Gabapentin, a drug commonly prescribed for epilepsy and chronic pain, has recently come under scrutiny due to its potential link to dementia and cognitive decline. A study led by researchers from Case Western Reserve University School of Medicine has revealed that long-term use of gabapentin in patients with chronic low back pain is associated with a significantly increased risk of developing dementia and mild cognitive impairment (MCI) over the course of ten years. Specifically, the risk of developing dementia in gabapentin users was 29% higher, and the risk of MCI was 85% higher, compared to those with back pain who were not prescribed the drug.
Although these findings have sparked concern, they also open the door for further research into whether gabapentin plays a causal role in cognitive decline. The researchers emphasize the importance of closely monitoring patients who are prescribed gabapentin for any signs of cognitive deterioration, particularly among older adults.
Gabapentin has become a popular alternative to opioids for managing chronic pain, due to its lower abuse potential. However, its connection to cognitive decline remains ambiguous. To investigate this, the researchers utilized the TriNetX national database of de-identified patient records to create a cohort of 26,416 gabapentin users and an equal number of non-users. In their initial analysis, the study found that gabapentin use was associated with a higher incidence of both dementia (risk ratio [RR], 1.29) and MCI (RR, 1.85) in adults aged 18 and older.
The researchers further stratified the cohort by age, finding that gabapentin use was linked to an increased incidence of both dementia and MCI in elderly patients (aged 65 and older), with risk ratios of 1.28 and 1.53, respectively. Similarly, in younger adults aged 18-64, gabapentin users showed higher rates of dementia and MCI compared to non-users, with risk ratios of 2.10 and 2.50, respectively.
In a more detailed breakdown, patients aged 35-49 and 50-64 had an even higher risk of developing cognitive issues when using gabapentin. For example, those aged 35-49 had a 2.44 times greater risk of dementia and a 3.50 times higher risk of MCI compared to non-users. The risks were similarly elevated in those aged 50-64, with dementia risk at 2.28 times and MCI at 2.22 times greater in gabapentin users.
The study also found that patients who were prescribed gabapentin more frequently had a greater likelihood of developing cognitive issues. Those who received 12 or more prescriptions for gabapentin had a 40% higher risk of dementia and a 65% higher risk of MCI than those who were prescribed the drug between three and eleven times.
While these findings raise alarm, many experts urge caution in interpreting the results. Professor Martin Prince of King’s College London pointed out that there could be confounding factors or reverse causality at play. He suggested that the observed effects may not be directly due to gabapentin, but could instead be influenced by other unmeasured factors.
Tara Spires-Jones, director of the Centre for Discovery Brain Sciences at the University of Edinburgh, echoed this sentiment, noting that while the researchers made efforts to control for other risk factors, observational studies like this cannot conclusively establish that gabapentin causes dementia. One important factor not examined in the study, she explained, is physical activity levels. Chronic pain patients who use gabapentin may be less physically active, and a lack of exercise is a known risk factor for dementia.
Professor John Hardy, a group leader at the UK Dementia Research Institute at University College London, also raised concerns about the findings. He stated that while the study is interesting, the results might be the result of short-term effects on cognitive performance rather than long-term effects on dementia or underlying brain disease.
Despite these warnings, the study’s findings are important and warrant further exploration. While the current evidence does not definitively link gabapentin to dementia, it highlights the potential cognitive risks associated with long-term use of the drug. As patients like Thomas, a 65-year-old American with chronic back pain, reflect: "I've relied on gabapentin to manage my pain, but now I’m beginning to question the long-term effects it could have on my brain." Thomas's concerns reflect a growing need for vigilance and careful consideration when prescribing this medication.
In conclusion, while gabapentin offers relief to many chronic pain patients, its potential impact on cognitive health should not be overlooked. As more research is conducted, we may better understand the relationship between gabapentin and cognitive decline, ultimately leading to safer and more effective treatment options for patients.