Haenisch Britta, von Holt Klaus, Wiese Birgitt, Prokein Jana, Lange Carolin, Ernst Annette, Brettschneider Christian, König Hans-Helmut, Werle Jochen, Weyerer Siegfried, Luppa Melanie, Riedel-Heller Steffi G, Fuchs Angela, Pentzek Michael, Weeg Dagmar, Bickel Horst, Broich Karl, Jessen Frank, Maier Wolfgang, Scherer Martin
German Center for Neurodegenerative Diseases (DZNE), c/o Federal Institute for Drugs and Medical Devices (BfArM), Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany,
Eur Arch Psychiatry Clin Neurosci. 2015 Aug;265(5):419-28. doi: 10.1007/s00406-014-0554-0. Epub 2014 Oct 24.
Drugs that modify the risk of dementia in the elderly are of potential interest for dementia prevention. Proton pump inhibitors (PPIs) are widely used to reduce gastric acid production, but information on the risk of dementia is lacking. We assessed association between the use of PPIs and the risk of dementia in elderly people. Data were derived from a longitudinal, multicenter cohort study in elderly primary care patients, the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe), including 3,327 community-dwelling persons aged ≥ 75 years. From follow-up 1 to follow-up 4 (follow-up interval 18 months), we identified a total of 431 patients with incident any dementia, including 260 patients with Alzheimer's disease. We used time-dependent Cox regression to estimate hazard ratios of incident any dementia and Alzheimer's disease. Potential confounders included in the analysis comprised age, sex, education, the Apolipoprotein E4 (ApoE4) allele status, polypharmacy, and the comorbidities depression, diabetes, ischemic heart disease, and stroke. Patients receiving PPI medication had a significantly increased risk of any dementia [Hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.04-1.83] and Alzheimer's disease (HR 1.44, 95% CI 1.01-2.06) compared with nonusers. Due to the major burden of dementia on public health and the lack of curative medication, this finding is of high interest to research on dementia and provides indication for dementia prevention.
能够改变老年人患痴呆症风险的药物对于预防痴呆症具有潜在意义。质子泵抑制剂（PPIs）被广泛用于减少胃酸分泌，但关于其与痴呆症风险的信息却很缺乏。我们评估了使用质子泵抑制剂与老年人患痴呆症风险之间的关联。数据来自一项针对老年初级保健患者的纵向多中心队列研究，即德国初级保健患者衰老、认知与痴呆研究（AgeCoDe），该研究纳入了3327名年龄≥75岁的社区居住者。从随访1到随访4（随访间隔为18个月），我们共识别出431例新发任何类型痴呆症的患者，其中包括260例阿尔茨海默病患者。我们使用时间依赖性Cox回归来估计新发任何类型痴呆症和阿尔茨海默病的风险比。分析中纳入的潜在混杂因素包括年龄、性别、教育程度、载脂蛋白E4（ApoE4）等位基因状态、多种药物联合使用情况以及抑郁症、糖尿病、缺血性心脏病和中风等合并症。与未使用质子泵抑制剂的患者相比，使用质子泵抑制剂药物的患者患任何类型痴呆症的风险显著增加[风险比（HR）1.38，95%置信区间（CI）1.04 - 1.83]，患阿尔茨海默病的风险也显著增加（HR 1.44，95% CI 1.01 - 2.06）。鉴于痴呆症对公共卫生造成的重大负担以及缺乏治愈性药物，这一发现对痴呆症研究具有高度意义，并为痴呆症预防提供了线索。
