Gabapentin is one of the most commonly prescribed drugs in the U.S., used for nerve pain, seizure disorders, and sometimes off-label for sleep or anxiety. I don’t prescribe it myself. It’s generally not a medication that gets started over telemedicine, but many of the patients I see are already on it, sometimes for years, by the time it comes up in our visit. Dizziness, fatigue, and the risk of misuse are the usual concerns. Now there’s new research raising concern about a possible link to dementia.

A study published in July 2025 in Regional Anesthesia & Pain Medicine looked at prescription records and medical outcomes for thousands of adults. This was a retrospective cohort study. In other words, the researchers didn’t assign patients to groups or give some people placebo pills. They looked back at existing data and compared outcomes between people who had taken gabapentin and those who had not (Lin et al., 2025).

That design matters. The gold standard in medical research is a randomized, double-blind, placebo-controlled trial, where patients are randomly assigned to receive either the medication or a placebo and neither patients nor researchers know who is in which group until the study ends. This approach minimizes bias and helps establish cause and effect. An observational study like this one, by contrast, can only show association. It tells us that patients on gabapentin had higher rates of dementia, but it can’t prove gabapentin caused it. Other factors, such as the underlying conditions that led to prescribing gabapentin, may have influenced the outcome.

Even with that limitation, the findings are striking. Adults aged 35 to 49 who filled six or more prescriptions were more than twice as likely to develop dementia and more than three times as likely to develop mild cognitive impairment compared to non-users. Adults aged 50 to 64 had a 29 percent higher risk of dementia and an 85 percent higher risk of mild cognitive impairment.

I tell patients not to stop gabapentin suddenly. For someone with a seizure disorder or severe neuropathic pain, stopping without a plan can be unsafe. But it may be time to review why a patient is on it and whether the benefit is still there. The pattern I run into is people staying on it. It gets started for something like restless legs, it helps at first, and then it just stays on the list long after symptoms have settled, because nobody goes back and revisits the prescription. Now there’s another reason to ask whether it still belongs there.

For families, this means paying attention too. If a parent or older relative is taking gabapentin, bring it up at their next appointment. Long-term prescriptions sometimes get renewed automatically. I don’t taper gabapentin myself. When it comes up in a visit, I tell the patient to bring it to their primary care provider, or whoever prescribes it for them, and talk through together whether it still makes sense.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources:

Lin S, et al. “Gabapentin exposure and risk of cognitive decline and dementia.” Regional Anesthesia & Pain Medicine. July 2025.

Fisher Center for Alzheimer’s Research Foundation. “Pain Reliever Tied to Higher Dementia Risk.” alzinfo.org.