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The use of gastroprotective agents and the onset of senile dementia - Dr Antonio Giordano

The use of gastroprotective agents and the onset of senile dementia - Dr Antonio Giordano

According to a study published in JAMA Neurology in 2016, a significant number of people who regularly took proton pump inhibitors (PPIs), gastric protectors belonging to the family of pantoprazole, rabeprazole, lansoprazole, or esomeprazole, showed about one and a half times higher risk of "onset of senile dementia." The relationship, or rather the "close correlation," between these drugs and cognitive decline was also observed in a study conducted at the University of Bonn. This study involved continuous observation on a quarterly basis of a population with habitual intake of this class of drugs. The results indicated that the use of PPIs could increase the risk of cognitive decline over time by 30%. The main risk is associated with impaired absorption of vitamin B12 and magnesium, resulting from prolonged PPI usage.

Digestive enzymes require an acidic environment to properly function, but the intake of gastric protectors "neutralizes" acidity, causing damage and contributing to the formation of active macromolecules stimulating the production of inflammatory cytokines, thereby promoting the development of food allergies and intolerances. It's clear that when administration is under strict medical control and for limited duration to absorb excess acidity, significant changes in cognitive impairment and decline do not occur. However, when discussing habitual and prolonged use, this could lead, among other things, to "arthritic" phenomena and an increase in the incidence of femoral fractures in the elderly. Therefore, PPIs should be limited to the "acute phase" of inflammation or gastric acidity, as prolonged use could also be a cause of specific gastrointestinal tract tumours.

Hence, treatment guidelines should not be exceeded, as it has been demonstrated that PPIs contribute to rapid progression of cognitive decline or incidence of senile dementia in those who are already at risk. It is preferable to opt for alternative medications not belonging to the proton pump inhibitor family.

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