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Comment & Response |

Proton Pump Inhibitors and Dementia Incidence

William D. Freeman, MD1,2,3
[+] Author Affiliations
1Department of Critical Care, Mayo Clinic, Jacksonville, Florida
2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
3Department of Neurology, Mayo Clinic, Jacksonville, Florida
JAMA Neurol. 2016;73(8):1026-1027. doi:10.1001/jamaneurol.2016.1503.
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To the Editor I read with interest the article by Gomm et al1 investigating the association of proton pump inhibitors and dementia. The authors are to be commended for their large data set, analysis, and detailed proposed pathophysiologic mechanism by which this association might occur. However, 2 important medical comorbidities seem to be missing from their study: gastroesophageal reflux disease and obstructive sleep apnea. Both of these comorbidities can cause cognitive issues, especially in those with apolipoprotein E genetic variants2 and those who have had a stroke. Gastroesophageal reflux disease would constitute the reason patients took a proton pump inhibitor but could also be a surrogate for obesity, increased body mass index, and comorbid obstructive sleep apnea. Obstructive sleep apnea is a known risk factor for nocturnal hypoxic episodes and could, in theory, be covariate to help explain why this association may be statistically present.

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Correspondence

August 1, 2016
David Louis Keller, MD
1Lomita, California
JAMA Neurol. 2016;73(8):1025. doi:10.1001/jamaneurol.2016.1488.
August 1, 2016
Tomoyuki Kawada, MD
1Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
JAMA Neurol. 2016;73(8):1025-1026. doi:10.1001/jamaneurol.2016.1491.
August 1, 2016
Helge L. Waldum, MD, PhD; Tom Christian Martinsen, MD, PhD
1Norwegian University of Science and Technology2Department of Gastroenterology and Liver Diseases, St Olavs Hospital, Trondheim, Norway
JAMA Neurol. 2016;73(8):1026. doi:10.1001/jamaneurol.2016.1497.
August 1, 2016
Jineane V. Venci, PharmD, BCACP; Katherine W. Eisenberg, MD, PhD
1University of Rochester Medical Center, Rochester, New York
JAMA Neurol. 2016;73(8):1026. doi:10.1001/jamaneurol.2016.1500.
August 1, 2016
Kanika Sharma, MD; Alireza Minagar, MD; Hai Sun, MD, PhD
1Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport
2Department of Neurology, Louisiana State University Health Sciences Center, Shreveport
JAMA Neurol. 2016;73(8):1027. doi:10.1001/jamaneurol.2016.1959.
August 1, 2016
Long Nguyen, MD, MS; Chin Hur, MD, MPH
1Gastroenterology, Massachusetts General Hospital, Boston
JAMA Neurol. 2016;73(8):1027-1028. doi:10.1001/jamaneurol.2016.1962.
August 1, 2016
Willy Gomm, PhD; Britta Haenisch, PhD
1German Center for Neurodegenerative Diseases, Bonn, Germany
JAMA Neurol. 2016;73(8):1028-1029. doi:10.1001/jamaneurol.2016.1494.
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