Uso prolongado de inibidor de bomba de prótons e sua relação com a demência em idosos: uma revisão sistemática.

Abstract

Dementia is one of the main causes of disability in old age and is considered by the World Health Organization (WHO) as a public health concern. Due to its important social and economic repercussions, studies related to the possible risks of such disorder have shown that prolonged use of Proton-pump Inhibitors (PPI) may be associated with cognitive impairment. Aim: To analyze the association between prolonged use of PPI and the development of cognitive impairment and dementia. Methods: This study comprised search in electronic databases - Scopus, PubMed and BVS (MEDLINE and LILACS). Only original case-control, transverse cohort or cohort studies were selected, which should be in English, Portuguese or Spanish; published until March 2017; and whose aimed to analyze the PPI association with cognitive alterations in the elderly. Results: The risk of dementia related to the use of PPIs was evident in all studies analysed, being slightly more pronounced in males when compared to females. Discussion: Studies demonstrated that PPIs can reduce the brain mononuclear phagocytic system activity as well as increase enzyme β-secretase BACE1 activity, resulting in accumulation of beta-amyloid peptides. Another possible relationship between PPI and dementia regards vitamin B12 deficiency. Decreased gastric acid production induced by PPI could perhaps lead to poor absorption of this vitamin, as a consequence, DNA synthesis gets impaired. Although there is little published research on the effects of PPIs on human beings and their relation to cognitive impairments, most of them presents with observationald design; after exclusion of potential confounders, the studies analyzed were in agreement with the risk of increased incidence of dementia associated with chronic use of PPI. Conclusion: Based on the results, it is possible to conclude that the use of PPIs is associated with increased risk of dementia, however this literature review displayed limited results due to the small number of studies selected by the previously established criteria for the research as well as due to the predominant observational study-design in such studies.