Recent research suggests certain medications taken by millions may be associated with a higher risk of dementia—especially strong anticholinergics (e.g., some overactive-bladder drugs), very long-term proton-pump inhibitors (PPIs) (evidence mixed), and frequent gabapentin use in specific groups. These are associations, not proof of causation, but they’re worth discussing with a clinician—especially if you’re older or already at cognitive risk.
Why This Matters
Dementia affects more than 55 million people worldwide and prevention is an urgent priority. Medication exposures are modifiable—meaning we can often switch, lower doses, or shorten duration without sacrificing care. A holistic approach asks: What’s the minimum effective medication plan combined with lifestyle support for the brain?
The Strongest Signal: Anticholinergic Drugs
Anticholinergics block acetylcholine, a neurotransmitter essential for memory and attention. High “anticholinergic burden” has repeatedly been linked to cognitive problems.
- A large English case-control study of older adults found an increased dementia risk with several overactive-bladder anticholinergics, notably oxybutynin, solifenacin, and tolterodine. Risk rose with higher cumulative exposure.
- A recent Swedish population study again tied overall anticholinergic burden to incident dementia, with risk scaling up by drug potency.
Holistic takeaway: If you or a family member uses anticholinergics (including some allergy pills, sleep aids, certain antidepressants, or overactive-bladder drugs), ask your clinician about safer alternatives (e.g., mirabegron for OAB, non-sedating antihistamines, or non-drug strategies) and about deprescribing where appropriate.
Mixed Evidence: Acid-Reflux Drugs (PPIs)
Proton-pump inhibitors (PPIs) like omeprazole and esomeprazole are effective for reflux, but some observational data have linked very long-term use to higher dementia risk.
- A Neurology cohort reported a 33% increased risk among people taking PPIs for >4.4 years; shorter use wasn’t linked.
- However, more recent Mendelian randomization research (a genetic approach less prone to confounding) found no robust causal link overall.
- Reviews note conflicting results; individual risks (e.g., B12 deficiency, microbiome changes) may contribute.
Holistic takeaway: Use PPIs for clear indications and shortest necessary duration. Discuss step-down strategies (dietary changes, H2 blockers, meal timing) rather than stopping abruptly.
Newer Signal: Frequent Gabapentin Use (for Chronic Back Pain)
Gabapentin is widely prescribed off-label for chronic pain. A 2025 U.S. database study of adults with chronic low-back pain reported that ≥6 prescriptions were associated with higher dementia (≈29%) and mild cognitive impairment (MCI) (≈85%) risks over 10 years; risks appeared greater in mid-life adults and rose with more prescriptions. Experts stress this is observational (can’t prove cause).
Other studies show inconsistent findings (some report associations, others don’t), so the evidence is emerging, not settled.
Holistic takeaway: If you’re on long-term gabapentin for pain, ask about non-drug pain strategies (targeted exercise, sleep optimization, CBT-I for pain, anti-inflammatory nutrition) and whether dose/duration can be reduced without losing benefit.
What This Does Not Mean
- These studies do not prove that the drugs cause dementia. People who need these medications often differ in important ways (pain severity, vascular risks, sleep, physical activity) that can independently affect brain health.
- Never stop a prescribed medication abruptly—that can be dangerous. Instead, review your regimen with a clinician and consider safer substitutions or dose minimization.
Talk to Your Clinician: Smart Questions to Ask
- “What’s my anticholinergic burden?” Could we switch to lower-burden options (especially for bladder, sleep, allergies)?
- “Do I still need a daily PPI?” If yes, what’s the plan to reassess or step down later?
- “For chronic pain, are there non-drug add-ons that reduce my gabapentin dose?” (physiotherapy, graded activity, sleep therapy).
- “Can we screen for reversible risks?” (e.g., B12, thyroid, hearing/vision, depression), which can masquerade as memory issues.
Holistic Brain-Health Playbook (Evidence-Aligned)
- Move daily: Aerobic + resistance training improve blood flow, insulin sensitivity, and brain-derived neurotrophic factor (BDNF).
- Eat for the brain: Focus on Mediterranean-style patterns—leafy greens, berries, olive oil, legumes, nuts, fish; limit ultra-processed foods.
- Nerve-friendly nutrients: Prioritize B12, folate, vitamin D, omega-3s, magnesium, and polyphenols (berries, cocoa, green tea).
- Sleep & stress: 7–9 hours/night; chronic stress and sleep loss worsen pain and cognition (and often drive medication use).
- Hearing & vision: Correcting deficits lowers cognitive load and may reduce dementia risk.
- Alcohol & tobacco: Minimize; both harm cerebrovascular and cognitive health.
(These strategies complement, not replace, medical care.)
Who Should Be Most Cautious?
- Adults 55+, or anyone with family history of dementia
- People taking multiple anticholinergic medicines or high cumulative doses over months to years
- Long-term daily PPI users without a plan to reassess
- Individuals on frequent gabapentin for chronic pain, especially middle-aged adults (based on the 2025 study’s signal).
A Practical, Safer-Use Checklist
- Inventory your meds (including over-the-counter sleep/allergy aids).
- Ask about swaps: e.g., mirabegron (β3-agonist) for overactive bladder; non-sedating antihistamines; behavioral sleep therapy.
- Set a review date: Re-evaluate PPI need; consider taper plans if appropriate.
- Titrate thoughtfully: Never stop suddenly—coordinate with your clinician.
- Layer lifestyle: Use movement, nutrition, sleep, and stress care to make lower doses feasible.
Bottom Line
There’s credible, growing evidence that high-burden anticholinergics are linked with increased dementia risk, mixed evidence for very long-term PPIs, and emerging observational signals around frequent gabapentin use for chronic pain. None of this means you should panic—or stop medications on your own. It does mean a medication review plus holistic brain-support habits can meaningfully lower risk while keeping symptoms controlled.