Dementia is developing into a global pandemic, with our country being at the “core” of the evolving problem due to the rapid aging of the population. Under these conditions, the scientific community is working at an intensive pace, looking for effective treatments on the one hand and documented aggravating factors on the other, which, if modified, can significantly prevent or delay the onset of the disease.
In this context, the results of a new study add an important piece to the puzzle of the possible causes that trigger dementia. In a large study involving nearly two million volunteers, Danish researchers found evidence to suggest that certain antacid drugs may increase the risk of dementia.
These drugs are called proton pump inhibitors (PPIs) and are given to treat GERD. However, it is important to underline that the specific conclusions are not surprising. Previous research has also found that people taking the drugs for more than 4½ years may be at higher risk. However, the “pool” of participants was limited as it did not exceed 5,712 volunteers. Fatefully, the event left unanswered questions and room for… second thoughts.
In the new study published last month in the medical journal “Alzheimer’s & Dementia”, Danish researchers put a much larger number of participants under their microscope, and the correlations open a new circle of thought.
To conduct the study, the scientists recruited 1,983,785 people aged 60 to 75, who at the start of the research – which lasted from 2000 to 2018 – had not been diagnosed with dementia or were not receiving treatment for the disease .
Then, and since PPIs are prescription drugs in Denmark, the researchers used this data to determine which participants had filled such prescriptions and with what frequency.
The data showed that, on average, participants who used PPIs started taking them when they were about 68 years old. The Danish scientists then analyzed the data, weighing important parameters such as the age, gender and level of education of the individuals. In addition, the health status of the participants was taken into account, such as whether they suffer from any chronic diseases such as diabetes, cardiovascular diseases and high blood pressure.
During the follow-up period, 99,384 participants developed dementia. 55.4% were women and the median age at diagnosis was 79 years (74 to 83 years) for women and 77 years (72 to 82 years) for men. Among those who developed dementia, about 21.2% filled at least two prescriptions of PPIs compared to 18.9% in the non-dementia group.
But the scientists concluded that the use of PPIs is associated with an increased risk for two additional reasons. The incidence of dementia was more pronounced in those participants who had been taking the specific antacid drugs for more than 15 years. Additionally, the increased risk was highest in participants aged 60 to 69 and lowest in older people.
The possible causes
The scientists argue that one possible explanation is that PPIs may affect brain cells through various mechanisms, such as increasing the levels of beta-amyloid, which is believed to be involved in the development of Alzheimer’s disease.
In addition, and drawing relevant data from other researches, they note that the side effects of the use of the specific drugs used for peptic ulcer, also include neurological conditions. For example, they have been associated with migraines, peripheral neuropathy as well as vision, hearing and memory disorders.
Indicatively, the authors cite the findings of their study as another earlier study that showed that PPIs can selectively inhibit the enzyme responsible for the synthesis of acetylcholine – a brain neurotransmitter that transmits messages between nerve cells. Therefore, its selective inhibition may prevent this transmission, the researchers note in their article.
The limitations of the research
Although the conclusions of the new study are cause for concern, the researchers also acknowledge the limitations. For example, the data included prescriptions of PPIs that began to be prescribed since 1995. However, other important elements are excluded from the analysis, such as the use of corresponding non-prescription preparations as well as their in-hospital use. Consequently, incomplete recording of the use of PPIs may have led to an underestimation of their intake as well as a misclassification of participants who were taking these preparations and those who were not.
Finally, the researchers themselves point out that their study showed a simple correlation and emphasize that more studies are needed to determine whether proton pump inhibitors actually contribute to the development of dementia.
In any case, this is an important finding given that worldwide, the use of these drugs has increased significantly in the last two decades, mainly among people aged 40 and over. In fact, many studies have shown – as underlined in the same publication – that these drugs are abused, as in 50% of cases their use is not based on their indications.
The “scourge” of dementia
It is noted that today 450,000 Greeks suffer from dementia and related disorders (AKSD). According to the relevant estimates, Greece will be significantly affected in the coming years since soon 1/4 of the population will be over 60 years old. It is also noteworthy that for each patient 2-3 members of his family need to take care of him for long-term care (5-15 years), so more than 10% of Greeks are sick or work daily as caregivers.
Accordingly, worldwide, it is estimated that there are currently 50 million people living with dementia, a number that will also increase dramatically in the future due to the increase in life expectancy in both developed and developing countries.
Alzheimer’s disease is the most common cause of dementia (60-70% of all). Other neurological entities that lead to dementia are vascular dementia (dementia due to strokes), parkinsonian dementia (dementia as a result of Parkinson’s disease), dementia with Lewy bodies, frontotemporal dementia, etc.