Is there an association between gabapentin (Neurontin) use and an increased risk of dementia?

Gabapentin Use and Risk of Dementia

Current evidence suggests that gabapentin use may be associated with an increased risk of dementia and cognitive impairment, particularly with long-term use and in younger adults. 1

Evidence on Gabapentin and Cognitive Impairment

Recent Research Findings

• A 2023 retrospective cohort study using Taiwan's National Health Insurance Database found that patients treated with gabapentin or pregabalin had a 45% increased risk of dementia (HR 1.45,95% CI 1.36-1.55) compared to matched non-users 2

• A 2022 study examining neurocognitive changes in older adults found that gabapentin initiation was significantly associated with:

  • Cognitive decline (increased CDR global score)
  • Functional status decline
  • Increased falls at follow-up visits 3

• The most recent 2025 study specifically examining chronic low back pain patients found:

  • Patients with six or more gabapentin prescriptions had 29% higher risk of dementia (RR 1.29,95% CI 1.18-1.40)
  • Non-elderly adults (18-64) had over twice the risk of dementia (RR 2.10,95% CI 1.75-2.51)
  • Risk increased with prescription frequency - patients with 12+ prescriptions had higher incidence of dementia (RR 1.40,95% CI 1.25-1.57) 1

Clinical Guideline Recommendations

• The 2023 VA/DoD Clinical Practice Guideline for Headache Management now suggests against the use of gabapentin for episodic migraine prevention, citing concerns about misuse, dependence, and withdrawal 4

• The 2024 AUA/SUFU Guideline on Overactive Bladder recommends discussing the potential risk for developing dementia with patients taking antimuscarinic medications, though it doesn't specifically address gabapentin 4

Mechanisms and Risk Factors

The exact mechanism by which gabapentin may affect cognition is not fully understood, but several factors may increase risk:

• Higher cumulative doses and longer duration of treatment 5
• Pre-existing cognitive vulnerability 5
• Concomitant use of other CNS depressants 5
• Age - interestingly, younger adults may have higher relative risk 2, 1

Clinical Implications

Patient Counseling

When discussing gabapentin with patients concerned about dementia risk:

1. Acknowledge that recent research suggests a possible association between gabapentin use and increased dementia risk
2. Explain that the risk appears to increase with:
   • Higher cumulative doses
   • Longer duration of treatment
   • Concomitant use of other CNS depressants

Monitoring Recommendations

For patients on gabapentin therapy:

• Consider regular cognitive assessments
• Be vigilant for early signs of altered mental status
• Monitor for falls, especially in older adults 3

Alternative Treatment Considerations

For patients concerned about cognitive risks:

• For neuropathic pain: Consider duloxetine as an FDA-approved alternative with fewer cognitive concerns 5
• For seizure disorders: Discuss other anticonvulsant options with potentially lower cognitive impact
• For anxiety: Consider evidence-based non-pharmacological approaches or medications with better established safety profiles

Conclusion

While gabapentin remains an important medication for several indications, clinicians should be aware of the emerging evidence suggesting an association with increased dementia risk. The decision to use gabapentin should carefully weigh potential benefits against these risks, particularly for long-term use, and patients should be monitored for cognitive changes.