A widely prescribed medication for nerve pain and seizures, gabapentin, may come with a troubling side effect: an increased risk of dementia and mild cognitive impairment (MCI). A new study from Case Western Reserve University reveals a strong statistical association between long-term gabapentin use and cognitive decline—especially among people once thought too young to be affected.
What Gabapentin Is Used For
Gabapentin, first approved by the FDA in 1993, is commonly used to treat epilepsy, nerve pain from shingles, restless leg syndrome, and chronic lower back pain. It gained popularity as a non-opioid option for managing long-term pain because it was believed to have a low risk of addiction or abuse. However, its widespread use has raised concerns, including its potential misuse to enhance opioid effects and now, possible links to dementia.
Gabapentin works by altering the way nerves communicate with each other, dampening electrical activity in the brain. While this is helpful in controlling seizures and pain, it may also interfere with cognitive function over time.
What the New Study Found
The research, published in the journal Regional Anesthesia & Pain Medicine, analyzed data from over 52,000 patients using electronic health records spanning from 2004 to 2024. Half of the patients had been prescribed gabapentin for chronic lower back pain; the other half had not.
The study found that patients who had received six or more gabapentin prescriptions were:
- 29% more likely to be diagnosed with dementia
- 85% more likely to develop mild cognitive impairment within ten years of their pain diagnosis
Even more concerning, the risk was significantly higher among middle-aged adults:
- For patients aged 35 to 49, the risk of dementia more than doubled, and the risk of MCI more than tripled
- Similar elevated risks were seen in people aged 50 to 64
The frequency of prescriptions also mattered. Those who had 12 or more gabapentin prescriptions were:
- 40% more likely to develop dementia
- 65% more likely to develop MCI compared to patients with only three to eleven prescriptions
The study’s authors, led by medical student Nafis Eghrari at Case Western, suggest the brain-slowing effects of gabapentin may impair cognition over time. By suppressing nerve communication, the drug could gradually interfere with memory, judgment, and language, hallmarks of dementia-related decline.
Still, the researchers caution that the findings are from an observational study. This means they cannot prove gabapentin causes dementia, only that there is a significant link. They were also unable to account for exact dosages, how long patients were on the medication, or factors like physical activity levels—another known risk factor for cognitive decline.
As Tara Spires-Jones, director of the Centre for Discovery Brain Sciences at the University of Edinburgh, noted, “People with chronic pain requiring gabapentin may have been less physically active, which is a known risk factor for developing dementia.”
More than six million Americans live with dementia, a number expected to grow as the population ages. The possibility that a commonly used medication could be contributing to this trend, especially in middle-aged adults, is alarming.
The research team emphasized the need for “close monitoring of adult patients prescribed gabapentin to assess for potential cognitive decline.” They also called for more studies to explore whether gabapentin plays a causal role in brain deterioration and to better understand the biological mechanisms at work.
There is no immediate recommendation to halt gabapentin use, but the findings are likely to prompt physicians and policymakers to take a closer look. Patients concerned about the drug should not stop it abruptly, but rather consult their doctors about risks and possible alternatives—especially if they are using it for chronic pain rather than for epilepsy.
At the same time, the study adds to a growing awareness of the need to balance the risks and benefits of long-term medications. For gabapentin, a drug once considered a safer alternative to opioids, the story may be more complicated than previously thought.
