Gabapentin and the Brain: A Trusted Drug Faces New Questions About Memory and Dementia Risk
For years, gabapentin has been viewed as a safer alternative to opioids—a non-addictive solution for chronic pain, anxiety, and a host of off-label conditions.
Originally approved by the FDA as an anticonvulsant, gabapentin has become a staple in treating everything from nerve pain and fibromyalgia to insomnia and hot flashes.
Its broad utility and reputation for safety have made it a go-to prescription. But new research is beginning to challenge that narrative, raising unsettling questions about the drug’s impact on cognitive health.
A Surprising Link to Cognitive Decline
A recent study published in Regional Anesthesia & Pain Medicine suggests that long-term use of gabapentin may carry a greater cognitive cost than previously recognized. The study, which drew on data from the TriNetX global health research network, tracked more than 26,000 adults with chronic pain conditions over a ten-year period. Participants were divided into those who had taken gabapentin and those who had not, across five age groups ranging from 18 to 65+.
What researchers found was striking: patients with six or more gabapentin prescriptions were 29% more likely to develop dementia and 85% more likely to experience mild cognitive impairment (MCI). Even more surprising was that the highest risk wasn’t in older adults—it was in those aged 35 to 49. In this group, the risk of developing dementia was twice as high as in non-users, and the risk of MCI was nearly three times greater.
Lead author Nafis B. Eghrari, a medical student at Case Western Reserve University, noted that the goal was to address the ongoing uncertainty around gabapentin’s long-term neurological effects. “There’s still a lack of clarity on how gabapentin affects cognitive health,” he explained. “Past studies have been mixed, so we wanted to take a deeper look.”
Observational Study, Not a Final Verdict
As concerning as these numbers may be, experts caution that this study doesn’t prove causation. It’s observational in nature, which means it shows correlation—but not necessarily that gabapentin causes dementia or memory loss.
Several limitations have been pointed out. The study didn’t fully account for factors like physical activity, co-prescribed medications, lifestyle differences, or dosage levels—all of which could influence cognitive decline. For example, patients dealing with chronic pain may already be at increased risk for dementia due to decreased mobility and social isolation.
Tara Spires-Jones, a professor at the University of Edinburgh, emphasized that inactivity itself is a known contributor to cognitive decline. Meanwhile, Ian Maidment of Aston University pointed to other studies that found no clear connection between gabapentin and dementia, reinforcing the idea that further research is necessary before drawing conclusions.
Orthopedic spine surgeon Dr. Neel Anand agreed that the findings raise important questions but stopped short of calling them definitive. “This study is a wake-up call,” he said. “But we still need controlled trials to truly understand the relationship between gabapentin and brain health.”
What Should Patients and Doctors Do Now?
Until more conclusive evidence emerges, the study’s authors advise caution—not panic. Patients currently taking gabapentin should not stop abruptly, as doing so can trigger withdrawal symptoms, including seizures. Instead, doctors are encouraged to monitor cognitive function during treatment and discuss any mental changes, such as forgetfulness, difficulty concentrating, or confusion.
Gabapentin’s known side effects already include dizziness, fatigue, speech difficulties, and short-term memory issues. More serious adverse effects can involve allergic reactions, mood changes, suicidal thoughts, jaundice, and blood in the urine. All of these should prompt immediate medical consultation.
Crucially, gabapentin should not be seen as entirely benign just because it isn’t classified as addictive in the way opioids are. That perception may have contributed to its overuse and off-label prescribing—often without a full understanding of the long-term consequences.
Rethinking a “Safe” Drug
Gabapentin has undoubtedly helped millions of patients manage chronic pain and neurological conditions. Its use as an alternative to opioids is understandable, even beneficial, in many cases. But this new research adds a layer of complexity that can’t be ignored. While it doesn’t confirm a direct link to dementia, it suggests a need for closer oversight and more rigorous investigation.
As with many widely prescribed medications, the full story of gabapentin is still unfolding. For now, its use should be thoughtful, well-monitored, and accompanied by informed conversations between patients and healthcare providers. The goal isn’t to abandon a helpful drug—but to ensure it’s used as safely and effectively as possible.
The conversation around gabapentin’s long-term effects is only beginning—and it’s one that both doctors and patients can no longer afford to overlook.