Science

Nelsan Pourhadi, Janet Janbek, Christina Jensen-Dahm, Christiane Gasse, Thomas Munk Laursen, Gunhild Waldemar

INTRODUCTION
Proton pump inhibitors (PPIs) may increase dementia risk. However, it is currently unknown whether timing of exposure or age at dementia diagnosis influence the risk.

METHODS
We assessed associations between cumulative PPI use and dementia at different ages in a nationwide Danish cohort of 1,983,785 individuals aged 60 to 75 years between 2000 and 2018.

RESULTS
During follow-up, there were 99,384 all-cause dementia incidences. Incidence rate ratio (IRR) of dementia with PPI ever-use compared with never-use was 1.36 (95% CI, 1.29 to 1.43) for age 60 to 69 years at diagnosis, 1.12 (1.09 to 1.15) for 70 to 79 years, 1.06 (1.03 to 1.09) for 80 to 89 years, and 1.03 (0.91 to 1.17) for 90+ years. Longer treatment duration yielded increasing IRRs. For cases below 90 years, increased dementia rate was observed regardless of treatment initiation up to >15 years before diagnosis.

DISCUSSION
Regardless of timing of treatment initiation, PPI use was associated with increased dementia rate before age 90 years. Dementia rates increased with younger age at diagnosis.

HIGHLIGHTS
After following 1,983,785 individuals for a median of 10 years, 99,384 developed dementia

PPIs were used by 21.2% of cases and 18.9% of controls

PPI use was associated with increased dementia rate regardless of time of treatment onset

Magnitude of associations increased with younger age at diagnosis

PPI use was not associated with dementia occurring after age 90 years