it was also her government that changed the frequency of injections for PA patients from monthly to three monthly !

    The following is an interesting sponse to a BMJ article on B12 deficiency:

    " It may be worth looking closer into three issues: firstly, what were the deficient levels intended to identify? A brief look back at history in the 1940s and 50s shows that pharmaceutical companies interests were related to the identification and treatment of anaemia. A condition, which at the time was believed to precede neurological damage. Yet in the 1960s the metabolic functions of b12 were established and indicated that the neurological damage most likely would precede the anaemia. Yet were the deficient ranges adjusted accordingly? "

    "The second issue relates to treatment and returning the serum b12 levels to normal. Even back in 1926 this was, in respect of the anaemia, recognised as being a symptom that was quickly and easily treated. Yet even then (at a time when the anaemia was thought to precede the neurological damage) the nerve damage proved difficult to treat and reverse fully even with intensive care and treatment. In short, returning a patient's b12 levels to within the normal range has no relationship to whether or not the neuro damage has been resolved."

  • I believe, and you can correct me if i'm wrong, that the B12 deficiency can cause neurological damage if it is left too long, and can be prevented by prompt and adequate treatment. However, once the damage is done it is not reversible.

  • I'm still reeling from the news that Dr Chandy was asked to stop prescribing B12 just before the £ 55 bonus to GPs for dementia was announced - after all the evidence and work on his excellent site - his poor patients !!! It does make you wonder what IS going on?

    You are absolutely right Fennel. Neurological symptoms are permanent if not treated urgently, which is why we were so determined to push for more frequent injections - alas to no avail - completely ignored - and having to supplement with methylcobalamin spray, patches and lozenges in between shots to keep levels high.

  • You can attend a homeopathic hospital on the nhs if you can get your GP to refer you. I went with a knee that was diagnosed as osteoarthritis, and the doctor spent some time with me and discovered it was actually a pronation of the foot causing mechanical problems. I am now working on the feet and the knee is better.

  • I have a homeopathic hospital up the road from me - I am hoping that my GP may refer me. But if the PPI is not helping me would they just refer me to an ENT or gastro as they had suggested? Would you rate a homeopath quite highly?

    If so is it worth taking charge of my health myself rather than letting the GP intervene?

  • Seeing a homeopath is still in the nhs system and I would not count it as taking charge of your health as you are still being looked after by your GP and a nhs hospital. A homeopath is a qualified doctor who takes an extra training in homeopathy, and they still specialise as the one I saw was a rheumatologist. I would rate the homeopath highly because they have more solutions to choose from, and more time to spend with you, mine was with me for an hour on my first appointment. You can give it a try and see if it works for you, you will have to make a special request as they will not automatically refer you there.

  • Thanks for explaining it all to me.

    If I was already under the care of a specialist consultant would they be more likely to refer me then? I am already under an endocrinologist since I was found to have vitiligo.

    What sort of things qualify for a special request? Is it things like symptoms?

  • no there is no qualifying reasons, just ask and hope for the best that the GP will spend some of his budget on it instead of the conventional hospital.

  • I too saw the article late last evening....in Thyroid Lifestyle and was going to post it this morning :-) Thank you for beating me to it !!

    Another pill that is a huge earner for Big Pharma - recently saw the figures for prescribing in the States - but sadly cannot remember what they were or where :-( Maybe someone can resurrect for me !

  • apart from statins?

  • :-)

  • Wow. Have also followed the links from Sparerib and reserved the book by Professor Peter Gøtzsche. This is frightening and obscene - the whole damn pharmaceutical world-domination schtick, and that whilst they torture animals - and for what? I remember 30 years ago reading a book by, of all people, Sidney Sheldon, called 'Bloodline', about the deadly and unbreakable hold of the pharmaceutical industry, and have hated them ever since. Maybe Russell Brand is right!

    Oh, and oddly enough, I was very recently prescribed a PPI for gastric reflux. I read-up on it, saw that it was linked to this condition, changed my diet and guess what? Didn't need to take them, which I hadn't done anyway.

    It's come to something when doctors make you sick.

  • Great. That's not what I wanted to hear :-( I've been on acid lowering drugs for 11 years. I have no choice.

    I know they have really messed up my absorption of iron, Vit B12, Folate and of course magnesium. It's a constant battle to keep on top. Definitely affecting my absorption of thyroid meds too. I only do well on huge doses. I've cut down to just T3 and 12 llbs have piled on :-(

    Dementia is such a horrible disease, so sad for anyone diagnosed with this.

  • Helcaster, elderly is usually defined as >75 :) PPIs are good for people who have high stomach acid which can burn the oesophagus, people who have Barrett's for instance.

  • I'd like to think for gut issues there are healthier alternatives to drugs. Of course if you're prone to ulcers then you would have to take these.

    In my case it's a standard treatment for interstitial cystitis. I've managed to cut my dose by a third for the last 3 years. What annoys me is there is a much better alternative to this treatment, Elmiron, which you ate supposed to get on a named patient basis, but we have the cost issues just like every thing else!

  • I've had various gut issues over the years but eventually managed to avoid drugs, apart from antibiotic treatment for heliocobacter pylori. by altering diet (reducing gluten, sugar, transfats and carbs), supplementing with B12, Vit D and C, and taking the following remedies when needed:

    Cider Vinegar and beetroot for gallstones, migraine and heartburn

    Centaurium herbal drops by A. Vogel for heartburn

    Digestive enzymes with meals

    Swedish bitters for normalising the bowels and digestion.

    Thankfully, I now feel better than ever before and the consolation of knowing that B12, already reducing with age, will hopefully not be depleted further!

  • You did your research Polaris, well done for that! I would like to take cider vinegar but I have to avoid all acids in food and drink too. I don't think there can be any pain free way to get my stomach more acidic.

    I've had a kidney stone which was so painful, I know from a scan there are others forming. I think the lack of acid is definitely contributing.

    Really pleased you're doing so well!

  • I'm so sorry Helcaster - it must be really difficult for you and so painful...

    I vaguely remember reading somewhere about too much protein in the diet being involved with kidney stones (you can't win can you - too little and deficient B12!) Someone I know is presently being treated by a homoeopath after an operation to remove them - hopefully to prevent recurrence.

    PS. I forgot to add high strength probiotics to my list.

  • I can't pretend it's easy, but I'm really good at managing it now. My stones are definitely not protein, I'm naughty and don't eat enough! I was hoping the stone would be analysed so I could know what to avoid. I do drink a lot of milk and I know dairy can be a problem. I was just told by the hospital to drink 3 litres of water a day, and that it's likely I'll pass another. The stone I had got stuck in my ureter and the pain was worse than childbirth. I did read apple cider vinegar can help dissolve them but it's out of the question.

    I do take a good probiotic, it helps a lot with bloating and discomfort. X

  • Perhaps me taking the Omeprazole isn't such a good idea...the GP would only refer me to an ENT or gastro if the Omprazole didn't work. Now there's always a risk that my iron, B12, folate and magnesium could be low! Maybe getting tested for folate, iron, B12 and magnesium might be a good idea once the Omeprazole review has been done.

  • I was put on Omeprazole 14 years ago for a Hiatus Hernia, then 4 years later was told i had Barretts Esophagus.I have to say these tablets do stop heartburn but i wish i did not have to take them (i have cut the dose by half ) i have tried over the last four years to stop them on and off but no joy . And that 's not stopping just for a few days but a few weeks ,i have tried Ranitidine instead ,but have always had to go back to the Omeprazole.

    One thing i did find when not taking these tablets was that as soon as i took my Levo in the morning my heartburn and stomach problems would start .A funny thing is i have had one GP advise me to try and stop them and another say why would you want to do that.

  • It's confusing isn't it. :(

  • Lizzy, Ranitidine is also an acid inhibitor. As you have Barrett's it's probably more important to avoid acid burning the oseophagus but you're also right to take the least amount of Omeprazole you can manage on.

  • Yes ,i just thought maybe the Ranitidine would not be as armfull.

  • At least Ranitidine doesn't mess with your liver enzymes, cimetidine does, and I think that is what is messing with my thyroid meds. I tried ranitidine but my bladder pain came back on day 3 :-( I would like to give it another go with an increase in hydroxyzine which is the other drug I take for my bladder. According to a pharmacist I spoke to ranitidine has less side effects.

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