Can gabapentin (anticonvulsant medication) cause dementia?

Gabapentin Does Not Cause Dementia Based on Current Evidence

Based on available guideline evidence, gabapentin itself does not cause dementia, though recent observational research suggests a potential association between gabapentin use and increased dementia risk that warrants clinical caution, particularly in younger adults and with prolonged use. 1

Guideline Evidence

The British Association of Dermatologists guidelines (2018) specifically address gabapentin safety and make no mention of dementia as a side effect, despite discussing dementia risks with other medications in the same document 1. These guidelines:

• Recommend gabapentin for uremic pruritus with documented efficacy 1
• Note only mild side effects of drowsiness in treatment groups 1
• Specifically warn that sedative antihistamines (not gabapentin) may predispose to dementia and should be avoided except in palliative care 1

The distinction is critical: guidelines warn about sedative antihistamines causing dementia but make no such warning about gabapentin, despite discussing both medications in the same context 1.

Emerging Research Evidence Shows Concerning Associations

While guidelines do not identify gabapentin as causing dementia, three recent high-quality observational studies (2022-2025) have identified associations between gabapentin use and cognitive decline/dementia risk that cannot be ignored:

Most Recent and Highest Quality Evidence

A 2025 retrospective cohort study of 26,416 adults with chronic low back pain found that gabapentin prescription was associated with increased dementia risk, with the strongest effect in non-elderly adults (18-64 years) 2:

• Six or more prescriptions: 29% increased dementia risk (RR: 1.29) and 85% increased mild cognitive impairment risk (RR: 1.85) 2
• Non-elderly adults had over twice the dementia risk (RR: 2.10) and 2.5 times the cognitive impairment risk (RR: 2.50) 2
• Dose-response relationship: 12+ prescriptions showed 40% increased dementia risk (RR: 1.40) 2

Supporting Studies

A 2023 Taiwanese population-based study of 206,802 patients demonstrated that gabapentin/pregabalin exposure increased dementia risk by 45% (HR: 1.45), with risk increasing with cumulative dose 3. Younger patients (<50 years) showed the highest risk (HR: 3.16) 3.

A 2022 study using the National Alzheimer's Coordinating Center database found gabapentin initiation in cognitively normal older adults was associated with cognitive decline (OR: 1.55-1.94) and functional status decline (OR: 1.78), plus increased falls (OR: 2.51) 4.

Important Caveat About Existing Cognitive Impairment

A 2024 study found that in patients who already had cognitive impairment at gabapentin initiation, the medication was not associated with further cognitive or functional decline over 1-2 years, though falls risk remained elevated (OR: 2.5) 5. This suggests the risk may be primarily in cognitively intact individuals rather than those with established dementia.

Clinical Implications and Recommendations

When to Exercise Caution

• Younger adults (<65 years) appear at highest risk and require closest monitoring 3, 2
• Prolonged use (6+ prescriptions or 12+ prescriptions) shows dose-dependent risk 2
• Cognitively normal patients may be more vulnerable than those with existing impairment 4, 5

Monitoring Strategy

When prescribing gabapentin, particularly for chronic conditions:

• Baseline cognitive assessment should be considered, especially in younger patients 2
• Monitor for cognitive changes during treatment, not just traditional side effects 4
• Reassess necessity of continued treatment regularly, avoiding indefinite prescriptions 2
• Be particularly vigilant about falls risk in all age groups 4, 5

Common Pitfalls to Avoid

• Assuming gabapentin is cognitively benign because it's not a sedative antihistamine or anticholinergic - the mechanism may differ but risk appears real 4, 3, 2
• Failing to distinguish between acute side effects (drowsiness) and long-term risks (dementia) - guidelines address the former but recent research identifies the latter 1, 4
• Overlooking younger patients as being at risk - the association is actually stronger in non-elderly adults 3, 2
• Continuing gabapentin indefinitely without reassessing benefit versus emerging cognitive risks 2

Reconciling Guideline and Research Evidence

The apparent contradiction exists because:

• Guidelines predate the recent observational research (2018 guidelines vs. 2022-2025 studies) 1, 4, 3, 2
• Observational studies cannot prove causation, only association 4, 3, 2
• The mechanism remains unclear - gabapentin modulates GABA/glutamate transmission, which theoretically could affect cognition long-term 6

However, the consistency across multiple large databases, the dose-response relationship, and the biological plausibility warrant clinical vigilance even without definitive causation 4, 3, 2.