Recent scientific research has revealed a concerning link between the commonly used nerve pain medication gabapentin and an increased risk of cognitive decline. This finding, particularly relevant for adults, raises questions about the drug’s long-term safety and demands greater attention to patient monitoring.
The study, published in Regional Anesthesia & Pain Medicine, is based on anonymous records of over 52,000 adult patients from 2004-2014. The research indicated that individuals who had been prescribed six or more gabapentin prescriptions for chronic low back pain showed significantly higher rates of dementia and mild cognitive impairment (MCI).
The study’s results highlight a dose-response relationship: the more frequently gabapentin was prescribed, the higher the risk of cognitive decline. In patients with six or more prescriptions, the risk of dementia increased by 29% and the risk of MCI by 85% within 10 years of initial pain symptom onset. The risks were even more pronounced in patients with 12 or more prescriptions, with a 40% increased risk of dementia and a 65% increased risk of MCI compared to patients with 3 to 11 prescriptions.
Risks Across Different Age Groups
One of the most significant conclusions from the study is the uneven distribution of risk across age groups. The cognitive impact of gabapentin is most pronounced in middle-aged patients, where the likelihood of developing complications is doubled.
Study results by age group:
Middle-aged group (35 to 64 years old): The likelihood of developing complications in this group was twice as high as in patients of the same age who were not taking gabapentin. Specifically, in patients aged 35-49, the risk increased even more dramatically: they had a twice higher risk of dementia and a three times higher risk of MCI.
Young adults: Interestingly, the study did not find an increased risk of dementia or MCI in patients aged 18 to 34. This suggests that the clinically more pronounced effect is observed in middle-aged patients (35-64 years old) rather than very young or younger adults.
Study Limitations and Significance
Gabapentin, with its low potential for addiction, is often considered a safer alternative to opioids. This is why it has become popular for treating chronic, especially neuropathic, pain.
It is crucial to note that this was an observational study; therefore, it cannot establish a direct cause-and-effect relationship between gabapentin use and cognitive decline. More evidence and a more precise analysis are needed for that. Furthermore, one of the main limitations of the study was that it only analyzed the number of prescriptions (e.g., 3 to 11, or 12 or more) and not the exact daily dose of the drug received by the patient in milligrams. This significant limitation means that a precise “dose-effect” relationship with cognitive impairments could not be determined. Further, detailed studies are needed to understand how the drug’s dosage and long-term use affect brain health. Other factors, such as underlying pain conditions or additional medications, could also contribute to cognitive decline.
Expert Opinion
According to the Science Media Centre, this research confirms previous suspicions that neurocognitive effects occur in patients using gabapentin, but it does not mean that the drug directly causes dementia. Rather, it indicates that the issue definitely requires additional research. Robert Henderson, a cardiologist at the University of Nottingham, believes the study shows an association, not a causal link, because the pain for which gabapentin is used can independently affect cognitive functions.
Professor Torsten Paske of University College London believes that the correlation found in the study is important and it is essential for doctors to pay closer attention to cognitive problems in patients taking gabapentin. These findings necessitate further clinical trials to definitively determine whether the drug truly has a direct cognitive impact.
Sources
Medical Xpress. Nerve pain drug gabapentin linked to increased dementia and cognitive impairment risks.
Neuroscience News. Common pain medication linked to cognitive decline risk.
Raphael, J., & Smith, L. (2025). Risk of dementia following gabapentin prescription in chronic low back pain patients: A cohort study. Regional Anesthesia & Pain Medicine. Advance online publication.
Science Media Centre. Expert reaction to observational study of gabapentin and risk of dementia and cognitive impairments.
