Frequent gabapentin use tied to higher dementia risk in back‑pain patients— younger adults see greatest jump in cognitive decline
A new nationwide study warns that chronic low back pain patients who repeatedly refill gabapentin prescriptions face a measurable uptick in dementia and mild cognitive impairment, with the steepest climb among people under 65.
Researchers reviewed 52,832 adult health‑care records spanning 2004‑2024. After following each participant for a decade, the team found that six or more gabapentin scripts pushed dementia incidence up 29 % and MCI up 85 % compared with non‑users. Those with a dozen or more refills fared even worse.
Study finds frequent gabapentin prescriptions double dementia danger for under‑65s
How big is the gap? In younger patients (18‑64), dementia risk more than doubled, and MCI risk soared 150 %. No extra danger appeared in 18‑ to 34‑year‑olds, but the curve rose sharply from age 35 onward. Older adults also saw elevated rates, though increases were smaller.
Cognitive risk by prescription count and age group
| Gabapentin exposure | Dementia risk ratio | MCI risk ratio | Age group most affected |
|---|---|---|---|
| 6–11 scripts | 1.29 | 1.85 | 35–49 |
| 12+ scripts | 1.40 | 1.65 | 50–64 |
| Any use, 18–64 | 2.10 | 2.50 | 18–64 |
| Any use, 65+ | 1.28 | 1.53 | 65+ |
Wondering what these numbers mean for day‑to‑day practice? Keep reading.
Age‑based analysis reveals sharp cognitive risks for midlife chronic pain patients
Investigators, led by MetroHealth Medical Center neurologist Chong Kim, MD, controlled for opioids, benzodiazepines, comorbid illness, and demographic factors through propensity matching. Even after leveling the field, repeated gabapentin users outpaced non‑users in cognitive decline. Kim stresses the project’s observational design: “Limitations remain, and more work is needed,” he said.
Common gabapentin side effects—drowsiness, dizziness, blurred vision—were already on clinicians’ radar. The Food and Drug Administration also issued a 2019 alert on respiratory depression when the drug is paired with CNS depressants or used in people with lung disease. The new findings add potential neurodegenerative consequences to the checklist.
Researchers urge closer monitoring and further trials before routine off‑label use
Approved for seizures and post‑herpetic neuralgia, gabapentin is nevertheless prescribed off‑label for a long menu of pain syndromes. So, should patients stop taking it tomorrow? Probably not, but prescribers may want to:
- Reassess dose and duration for chronic back pain
- Screen midlife patients for early cognitive symptoms
- Discuss alternative therapies when appropriate
First steps could be as simple as scheduling a cognitive baseline test before long‑term therapy. Consequently, monitoring might catch subtle changes sooner, giving both doctor and patient room to pivot.
In short, higher refill counts equal higher cognitive risk—especially for adults in their mid‑30s to early 60s. Until randomized trials clarify causation, vigilance and patient‑specific decision‑making remain the best defense.