Effect And Mechanism Of Proton Pump Inhibitors On Cognitive Function In Elderly Patients

Objective:To study the effect and mechanism of Proton Pump Inhibitor（PPI）on cognitive function in elderly patients.Methods:（1）Collect 330 patients with cognitive dysfunction in the Mini-mental State Examination（MMSE）of a tertiary A hospital as the case group,and randomly match 300patients without cognitive impairment as the case group.In the control group,the relationship between PPI medication and cognitive function was explored.（2）Collected2167 elderly patients who were hospitalized in a tertiary A hospital from December 2018 to January 2021 and used PPI greater than 6 months.Among them,522 patients with hypomagnesemia were extracted,and 500 patients without PPI medication history were randomly matched.Collect the clinical case data of the above patients,including age,gender,education level,marital status,PPI medication type,PPI medication quantity,PPI medication dosage,PPI medication duration,main diagnosis,comorbid conditions,multiple medications,multiple visits to Mg²⁺Concentration average,MMSE score,etc.,to explore the relationship between PPI medication and cognitive function.Results:（1）The PPI usage rate of patients in the cognitive impairment group was significantly higher than that of the control group,and the PPI usage rate of the two groups of patients was significantly different（x²=297.18,P<0.05）,the cognitive impairment group,the PPI usage rate was 82.42%,in the control group,the use rate of PPI was 13.67%.（2）The incidence of hypomagnesemia accounts for 24.09%of patients who have been taking PPI continuously for more than 6 months,and the age group with the highest incidence of hypomagnesemia is 80-89 years old.（3）Among the 522 patients with hypomagnesemia that require PPI treatment,the top three diseases with the highest incidence are gastric ulcer（56.07%）,duodenal ulcer（29.89%）,and gastroesophageal reflux disease（11.88%）;The top three applications of proton pump inhibitors are omeprazole,lansoprazole,and rabeprazole in order.（4）Comorbidities:The top three with the highest incidence are coronary atherosclerotic heart disease,diabetes and atrial fibrillation.（5）The top three most commonly used drugs are drugs to protect the gastric mucosa,anticoagulant and antiplatelet drugs,and drugs to treat diabetes.（6）Among the use of anticholinergic drugs,the most frequently used is ACB（Anticholinergic burden）1 cardiovascular disease drugs.The hypomagnesemia group was more likely to have cholinergic overburden than the control group（total ACB score≥3）,and there was a significant difference between the two（P<0.05）.（7）The MMSE score of the hypomagnesemia group and the control group is significantly different（P<0.05）,and the MMSE score of the control group is significantly higher than that of the low magnesium group.The low magnesium group is treated with PPI for 6-12 months,and the average MMSE score It was 25.45±1.79.The average score of MMSE was 23.67±1.29 for patients in the low-magnesium group who used PPI for more than 12 months,and the average score of the control group was 27.53±2.15.（8）In the hypomagnesemia group,there was a significant positive correlation between cognitive impairment grade and PIM,medication type,ACB score,and magnesium ion concentration（P<0.01）;cognitive impairment grade and age,PPI medication duration,combined There was no significant correlation between the types of chronic diseases（P>0.05）.（9）Multivariate logistic analysis shows that age,PPI medication duration,types of comorbidities,PIM,ACB scores are risk factors for aggravation of cognitive impairment,magnesium ion concentration in the normal range is a protective factor for cognitive impairment,and gender has an effect on cognition.The obstacle has no effect.Conclusion:1.Long-term use of proton pump inhibitors leads to a decline in cognitive function in elderly patients.2.The change of magnesium ion concentration is a possible mechanism for proton pump inhibitors to cause cognitive decline.