Non-elderly adults with chronic low back pain who were prescribed gabapentin had more than double the risk of developing dementia compared with those who were not prescribed the drug, according to the results of a retrospective cohort study.
Gabapentin use was associated with a 29% increased risk of dementia and an 85% increased risk of mild cognitive impairment (MCI) within 10 years of pain diagnosis. Among non-elderly adults aged 18 to 64 years, the risk was notably higher: dementia risk increased by 110% and MCI risk by 150% in those prescribed gabapentin compared with those not exposed. Elderly adults (≥ 65 years) also experienced increased risks, though to a lesser extent: 28% for dementia and 53% for MCI.
Patients prescribed gabapentin 12 or more times had a 40% greater risk of developing cognitive impairment and a 65% greater risk of MCI compared with those receiving 3 to 11 prescriptions. In patients aged 50 to 64 years, risk of dementia and MCI was nearly doubled in the higher-exposure group compared with the lower-exposure group.
The researchers, led by Nafis B. Eghrari of Case Western Reserve University School of Medicine, Cleveland, Ohio, and colleagues, utilized data from the TriNetX U.S. Collaborative Network, identifying 1,428,372 adults diagnosed with chronic pain between 2004 and 2014. Patients with prior gabapentin use, dementia, epilepsy, cancer, or stroke were excluded. They were categorized based on gabapentin exposure, defined as receiving six or more prescriptions following initial diagnosis.
To minimize confounding, the investigators applied 1:1 propensity score matching, resulting in two well-balanced cohorts of 26,416 patients each. Matching accounted for demographics, comorbidities linked to cognitive decline, and concurrent prescriptions for other pain-related medications. The mean age in the gabapentin group was 52.4 years, compared with 53 years in the unexposed group.
The researchers recommended that physicians monitor cognitive outcomes in patients receiving gabapentin and encouraged further investigation into possible causal mechanisms.
They reported no conflicts of interest.
