Does gabapentin cause cognitive problems with short‑term or long‑term use?

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Last updated: September 4, 2026 • View editorial policy

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Gabapentin and Cognitive Problems

Yes, gabapentin is known to cause cognitive problems both short-term and long-term, with the FDA labeling explicitly warning about cognitive side effects including problems with concentration, memory impairment, and behavioral changes, particularly in vulnerable populations.

Short-Term Cognitive Effects

Gabapentin causes acute cognitive impairment that can manifest within the first week of treatment. The FDA label specifically warns about changes in behavior and thinking, including problems with concentration, restlessness, and changes in school performance 1.

In the short term, expect:

  • Drowsiness (6% of patients)
  • Dizziness (6%)
  • Loss of energy (6%)
  • Difficulty with coordination and speaking 2, 1

A prospective study in spinal cord injury patients demonstrated that six out of nine neuropsychological measures showed decline in cognitive function at 1 week post-initiation of gabapentin, affecting memory, attention, and executive function 3. While some improvement occurred by 4 weeks, the initial cognitive hit is substantial and clinically meaningful.

Pediatric Populations at Higher Risk

In children ages 3-12, gabapentin causes particularly concerning neuropsychiatric effects including emotional lability (6% vs 1.3% placebo), hostility and aggressive behaviors (5.2% vs 1.3%), hyperkinesia/restlessness (4.7% vs 2.9%), and thought disorders affecting concentration and school performance (1.7% vs 0%) 1.

Long-Term Cognitive Effects

The evidence on long-term cognitive effects is more complex but increasingly concerning, particularly regarding dementia risk.

Dementia Risk: Conflicting Evidence

Two large population-based studies show increased dementia risk with chronic gabapentin use:

  • A 2023 Taiwanese study of 206,802 patients found gabapentin/pregabalin exposure increased dementia risk with an adjusted hazard ratio of 1.45 (95% CI 1.36-1.55), with risk increasing proportionally to cumulative dose. Younger patients under age 50 had the highest risk (HR 3.16,95% CI 2.23-4.47) 4.

  • A 2025 U.S. study of chronic low back pain patients found that six or more gabapentin prescriptions increased dementia risk (RR 1.29,95% CI 1.18-1.40) and mild cognitive impairment (RR 1.85,95% CI 1.63-2.10). Non-elderly adults (18-64) had over twice the dementia risk (RR 2.10) and 2.5 times the mild cognitive impairment risk. Patients with 12+ prescriptions had even higher risk (dementia RR 1.40, MCI RR 1.65) 5.

However, one contradictory 2024 Taiwanese study of 201,492 chronic pain patients found no significant dementia risk (adjusted OR 0.91,95% CI 0.83-1.01) 6.

Reconciling the Evidence

Given the conflicting data, I recommend erring on the side of caution: Two large, recent studies show dose-dependent dementia risk, while one shows no effect. The mechanistic data supports cognitive harm (see below). The 2019 Lancet Psychiatry guideline notes that gabapentinoids were "initially believed to carry a relatively low risk" but evidence now shows they cause "euphoria, sedation, and dissociation" 7.

Mechanism of Long-Term Cognitive Decline

A 2025 preclinical study elucidated the mechanism: Long-term gabapentin treatment causes tau hyperphosphorylation in the hippocampus by suppressing Sirt1 expression and elevating CaMKIIα levels, leading to measurable learning and memory impairment 8. This provides biological plausibility for the epidemiological findings.

Falls Risk in Cognitively Impaired Patients

In older adults with existing cognitive impairment, gabapentin initiation significantly increased fall risk (OR 2.5,95% CI 1.3-4.6) at 2-year follow-up, though it did not worsen cognitive scores further 9. This is critical because falls represent a major morbidity and mortality risk in this population.

Clinical Implications

Monitor cognitive function closely in all patients on gabapentin, especially:

  • Patients under 50 years old (paradoxically highest dementia risk with chronic use)
  • Children 3-12 years (highest acute neuropsychiatric effects)
  • Older adults with baseline cognitive impairment (fall risk)
  • Patients requiring 6+ prescriptions (dose-dependent dementia risk)

Common Pitfalls to Avoid

  1. Don't assume gabapentin is cognitively "safe" because it's not a benzodiazepine - the evidence shows clear cognitive harms
  2. Don't ignore early cognitive complaints - they may represent the beginning of cumulative neurotoxicity
  3. Don't prescribe long-term without periodic cognitive assessment - particularly in younger patients where dementia risk appears highest
  4. Don't combine with opioids - this increases respiratory depression risk beyond cognitive concerns 7

When Gabapentin Must Be Used

If gabapentin is necessary despite cognitive risks:

  • Use the lowest effective dose
  • Limit duration when possible (the 2019 Lancet guideline notes that long-term use is "either not recommended by clinical guidelines or of doubtful efficacy in many cases") 7
  • Establish baseline cognitive function before initiation
  • Monitor for concentration problems, memory complaints, behavioral changes, and falls
  • Consider Sirt1 activators (resveratrol showed protective effects in animal models) 8, though human data is lacking

The FDA warning about driving and operating machinery should be taken seriously - gabapentin can slow thinking and motor skills 1.

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.