The link between gabapentin and dementia is not established, but it’s not ruled out either. The research so far is mixed and complicated by the fact that the conditions gabapentin treats, particularly chronic pain, are themselves associated with higher dementia risk. What is clear is that gabapentin can cause short-term cognitive side effects like confusion, slowed thinking, and memory trouble, and these effects appear to be reversible when the drug is stopped.
What the Largest Studies Show
A 2025 study published in Regional Anesthesia & Pain Medicine found that people with chronic low back pain who received six or more gabapentin prescriptions had a 29% higher rate of dementia and an 85% higher rate of mild cognitive impairment compared to those not prescribed the drug. The risk climbed with more prescriptions: patients with 12 or more had a 40% higher dementia rate than those prescribed it fewer times. Adults under 65 showed the most striking numbers, with over twice the rate of dementia and 2.5 times the rate of mild cognitive impairment compared to non-users.
But a separate case-control study looking at adults with chronic pain found no meaningful increase in dementia risk from gabapentin use. The adjusted odds ratio was 0.91, essentially flat, and there was no difference between people who took low versus high cumulative doses. These two studies reached nearly opposite conclusions, which tells you the science is genuinely unsettled.
Why Chronic Pain Complicates the Picture
The biggest challenge in this research is something called confounding by indication. Gabapentin is typically prescribed for conditions like nerve pain, shingles, and chronic back pain. These conditions are more common in people who are already at higher risk for cognitive decline. Several experts reviewing the 2025 study pointed out that people prescribed gabapentin likely had more severe pain and more serious underlying conditions than those who weren’t, and severe chronic pain itself has been linked to dementia and shrinkage of the hippocampus, the brain’s memory center.
Reverse causality is another real concern. Early Alzheimer’s disease can change how the brain processes pain, potentially leading to more pain complaints, more doctor visits, and ultimately more gabapentin prescriptions. In that scenario, the disease came first and the prescription followed, not the other way around. There may also be a shared underlying cause, like chronic inflammation, that drives both nerve pain and neurodegeneration independently.
Physical activity matters too. People with chronic pain severe enough to require gabapentin tend to be less physically active, and reduced physical activity is one of the most consistent risk factors for dementia. None of the major studies have adequately accounted for this.
How Gabapentin Affects the Brain
Gabapentin works by binding to a protein on nerve cells called alpha-2-delta-1. This protein normally helps form new connections between brain cells, a process critical to learning and memory. Research published in Cell found that gabapentin blocks this protein from receiving signals that trigger new synapse formation. In lab and animal studies, the drug powerfully inhibited the creation of new excitatory connections in the brain. This mechanism is what makes gabapentin effective for nerve pain, but it also provides a plausible biological pathway through which long-term use could affect cognition.
In clinical trials, about 2% of people taking gabapentin for epilepsy reported amnesia (compared to 0% on placebo), and a similar proportion reported abnormal thinking. The FDA-approved label warns that gabapentin “can slow your thinking and motor skills” and lists confusion as a side effect to watch for. There is some evidence that these cognitive effects are most pronounced within the first year of treatment.
Cognitive Effects Appear Reversible
One reassuring finding comes from a 2026 preprint study that specifically examined whether gabapentin’s cognitive effects go away after stopping the drug. The study found that cognitive symptoms were 67% more common during active gabapentin use (particularly when combined with a common type of blood pressure medication called a calcium channel blocker) compared to after discontinuation. When both drugs were stopped, the difference was even more dramatic: cognitive symptoms were 2.2 times higher during use than after stopping. The researchers concluded that cognitive effects associated with gabapentin use “appear substantially reversible upon discontinuation.” This suggests that the thinking and memory problems people experience on gabapentin are more like a side effect of the drug being in your system than permanent brain damage.
Risk Factors That Raise Concern
Certain groups face more reason for caution. Older adults with reduced kidney function clear gabapentin from their bodies more slowly, which can amplify side effects including cognitive ones. The American Geriatrics Society’s Beers Criteria, a widely used guide for prescribing in older adults, recommends reducing the gabapentin dose when kidney function drops below a specific threshold. The same guidelines strongly advise against combining gabapentin with opioids due to the risk of severe sedation, and against taking three or more drugs that affect the central nervous system at the same time, as this significantly increases fall risk.
If you’re taking gabapentin alongside a calcium channel blocker for blood pressure, the combination appears to carry a higher cognitive burden than either drug alone. Falls were also 34% more common during combined use in the study that examined this pairing. If you’ve noticed new fogginess or balance problems, that specific drug combination is worth discussing with your prescriber.
What This Means in Practice
The honest answer is that gabapentin has not been proven to cause dementia, but the possibility hasn’t been eliminated. The strongest evidence points to reversible cognitive dulling during use rather than permanent decline. The biological mechanism exists for gabapentin to interfere with brain connectivity, but observational studies can’t separate the drug’s effects from the effects of the painful conditions it treats.
For people taking gabapentin who are concerned about their thinking or memory, the most practical takeaway is that these effects tend to improve after the drug is stopped or the dose is reduced. The risk appears to scale with the number of prescriptions and may be amplified by other medications, particularly opioids and blood pressure drugs. For most people using gabapentin at moderate doses for a defined period, the current evidence does not point to a lasting dementia risk.