January 30, 2026

@michaelokun

Does gabapentin really cause dementia? Spoiler alert: It likely does not. What does the data actually tell us. What does a nested case control mean? Nested case control means researchers start w/ a large group that is followed over time and then compare those who develop an outcome to carefully matched controls from within the same group. Tsai and colleagues describe a new paper in Journal of Affective Disorders examining whether gabapentin use in adults w/ chronic pain was linked to dementia risk. Key points: - Gabapentin use was not associated w/ a higher adjusted risk of dementia after accounting for age comorbidities and other medications. - No dose response signal emerged; low and high cumulative gabapentin doses showed similar dementia risk. - Results were consistent across age groups sex and multiple sensitivity analyses using different washout periods. My take: Try not to 'over-react' to any one study that comes out purporting that gabapentin is associated w/ dementia. This study I am sharing pushes back against the growing narrative that gabapentin directly causes dementia. Observational signals can be misleading when pain severity, comorbid disease and medication burden are not fully accounted for. Careful design matters and this one I am sharing was thoughtful. Let's wait for a few well designed studies before we prematurely draw a conclusion. Here are 5 points that resonated w/ me: 1- Chronic pain itself is strongly linked to dementia risk and must be separated from medication effects. 2- After adjustment, gabapentin did not independently raise dementia risk in this large real world dataset. 3- Lack of a dose response weakens the argument for a causal relationship. 4- Sensitivity analyses strengthen confidence that short term prescribing near the diagnosis did not drive results. 5- Health care providers should individualize decisions and balance symptom relief against known short term cognitive side effects rather than assuming long term dementia harm. https://pubmed.ncbi.nlm.nih.gov/38729220/ #michaelokun #gabapentin #pain #dementia #fixelinstitute #parkinson