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Time-Varying Use of Proton Pump Inhibitors and Cognitive Impairment and Dementia: A Real-World Analysis from Germany

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Abstract

Background

Cumulative evidence of dementia risk in patients taking proton pump inhibitors (PPIs) is still inconclusive, probably due to a variety of study designs.

Objective

This study aimed to compare how the association between dementia risk and use of PPIs differs by different outcome and exposure definitions.

Methods

We conceptualized a target trial using claims data with 7,696,127 individuals aged 40 years or older without previous dementia or mild cognitive impairment (MCI) from the Association of Statutory Health Insurance Physicians in Bavaria. Dementia was defined as either including or excluding MCI to compare how the results alter by different outcome definitions. We used weighted Cox models to estimate the PPI initiation effect on dementia risk and weighted pooled logistic regression to assess the effect of time-varying use versus non-use during 9 years of study period, including 1 year of wash-out period (2009–2018). The median follow-up time of PPI initiators and non-initiators was 5.4 and 5.8 years, respectively. We also evaluated the association between each PPI agent (omeprazole, pantoprazole, lansoprazole, esomeprazole, and combined use) and dementia risk.

Results

A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk. A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk.A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk.A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk.A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk.A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk.A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk.A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk.A total of 105,220 (3.6%) PPI initiators and 74,697 (2.6%) non-initiators were diagnosed with dementia. Comparing PPI initiation with no initiation, the hazard ratio (HR) for dementia was 1.04 [95% confidence interval (CI) 1.03–1.05]. The HR for time-varying PPI use versus non-use was 1.85 (1.80–1.90). When MCI was included in the outcome, the number of outcomes increased to 121,922 in PPI initiators and 86,954 in non-initiators, but HRs remained similar, showing 1.04 (1.03–1.05) and 1.82 (1.77–1.86), respectively. Pantoprazole was the most frequently used PPI agent. Although the estimated HRs for the time-varying use effect of each PPI showed different ranges, all agents were associated with an increased dementia risk.

Conclusion

Our large study supports existing evidence that PPI use is related to an increased risk of dementia.

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References

  1. Lassalle M, Le Tri T, Bardou M, Biour M, Kirchgesner J, Rouby F, et al. Use of proton pump inhibitors in adults in France: a nationwide drug utilization study. Eur J Clin Pharmacol. 2020;76:449–57.

    CAS  PubMed  Google Scholar 

  2. Rückert-Eheberg IM, Nolde M, Ahn N, Tauscher M, Gerlach R, Güntner F, et al. Who gets prescriptions for proton pump inhibitors and why? A drug-utilization study with claims data in Bavaria, Germany, 2010–2018. Eur J Clin Pharmacol. 2021;78:657–67.

    PubMed  PubMed Central  Google Scholar 

  3. Kumar R, Kumar A, Nordberg A, Långström B, Darreh-Shori T. Proton pump inhibitors act with unprecedented potencies as inhibitors of the acetylcholine biosynthesizing enzyme-A plausible missing link for their association with incidence of dementia. Alzheimers Dement. 2020;16:1031–42.

    PubMed  Google Scholar 

  4. Ortiz-Guerrero G, Amador-Munoz D, Calderon-Ospina CA, López-Fuentes D, Nava-Mesa MO. Proton pump inhibitors and dementia: physiopathological mechanisms and clinical consequences. Neural Plast. 2018;2018:5257285.

    PubMed  PubMed Central  Google Scholar 

  5. Ahn N, Nolde M, Günter A, Güntner F, Gerlach R, Tauscher M, et al. Emulating a target trial of proton pump inhibitors and dementia risk using claims data. Eur J Neurol. 2022;29(5):1335–43.

    PubMed  Google Scholar 

  6. Chen LY, Lin HJ, Wu WT, Chen YC, Chen CL, Kao J, et al. Clinical use of acid suppressants and risk of dementia in the elderly: a pharmaco-epidemiological cohort study. Int J Environ Res Public Health. 2020;17:8271.

    PubMed  PubMed Central  Google Scholar 

  7. Lin H-C, Huang K-T, Lin H-L, Uang Y-S, Ho Y, Keller JJ, et al. Use of gastric acid–suppressive agents increases the risk of dementia in patients with upper gastrointestinal disease: a population-based retrospective cohort study. PLoS One. 2021;16: e0249050.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Torres-Bondia F, Dakterzada F, Galván L, Buti M, Besanson G, Gill E, et al. Proton pump inhibitors and the risk of Alzheimer’s disease and non-Alzheimer’s dementias. Sci Rep. 2020;10:21046.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Weiss A, Gingold-Belfer R, Boltin D, Beloosesky Y, Koren-Morag N, Meyerovitch J, et al. Chronic omeprazole use in the elderly is associated with decreased risk of dementia and cognitive decline. Dig Liver Dis. 2021;54:622–8.

    PubMed  Google Scholar 

  10. Wu CL, Lei WY, Wang JS, Lin CE, Chen CL, Wen SH. Acid suppressants use and the risk of dementia: a population-based propensity score-matched cohort study. PLoS One. 2020;15: e0242975.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Wang H, Tian L, Yan X. No association between acid suppressant use and risk of dementia: an updated meta-analysis. Eur J Clin Pharmacol. 2022;78:375–82.

    CAS  PubMed  Google Scholar 

  12. Yoon KB, Bang CS, Kim JS. Proton-pump inhibitors and the risk of dementia: a systematic review and meta-analysis. Korean J Helicobacter Up Gastrointest Res. 2021;21:135–43.

    Google Scholar 

  13. Cooksey R, Kennedy J, Dennis MS, Escott-Price V, Lyons RA, Seaborne M, et al. Proton pump inhibitors and dementia risk: evidence from a cohort study using linked routinely collected national health data in Wales, UK. PLoS One. 2020;15: e0237676.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Goldstein FC, Steenland K, Zhao L, Wharton W, Levey AI, Hajjar I. Proton pump inhibitors and risk of mild cognitive impairment and dementia. J Am Geriatr Soc. 2017;65:1969–74.

    PubMed  PubMed Central  Google Scholar 

  15. Wu B, Hu Q, Tian F, Wu F, Li Y, Xu T. A pharmacovigilance study of association between proton pump inhibitor and dementia event based on FDA adverse event reporting system data. Sci Rep. 2021;11:10709.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Herghelegiu AMP, Prada GI, Nacu R. Prolonged use of proton pump inhibitors and cognitive function in older adults. Farmacia. 2016;64:262–7.

    CAS  Google Scholar 

  17. Lochhead P, Hagan K, Joshi AD, Khalili H, Nguyen LH, Grodstein F, et al. Association between proton pump inhibitor use and cognitive function in women. Gastroenterology. 2017;153:971-9.e4.

    CAS  PubMed  Google Scholar 

  18. Wod M, Hallas J, Andersen K, García Rodríguez LA, Christensen K, Gaist D. Lack of association between proton pump inhibitor use and cognitive decline. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2018;16:681–9.

    CAS  Google Scholar 

  19. Canevelli M, Grande G, Lacorte E, Quarchioni E, Cesari M, Mariani C, et al. Spontaneous reversion of mild cognitive impairment to normal cognition: a systematic review of literature and meta-analysis. J Am Med Dir Assoc. 2016;17:943–8.

    PubMed  Google Scholar 

  20. Taylor DH Jr, Østbye T, Langa KM, Weir D, Plassman BL. The accuracy of Medicare claims as an epidemiological tool: the case of dementia revisited. J Alzheimers Dis. 2009;17:807–15.

    PubMed  PubMed Central  Google Scholar 

  21. Booker A, Jacob LE, Rapp M, Bohlken J, Kostev K. Risk factors for dementia diagnosis in German primary care practices. Int Psychogeriatr. 2016;28:1059–65.

    PubMed  Google Scholar 

  22. Gamelas V, Salvado V, Dias L. Prescription pattern of proton pump inhibitors at hospital admission and discharge. GE Port J Gastroenterol. 2019;26:114–20.

    PubMed  Google Scholar 

  23. Hayes KN, Nakhla NR, Tadrous M. Further evidence to monitor long-term proton pump inhibitor use. JAMA Netw Open. 2019;2:e1916184-e.

  24. Taipale H, Tolppanen AM, Tiihonen M, Tanskanen A, Tiihonen J, Hartikainen S. No association between proton pump inhibitor use and risk of Alzheimer’s disease. Am J Gastroenterol. 2017;112:1802–8.

    CAS  PubMed  Google Scholar 

  25. Imfeld P, Bodmer M, Jick SS, Meier CR. Proton pump inhibitor use and risk of developing Alzheimer’s disease or vascular dementia: a case-control analysis. Drug Saf. 2018;41:1387–96.

    CAS  PubMed  Google Scholar 

  26. Chaibi S, Schulze Ehring F, Verband der Privaten Krankenversicherung e.V. PKV-Regionalatlas Bayern: Regionale Bedeutung der Privatversicherten für die medizinische Versorgung unter besonderer Berücksichtigung des ländlichen Raum. 2019.

  27. The Bavarian Association of Statutory Health Insurance Physicians About Us. https://www.kvb.de/fileadmin/kvb/dokumente/UeberUns/KVB-About-us.pdf. Accessed 13 Feb 2023.

  28. Knopman DS. Young-onset dementia—new insights for an underappreciated problem. JAMA Neurol. 2021;78(9):1055–6.

    PubMed  Google Scholar 

  29. Hernan MA, Robins JM. Using big data to emulate a target trial when a randomized trial is not available. Am J Epidemiol. 2016;183:758–64.

    PubMed  PubMed Central  Google Scholar 

  30. Danaei G, Rodriguez LA, Cantero OF, Logan R, Hernan MA. Observational data for comparative effectiveness research: an emulation of randomised trials of statins and primary prevention of coronary heart disease. Stat Methods Med Res. 2013;22:70–96.

    PubMed  Google Scholar 

  31. Ohneberg K, Beyersmann J, Schumacher M. Exposure density sampling: dynamic matching with respect to a time-dependent exposure. Stat Med. 2019;38:4390–403.

    PubMed  Google Scholar 

  32. Panageas KS, Ben-Porat L, Dickler MN, Chapman PB, Schrag D. When you look matters: the effect of assessment schedule on progression-free survival. JNCI: J Natl Cancer Inst. 2007;99:428–32.

    PubMed  Google Scholar 

  33. (ZI), Z.f.d.k.V.i.d.B.D. Demenz Zi-Kodier_Manual. 2020. https://www.zi.de/fileadmin/images/content/Kodierhilfe/Kodierrmanual_Demenz.pdf. Accessed 10 Feb 2023.

  34. VanderWeele TJ. Principles of confounder selection. Eur J Epidemiol. 2019;34:211–9.

    PubMed  PubMed Central  Google Scholar 

  35. Budson AE, Kowall NW. The handbook of Alzheimer’s disease and other dementias. West Sussex: Blackwell Publishing Ltd; 2011.

    Google Scholar 

  36. Hainmueller J. Entropy balancing for causal effects: a multivariate reweighting method to produce balanced samples in observational studies. Polit Anal. 2012;20:25–46.

    Google Scholar 

  37. Matschinger H, Heider D, König HH. A comparison of matching and weighting methods for causal inference based on routine health insurance data, or: what to do if an RCT is impossible. Gesundheitswesen. 2020;82(S 02):s139–s50.

  38. Cole SR, Hernán MA. Adjusted survival curves with inverse probability weights. Comput Methods Programs Biomed. 2004;75:45–9.

    PubMed  Google Scholar 

  39. Weuve J, Proust-Lima C, Power MC, Gross AL, Hofer SM, Thiébaut R, et al. Guidelines for reporting methodological challenges and evaluating potential bias in dementia research. Alzheimers Dement. 2015;11:1098–109.

    PubMed  PubMed Central  Google Scholar 

  40. Belviso N, Zhang Y, Aronow HD, Wyss R, Barbour M, Kogut S, et al. Addressing posttreatment selection bias in comparative effectiveness research, using real-world data and simulation. Am J Epidemiol. 2022;191:331–40.

    PubMed  Google Scholar 

  41. Tran T, Suissa S. Comparing new-user cohort designs: the example of proton pump inhibitor effectiveness in idiopathic pulmonary fibrosis. Am J Epidemiol. 2021;190:928–38.

    PubMed  Google Scholar 

  42. Hernán MA, Brumback B, Robins JM. Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men. Epidemiology. 2000;11:561–70.

    PubMed  Google Scholar 

  43. Mansournia MA, Etminan M, Danaei G, Kaufman JS, Collins G. Handling time varying confounding in observational research. BMJ. 2017;359: j4587.

    PubMed  Google Scholar 

  44. Fewell Z, Hernán MA, Wolfe F, Tilling K, Choi H, Sterne JAC. Controlling for time-dependent confounding using marginal structural models. Stata J. 2004;4:402–20.

    Google Scholar 

  45. VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;167:268–74.

    PubMed  Google Scholar 

  46. Desai M, Nutalapati V, Srinivasan S, Fathallah J, Dasari C, Chandrasekhar VT, et al. Proton pump inhibitors do not increase the risk of dementia: a systematic review and meta-analysis of prospective studies. Dis Esophagus. 2020;33:doaa041.

  47. Zhang Y, Liang M, Sun C, Song EJ, Cheng C, Shi T, et al. Proton pump inhibitors use and dementia risk: a meta-analysis of cohort studies. Eur J Clin Pharmacol. 2020;76:139–47.

    CAS  PubMed  Google Scholar 

  48. Pazzagli L, Linder M, Zhang M, Vago E, Stang P, Myers D, et al. Methods for time-varying exposure related problems in pharmacoepidemiology: an overview. Pharmacoepidemiol Drug Saf. 2018;27:148–60.

    PubMed  Google Scholar 

  49. Thomson AB. Are the orally administered proton pump inhibitors equivalent? A comparison of lansoprazole, omeprazole, pantoprazole, and rabeprazole. Curr Gastroenterol Rep. 2000;2:482–93.

    CAS  PubMed  Google Scholar 

  50. Gray SL, Walker RL, Dublin S, Yu O, Aiello Bowles EJ, Anderson ML, et al. Proton pump inhibitor use and dementia risk: prospective population-based study. J Am Geriatr Soc. 2018;66:247–53.

    PubMed  Google Scholar 

  51. Tai SY, Chien CY, Wu DC, Lin KD, Ho BL, Chang YH, et al. Risk of dementia from proton pump inhibitor use in Asian population: a nationwide cohort study in Taiwan. PLoS One. 2017;12: e0171006.

    PubMed  PubMed Central  Google Scholar 

  52. Yoshida K, Solomon DH, Kim SC. Active-comparator design and new-user design in observational studies. Nat Rev Rheumatol. 2015;11:437–41.

    CAS  PubMed  PubMed Central  Google Scholar 

  53. The European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) Guide on Methodological Standards in Pharmacoepidemiology (Revision 10). https://www.encepp.eu/standards_and_guidances/documents/methodologicalGuideFullRevision10.pdf. Accessed 10 Feb 2023

  54. Gau SY, Lai JN, Yip HT, Wu MC, Wei JC. Higher dementia risk in people with gastroesophageal reflux disease: a real-world evidence. Front Aging Neurosci. 2022;14: 830729.

    PubMed  PubMed Central  Google Scholar 

  55. Kowalski K, Mulak A. Brain-gut-microbiota axis in Alzheimer’s disease. J Neurogastroenterol Motil. 2019;25:48–60.

    PubMed  PubMed Central  Google Scholar 

  56. Saji N, Murotani K, Hisada T, Kunihiro T, Tsuduki T, Sugimoto T, et al. Relationship between dementia and gut microbiome-associated metabolites: a cross-sectional study in Japan. Sci Rep. 2020;10:8088.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Myers JA, Rassen JA, Gagne JJ, Huybrechts KF, Schneeweiss S, Rothman KJ, et al. Effects of adjusting for instrumental variables on bias and precision of effect estimates. Am J Epidemiol. 2011;174:1213–22.

    PubMed  PubMed Central  Google Scholar 

  58. Joling KJ, Janssen O, Francke AL, Verheij RA, Lissenberg-Witte BI, Visser PJ, et al. Time from diagnosis to institutionalization and death in people with dementia. Alzheimers Dement. 2020;16(4):662–71.

    PubMed  PubMed Central  Google Scholar 

  59. Park SK, Nam JH, Lee H, Chung H, Lee EK, Shin JY. Beyond uncertainty: negative findings for the association between the use of proton pump inhibitors and risk of dementia. J Gastroenterol Hepatol. 2019;34(12):2135–43.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany

    Nayeon Ahn & Jakob Linseisen

  2. Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany

    Nayeon Ahn, Nina Wawro, Christa Meisinger & Jakob Linseisen

  3. Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany

    Nina Wawro & Ina-Maria Rückert-Eheberg

  4. Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany

    Sebastian-Edgar Baumeister & Michael Nolde

  5. Association of Statutory Health Insurance Physicians in Bavaria (Kassenärztliche Vereinigung Bayerns, KVB), Munich, Germany

    Roman Gerlach & Martin Tauscher

  6. AOK Bayern, Munich, Germany

    Alexander Günter & Florian Güntner

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Funding

This study was supported by the Innovation Committee at the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA), the highest decision-making body of the joint self-government of physicians, dentists, hospitals, and health insurance funds in Germany (grant no. 01VSF18013). The funding agency played no role in the design, methods, data collections, analysis, and preparation of this article.

Competing interests

The authors declare no competing interests.

Author contributions

NA: study design, statistical analysis, interpretation of data, and writing and revising the manuscript; NW: statistical analysis, interpretation of data, and critical review of manuscript; SB: interpretation of data and critical review of manuscript; MN: interpretation of data and critical review of manuscript, RG: interpretation of data and critical review of manuscript; MT: interpretation of data and critical review of manuscript; AG: acquisition and interpretation of data and critical review of manuscript; FG: acquisition and interpretation of data and critical review of manuscript; IR: interpretation of data and critical review of manuscript; CM: study design, interpretation of data, and critical review of manuscript; JL: study design, interpretation of data, and critical review of manuscript.

Data availability statement

The data that support the findings of this study are available from the KVB (German: Kassenärztliche Vereinigung Bayerns; Association of Statutory Health Insurance Physicians of Bavaria) by contractual agreement.

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Ahn, N., Wawro, N., Baumeister, SE. et al. Time-Varying Use of Proton Pump Inhibitors and Cognitive Impairment and Dementia: A Real-World Analysis from Germany. Drugs Aging 40, 653–663 (2023). https://doi.org/10.1007/s40266-023-01031-7

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