Lack of association between proton pump inhibitor use and brain aging: a cross-sectional study

Nayeon Ahn,Markus M Lerch,Henry Völzke,Christa Meisinger,Stefan Frenzel,Jakob Linseisen,Michael Nolde,Ina-Maria Rückert-Eheberg,Hans Jörgen Grabe,Ulf Schminke,Sebastian E Baumeister,Jean-Francois Chenot,Robin Bülow,Katharina Wittfeld,Ute Amann

doi:10.1007/s00228-020-03068-8

Abstract

PurposeDue to conflicting scientific evidence for an increased risk of dementia by intake of proton pump inhibitors (PPIs), this study investigates associations between PPI use and brain volumes, estimated brain age, and cognitive function in the general population.MethodsTwo surveys of the population-based Study of Health in Pomerania (SHIP) conducted in Northeast Germany were used. In total, 2653 participants underwent brain magnetic resonance imaging (MRI) and were included in the primary analysis. They were divided into two groups according to their PPI intake and compared with regard to their brain volumes (gray matter, white matter, total brain, and hippocampus) and estimated brain age. Multiple regression was used to adjust for confounding factors. Cognitive function was evaluated by the Verbal Learning and Memory Test (VLMT) and the Nuremberg Age Inventory (NAI) and put in relation to PPI use.ResultsNo association was found between PPI use and brain volumes or the estimated brain age. The VLMT score was 1.11 lower (95% confidence interval: − 2.06 to − 0.16) in immediate recall, and 0.72 lower (95% CI: − 1.22 to − 0.22) in delayed recall in PPI users than in non-users. PPI use was unrelated to the NAI score.ConclusionsThe present study does not support a relationship between PPI use and brain aging.

Highlights

Much attention in the medical and scientific communities has been paid to suspected associations of proton pump inhibitors (PPIs) with adverse effects, since PPIs are widely used for gastric acid–related disorders, often over-prescribed and sold over the counter [1, 2]
We conducted an analysis of PPI use in relation to brain volumes and estimated brain age derived from magnetic resonance imaging (MRI) [11,12,13]
We further evaluated the modifying effects of age on PPI use for brain volumes, estimated brain age, and verbal memory tests

Summary

Introduction

Much attention in the medical and scientific communities has been paid to suspected associations of proton pump inhibitors (PPIs) with adverse effects, since PPIs are widely used for gastric acid–related disorders, often over-prescribed and sold over the counter [1, 2]. In view of the fact that dementia is a common and burdensome disease in aging societies, it is crucial to identify avoidable risk factors such as specific pharmaceutical agents [3]. Plausible pathophysiological pathways of brain deterioration that PPIs might be involved in have been described [4], previous researches have revealed conflicting evidence for a link between PPI use and the risk of dementia and cognitive decline [5,6,7]. We conducted an analysis of PPI use in relation to brain volumes and estimated brain age derived from magnetic resonance imaging (MRI) [11,12,13]. We evaluated the association between PPI use and cognitive function

Methods

Results

Conclusion