The study, led by researchers at Case Western Reserve University and published in the medical journal Regional Anesthesia & Pain Medicine, evaluated medical records from more than 26,000 adults who had been prescribed gabapentin for persistent low-back pain. These patients were compared with a closely matched group experiencing similar levels of chronic pain but who did not take the medication. By analyzing data from 68 health systems across the country, the researchers were able to look beyond small, limited samples and uncover broader patterns that might otherwise be missed. Their findings were striking: adults who received six or more prescriptions of gabapentin had a 29 percent higher likelihood of being diagnosed with dementia and an 85 percent higher likelihood of developing mild cognitive impairment (MCI) within ten years. The pattern held even after adjusting for other health conditions, demographic factors, and medications. While the study does not claim that gabapentin directly causes dementia, it raises important questions about how long-term medication use may intersect with brain health, especially in a population already vulnerable to age-related cognitive decline.

What surprised researchers most was the age pattern hidden within the data. The increased risk was not confined to older adults, as many might expect. In fact, younger adults — those between 35 and 49 — saw the most dramatic rise in future cognitive risks. For these individuals, the likelihood of developing dementia more than doubled compared to those not taking the medication, and the risk of mild cognitive impairment more than tripled. Adults aged 50 to 64 experienced similarly steep increases, suggesting the potential link may affect people long before the age typically associated with neurodegenerative conditions. The only group spared from increased cognitive risk was adults between 18 and 34, whose results showed no significant change in outcomes. This age disparity is one of the study’s most compelling findings, signaling that long-term cognitive health might be more sensitive to medication exposure during mid-adulthood than previously assumed.

Understanding why gabapentin might be associated with cognitive decline requires stepping back and looking at the drug’s history. Developed in the early 1990s, gabapentin was originally approved to treat epilepsy. Over time, doctors discovered that it could also help with nerve pain, shingles, fibromyalgia, restless legs syndrome, and a wide range of chronic pain conditions — even when these uses were not formally approved by regulators. As America searched for safer alternatives to opioid painkillers, gabapentin’s use surged. Today, it is prescribed to millions, often for long-term pain conditions that lack simple solutions. But like any medication, gabapentin is not without side effects. Patients frequently report dizziness, fatigue, concentration problems, and memory issues. Some studies have suggested it may impair balance or coordination, potentially increasing fall risk in older adults. Others have raised concerns about respiratory issues when combined with sedatives. The new study adds another layer to this evolving understanding: not only can gabapentin affect thinking in the moment, but long-term use may be associated with future cognitive decline.

Even so, researchers emphasize caution in interpreting these findings. This was an observational study, meaning the data shows correlation rather than direct proof of cause. It is possible that underlying factors — such as chronic pain severity, reduced mobility, or other undiagnosed conditions — may contribute to the increased risk. However, the study attempted to control for these possibilities by matching patients with similar health profiles, suggesting the relationship is not easily explained by obvious confounders. The researchers were also unable to determine precise dosages or durations of use, and they noted this as an important limitation. Still, the sheer scale of the dataset — one of the largest of its kind — and the consistency of the pattern across age groups and health backgrounds indicate that the potential risk deserves attention, further research, and careful monitoring among patients who depend on gabapentin for long-term relief.

For patients currently taking gabapentin, the study’s message is not to panic but to stay informed. Millions of Americans rely on this medication, and for many people it genuinely improves quality of life. The findings do not mean that everyone who takes gabapentin will experience cognitive decline. Instead, they highlight the importance of regular check-ins, conversations with healthcare providers, and thoughtful consideration of how and when the drug is used. Doctors may begin recommending more frequent cognitive screenings for long-term users or exploring alternative treatments where appropriate. Patients who have been on gabapentin for many years may want to discuss whether the benefits still outweigh the risks, and whether dosage adjustments or gradual tapering might be appropriate. It is also worth noting that gabapentin remains safer than many other pain medications, particularly opioids, which carry far greater immediate risks including addiction and overdose.

The broader implication of the study is that pain management cannot be separated from long-term health planning. Chronic back pain, one of the leading causes of disability in the United States, often leaves patients desperate for relief. As a result, medications intended for short-term use can quietly become long-term solutions, sometimes without periodic re-evaluation. This study serves as a reminder that every long-term medication — even those considered relatively low-risk — should be used with awareness, balance, and ongoing communication between patients and clinicians. The researchers themselves describe their work as a starting point for deeper investigation, not a final verdict. But their conclusion is clear: an association exists, and it deserves attention.

For a drug consumed by millions, even a modest increase in cognitive risk becomes significant when viewed at a population level. As the researchers wrote, their findings point to a need for ongoing monitoring and thoughtful prescribing practices. Given the widespread use of gabapentin, their message is simple but vital: stay informed, stay observant, and stay in conversation with your healthcare team. The more we understand about how medications shape the future of our health, the better we can protect the mind as well as the body — not only for ourselves, but for the generations who will inherit these evolving medical landscapes.