From the Guidelines
The long-term use of gabapentin and diazepam may contribute to the development of dementia, particularly in older adults, due to the potential cognitive decline associated with benzodiazepines like diazepam, as suggested by recent studies 1. When considering the potential risks of these medications, it's essential to weigh the benefits against the potential harms. Gabapentinoids, such as gabapentin, were initially believed to carry a relatively low risk of dependence and withdrawal symptoms, but evidence now shows that they can cause reinforcing euphoria, sedation, and dissociation, especially when taken with opioids 1. Benzodiazepines, like diazepam, are effective for short-term treatment of severe anxiety and insomnia but carry a risk of dependence and adverse neurological effects with longer-term treatment, including cognitive decline and possibly dementia 1. Key points to consider include:
- The risk of cognitive decline and dementia appears to be related to the duration of use and cumulative dose of benzodiazepines like diazepam.
- Gabapentin is generally considered to have fewer cognitive side effects than benzodiazepines, but there is less evidence linking it to dementia risk.
- Both medications can cause cognitive side effects like confusion, memory problems, and drowsiness, which are usually reversible when the medication is stopped.
- If concerned about cognitive effects, it's crucial to discuss these concerns with a healthcare provider, who can evaluate the specific situation and consider the benefits of these medications versus potential risks, and possibly suggest alternatives or a gradual tapering plan if appropriate.
From the Research
Association between Gabapentin and Dementia
- The study 2 found that patients treated with gabapentin or pregabalin had an increased risk of dementia, with a multivariate-adjusted hazard ratio of 1.45.
- The risk of dementia increased with higher cumulative defined daily doses during the follow-up period.
- The study suggests that gabapentin or pregabalin should be used with caution, particularly in susceptible individuals.
Association between Diazepam and Dementia
- There is no direct evidence from the provided studies that links diazepam to an increased risk of dementia.
- However, the study 3 mentions that long-term use of benzodiazepines, including diazepam, can lead to tolerance, dependence, and withdrawal effects, which may be a concern for patients with dementia.
- The study 4 found that diazepam produced full substitution for the discriminative stimulus effects of gabapentin in rats, suggesting that diazepam may have similar subjective effects to gabapentin.
Cognitive Impairment and Dementia
- The study 5 found no clear evidence that cognitive training improved global cognition in people with Parkinson's disease dementia or mild cognitive impairment.
- The study 6 suggests that gabapentin and pregabalin may be beneficial in treating behavioral and psychological symptoms of dementia, including agitation and aggression, but more research is needed to confirm this.
Interaction between Gabapentin and Diazepam
- The study 4 found that diazepam produced full substitution for the discriminative stimulus effects of gabapentin in rats, suggesting that diazepam may have similar subjective effects to gabapentin.
- However, there is no direct evidence from the provided studies that links the combination of gabapentin and diazepam to an increased risk of dementia.