Proton pump inhibitors (heartburn meds) linked with increased risk of dementia

Basically, I was having reflux symptoms minus the heartburn. Lots of throat issues, digestive issues, coughing, etc. My doctor looked everything over and concluded that reflux was the most likely cause and we did a treatment of PPIs for a few weeks.

The PPI didn't help, but by the time the treatment was over we were in the middle of this pandemic so I couldn't go back into the doc for a next step.

Luckily a few weeks later I randomly stumbled into a fix. One day I noticed the symptoms were gone and when I thought about it I realized I had started taking an additional allergy medication a few days prior. So it seems that instead of reflux I had postnasal drip.

To be fair to the doctor he did mention postnasal drip as a possibility, but reflux was deemed as more likely because I was already on allergy meds and the symptoms were very reflux-y.

Obviously if you have reflux like symptoms, see a doc, but I thought my experience was worth sharing for anyone in a similar boat. It's fairly simple to try new allergy meds and see if that's the root cause. In my case adding a steroidal nasal spray into the mix was what helped. And it resolved the issue in a couple days, whereas trying out PPIs was a two month long experiment of continued suffering. (Side note: not all steroidal nasal sprays are created equal. I had previously tried Flonase which did nothing for me.)

"No association between proton pump inhibitor use and risk of dementia: Evidence from a meta‐analysis" Journal of Gastroenterology and Hepatology (Jan 2020, https://doi.org/10.1111/jgh.14789)

"Dementia, cognitive impairment and proton pump inhibitor therapy: A systematic review" Journal of Gastroenterology and Hepatology (August 2017, https://doi.org/10.1111/jgh.13750)

"Risk factors for dementia diagnosis in German primary care practices" International Psychogeriatrics (July 2016, https://doi.org/10.1017/S1041610215002082)

From the last article: "The use of statins (OR: 0.94; 0.90–0.99), proton-pump inhibitors (PPI) (0.93; 0.90–0.97), and antihypertensive drugs (0.96, 0.94–0.99) were associated with a decreased risk of developing dementia."

The whole reason they decided to do this correlational study - and other studies like it - is because they have evidence that this cholinergic system plays a part in developing Alzheimers. Then, to back up that molecular theory and evidence, they're looking at correlations that the drugs that target this system have in developing Alzheimers. Sure enough things like how much one uses Diphenhydramine (active ingredient in benadryl and the same can be said for other allergy medications that are anti-cholinergic) shows that increased use has a direct correlation with increased risks of developing Alzheimer's disease.

Many studies on these anti-cholinergic drugs shows this correlation, they also have an understanding of the molecular basis of why, however in addition they also show that drugs that target this system in certain ways help reduce the symptoms of the disease.

Because of this, the evidence points to medications that fall into this "anti-cholinergic" or "slighly anti-cholinergic" drug category - allergy medications (diphenhydramine, loratadine) some PPI and others - might also amplify the chances of getting the disease.

There seems to be a lot of evidence pointing to this, and while its still an emerging area I'm confused as to how you are stating that this system and these drugs that interact with it, which has a lot of evidence that it is part of the disease pathophysiology, are weak on evidence?

What is your background and the experience you have to be able to state what you just said?

Here is some background on this system and its implications with Alzheimer's :

https://www.medscape.com/viewarticle/900644

"The Cholinergic System in the Pathophysiology and Treatment of Alzheimer's Disease"

"Cholinergic synapses are ubiquitous in the human central nervous system. Their high density in the thalamus, striatum, limbic system, and neocortex suggest that cholinergic transmission is likely to be critically important for memory, learning, attention and other higher brain functions. Several lines of research suggest additional roles for cholinergic systems in overall brain homeostasis and plasticity. As such, the brain's cholinergic system occupies a central role in ongoing research related to normal cognition and age-related cognitive decline, including dementias such as Alzheimer's disease. The cholinergic hypothesis of Alzheimer's disease centres on the progressive loss of limbic and neocortical cholinergic innervation. Neurofibrillary degeneration in the basal forebrain is believed to be the primary cause for the dysfunction and death of forebrain cholinergic neurons, giving rise to a widespread presynaptic cholinergic denervation. Cholinesterase inhibitors increase the availability of acetylcholine at synapses in the brain and are one of the few drug therapies that have been proven clinically useful in the treatment of Alzheimer's disease dementia, thus validating the cholinergic system as an important therapeutic target in the disease. "