No association between proton pump inhibitors use and risk of dementia: evidence from a meta-analysis

Introduction: A growing body of literature suggests the association between dementia risk and proton pump inhibitors (PPIs) use. Therefore, we aimed to investigate the association between PPI use and dementia risk.

Methods: An extensive literature search was performed in PubMed, Embase, and Cochrane till 31st March 2019. All the studies (cohort, case-control) assessing the association between PPI use and dementia risk was eligible for inclusion. Articles were selected based on the screening of title and abstract, data were extracted and risk of bias was assessed using Newcastle-Ottawa Scale. The primary outcome was pooled risk of dementia among PPI user as compared to non-PPI user. Secondary outcomes include dementia risk based on subgroups. Statistical analysis was performed using Review Manager software.

Results: Twelve studies (eight cohort and four case-control) were found to be eligible for inclusion. Majority of the studies were of high quality. Dementia was diagnosed based on ICD-9/10 codes in majority of the included studies. PPI use was not associated with the dementia risk, with a pooled relative risk (RR) of 1.05 (95% CI: 0.96 - 1.15), p = 0.31. Subgroup analysis based on study design [Cohort: p = 0.14; Case control: p = 0.14], sex [RR 1.25 (95% CI: 0.97 - 1.60), p = 0.08)], H2RA blockers (p = 0.93) and for Alzheimer's disease (AD) [RR 1.00 (95% CI: 0.91 - 1.09), p = 0.93)] revealed no significant association between PPI use and dementia risk.

Conclusion: We found no significant association between PPI use and the risk of dementia or AD.