Track any chronic low back pain patient’s gabapentin refills. When a patient receives their sixth prescription, recognize that their long-term dementia risk is already meaningfully elevated. If they reach twelve prescriptions, the risk rises further. At either threshold, consider tapering or substituting the drug.

According to the study, in all adults, six or more gabapentin prescriptions increase 10-year dementia risk by 29% (RR 1.29) and mild cognitive impairment (MCI) risk by 85% (RR 1.85). Among adults younger than 65, the relative risk more than doubles: RR 2.10 for dementia and RR 2.50 for MCI. Exceeding twelve prescriptions leads to an additional increase: dementia risk climbs by 40% (RR 1.40) and MCI by 65% compared with the group that received three to eleven prescriptions.

How the Study Collected 10 Years of Data

The TriNetX network includes up to 20 years of patient encounter data (2004–2024).
Researchers stopped enrolling new patients on November 1, 2014. This ensured that every included patient could be followed for a full 10 years, through late 2024.
They retrospectively identified adults whose first chronic low back pain diagnosis occurred between 2004 and 2014, recorded how many gabapentin refills each patient received after diagnosis, and tracked the next 10 years of their medical records for new ICD-10 codes indicating dementia or MCI.
The analysis was completed in 2025, using only historical data.

What the Results Mean

In this study, “six or more gabapentin prescriptions” means a patient refilled gabapentin at least six separate times after their chronic low back pain diagnosis. Hitting six refills signals ongoing, long-term use.

When the authors state that this level of exposure “raises 10-year dementia risk by 29% (RR 1.29),” they mean that over the decade following diagnosis, patients who reached the six-refill mark were 29% more likely to receive a dementia diagnosis than otherwise similar patients who never took gabapentin.

An 85% higher risk for MCI (RR 1.85) refers to mild cognitive impairment—a diagnosis often seen as a warning sign for dementia. Here, gabapentin users were 85% more likely to receive this code within ten years than matched non-users.

Researchers also analyzed age groups separately. Among adults under 65, gabapentin’s association with cognitive decline was even stronger: the risk was about 2.1 times higher for dementia and 2.5 times higher for MCI compared to younger people who never took the drug.

The analysis then focused on exposure within the user group. Patients with twelve or more refills—used as a marker for heavier or more prolonged gabapentin use—faced even higher odds than those with three to eleven refills. Crossing that twelve-refill threshold raised dementia risk by an additional 40% and MCI risk by 65%.

Altogether, the findings shows that six or more refills lead to a noticeable increase, and twelve or more refills bring a further rise. Because this pattern held after careful matching for dozens of health and demographic variables, it strengthens (though does not prove) the suspicion that gabapentin itself could contribute to cognitive decline.