Gabapentin Tied to 85 Percent Higher Risk of Cognitive Impairment: Study Finds

Regular use of the drug gabapentin for chronic low back pain is associated with a significantly increased risk of developing dementia and mild cognitive impairment, according to a large retrospective study published in Regional Anesthesia & Pain Medicine.

Gabapentin is often considered a safer alternative to opioids due to its lower addictive potential and supposed neuroprotective benefits. However, growing evidence suggests possible links between its use and neurodegeneration.

To better understand the cognitive risks, researchers analyzed electronic health records from the TriNetX database, which aggregates real-time data from 68 healthcare organizations across the U.S. The study compared two matched groups of 26,414 adults who had chronic low back pain between 2004 and 2024—one group received gabapentin prescriptions, while the other did not. Variables such as demographics, coexisting conditions, and other pain medications were accounted for.

Patients who received six or more gabapentin prescriptions were found to be 29% more likely to be diagnosed with dementia and 85% more likely to develop mild cognitive impairment within ten years of their initial diagnosis. Alarmingly, the risk was more than double in adults aged 18–64, a demographic not typically considered at high risk for cognitive decline. Among those aged 35-49, the risk of dementia more than doubled and mild cognitive impairment risk more than tripled.

The study also showed a dose-response trend: individuals with 12 or more prescriptions had a 40% higher risk of dementia and a 65% higher risk of mild cognitive impairment than those prescribed gabapentin three to eleven times.

As an observational and retrospective analysis, the study cannot establish causation, nor did it account for gabapentin dosage or duration. Still, the authors concluded: “Our findings indicate an association between gabapentin prescription and dementia or cognitive impairment within 10 years. Moreover, increased gabapentin prescription frequency correlated with dementia incidence.” They emphasize the importance of monitoring patients on gabapentin for signs of cognitive decline.

Reference: Eghrari NB, Yazji IH, Yavari B, et al, Risk of dementia following gabapentin prescription in chronic low back pain patients, Regional Anesthesia & Pain Medicine Published Online First: 10 July 2025. doi: 10.1136/rapm-2025-106577