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Proton Pump Inhibitor Use and Risk of Dementia in the Veteran Population

There was a statistically significant association between use of proton pump inhibitors and dementia diagnosis in a 11-year retrospective study of patients at the Sioux Falls Veteran Affairs Health Care System.
Federal Practitioner. 2019 June;36(4)s:S27-S31
June 1, 2020|Federal Practitioner
Jenna Welu, PharmD;Justin Metzger, PharmD;Scott Bebensee, PharmD, BCPS;April Ahrendt, MS, RDN, CNSC, LN;Micheal Vasek, MBA
Author and Disclosure Information

Jenna Welu is a Pharmacy Resident, Justin Metzger is Chief of Pharmacy, Scott Bebensee is a Home-Based Primary Care Clinical Pharmacy Specialist, April Ahrendt is a Systems Redesigner, and Micheal Vasek is a Program Analyst, all at the Sioux Falls VA Health Care System in South Dakota. April Ahrendt is an Academic Assistant Professor at the University of South Dakota School of Health Sciences in Vermillion.
Correspondence: Jenna Welu (jenna.donnelly@ jacks.sdstate.edu)

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

This study also had some limitations. First, the causal relationship of PPI use and dementia cannot be proven using a retrospective cohort design. This study’s design can show association, but it cannot prove causation. Also, due to the retrospective design, exposure to PPI use could not be randomized; thus, correlation between PPI use and dementia may be explained by confounding variables that are not captured within this study. This is especially true since the baseline characteristics were not equally distributed between the 2 groups. In fact, the PPI group had higher rates of many clinical comorbidities. This imbalance may have skewed the results of the primary endpoint. Lastly, OTC PPI use and non-VA PPI prescriptions were not available. Therefore, some of the patients included in the non-PPI group may have been PPI users if they received PPIs from OTC or non-VA sources, which could skew the results.

Conclusion

This study showed a significant association between PPI use and dementia within the veteran study population. The study also showed a significant association between PPI use and dementia within the secondary endpoint of individual PPI agent. Higher cumulative dose and duration of PPI use did not seem to increase risk of dementia. Finally, PPI use was not associated with significantly low vitamin B12 levels. More studies are needed to determine causation of dementia and its risk factors.

Acknowledgments
This material is the result of work supported with resources and the use of facilities at the Sioux Falls VA Health Care System.

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