Can pregabalin cause dementia?

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Last updated: May 11, 2026 • View editorial policy

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Can Pregabalin Cause Dementia?

Pregabalin does not directly cause dementia, but emerging evidence suggests it may increase dementia risk, particularly with prolonged use and higher cumulative doses, while also causing acute cognitive impairment (confusion, memory problems, attention difficulties) that can mimic or worsen dementia symptoms.

Key Evidence on Dementia Risk

The most concerning finding comes from a large Taiwanese population study 1 showing that patients prescribed gabapentin or pregabalin had a 1.45-fold increased risk of developing dementia (95% CI: 1.36-1.55). This risk was:

  • Dose-dependent: Higher cumulative doses correlated with greater dementia risk
  • Age-dependent: Paradoxically highest in younger patients (<50 years) with a hazard ratio of 3.16 (95% CI: 2.23-4.47)
  • Persistent across all age groups

A 2025 study on chronic low back pain patients 2 reinforced these concerns, finding that six or more pregabalin prescriptions increased dementia risk (RR: 1.29) and mild cognitive impairment (RR: 1.85). Non-elderly adults (18-64) had over twice the dementia risk (RR: 2.10).

However, one contradictory study 3 from Taiwan found no significant association between gabapentin use and dementia risk in chronic pain patients (adjusted OR: 0.91), though this focused specifically on gabapentin rather than pregabalin.

Acute Cognitive Effects (FDA-Documented)

The FDA label 4 clearly documents pregabalin's acute cognitive side effects:

  • "Thinking abnormal" (concentration/attention difficulties): 2-8% of patients depending on dose
  • Confusion: 2-7% (dose-dependent, up to 7% at 600mg/day)
  • Amnesia: 2-4% of patients
  • Cognitive impairment: Documented across all studied conditions (neuropathic pain, seizures, fibromyalgia)

These effects are dose-related and typically mild-to-moderate in intensity, but can be severe in 8% of treated patients.

Special Vulnerability in Older Adults

The 2019 AGS Beers Criteria 5 flags gabapentinoids as requiring caution in older adults, particularly when combined with other CNS-active drugs, due to increased fall risk, respiratory depression, and cognitive effects.

Patients with dementia with Lewy bodies show hypersensitivity to pregabalin 6, developing psychosis at doses as low as 25mg daily (far below typical therapeutic doses of 300-450mg).

Clinical Implications

When prescribing pregabalin:

  • Monitor cognitive function at baseline and regularly during treatment, especially in patients with pre-existing cognitive concerns
  • Use the lowest effective dose and avoid prolonged high-dose therapy when possible
  • Be particularly cautious in younger adults (<50 years), where dementia risk appears paradoxically elevated
  • Consider alternative treatments in patients with multiple dementia risk factors
  • Distinguish acute cognitive side effects (reversible with discontinuation) from potential long-term dementia risk

Red flags requiring immediate reassessment:

  • New confusion, disorientation, or memory complaints
  • Worsening of pre-existing cognitive symptoms
  • Multiple prescriptions (≥6) accumulating over time
  • Combination with other CNS-active medications

Important Caveats

The dementia association may reflect confounding by indication (chronic pain itself increases dementia risk) or detection bias (patients on pregabalin have more medical encounters). However, the dose-response relationship and consistency across multiple studies suggests a genuine signal requiring clinical vigilance.

Animal studies 7 demonstrate that pregabalin (but not gabapentin alone) significantly impairs memory in recognition tasks, providing biological plausibility for cognitive effects.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.