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GeriPal - A Geriatrics and Palliative Care Podcast

Feb 2, 2018

Proton pump inhibitors are one of the most widely used medications. As I note in the podcast below, I was in my local drug store the other day, and an entire shelf segment, top to bottom, was filled with medications for "heartburn," and most of them were proton pump inhibitors. And those are just the over the counter variety. So wouldn't it be a public health disaster if proton pump inhibitors, or PPIs, increased a persons risk for dementia? Even if the increase in dementia risk is only slight, on a population level, given the vast number of people using PPIs, the consequences would be disastrous. A major study in JAMA showed just such a linkage, raising serious alarm about this issue. So with this urgent question in mind, we talk with two authors about their more recent studies in JAGS suggesting that there is no such linkage. We talked with Shelly Gray, from the School of Pharmacy and the University of Washington, and Felicia Goldstein from Emory University, about their studies, the current evidence as a whole, and what an individual on PPI's should think at this time about his or her risk of dementia. Here is the bottom line, for those who can't wait. In response to Eric asking what advice they would give their 75 year old neighbor who is taking PPI's, Dr. Gray said: I would tell her that the information is conflicting, but some really high quality studies have been done and have not found an association, and if this medication is necessary to manage her condition, that she should continue taking it. However, I will say that we do know that these medications are overused, and so I still believe in the tenet of geriatric medicine that we try to deprescribe when possible, so I would try to reassure her and let her know that it's not a done deal and that the high quality studies do indicate that there doesn't seem to be an association.