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Gabapentin-induced worsening of neuropsychiatric symptoms in dementia with lewy bodies: case reports Gabapentin use has been associated with memory loss and cognitive decline. Studies suggest that the risk of dementia may be higher in patients treated with gabapentin. It is important for patients and healthcare providers to be aware of the potential cognitive side effects of gabapentin. Dementia is already associated with lowered levels of acetylcholine in the brain, which is why taking anticholinergics — which further restrict acetylcholine — can worsen symptoms. Common However, several case reports in which gabapentin was used for agitation in dementia with Lewy bodies question its appropriateness for all types of dementia-related agitation [14–16]. Indeed, paradoxical gabapentin-induced exacerbation of psychosis in a patient with schizophrenia has already been described . Gabapentin has been increasingly prescribed to older adults for off-label indications, and accumulating evidence suggests potential for gabapentin misuse and related adverse events. However, the relation between gabapentin initiation and longer-term neurocognitive changes is not well understood. Moreover, dementia risk increased along with the cumulative dose. Taking an anticholinergic for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less. The University of Washington study is the first to include nonprescription drugs. Respiratory Depression: Although not directly tied to dementia, gabapentin use can cause respiratory depression, especially when combined with other central nervous system depressants like opioids or benzodiazepines. This can result in reduced oxygen to the brain and, in extreme cases, could contribute to cognitive issues over time. We estimated the yearly prevalence of gabapentin use, both overall and within subgroups defined by cognitive status [normal, mild cognitive impairment, and dementia] and demographics [age and sex] for participants aged 65+. The results revealed that the risk of dementia associated with gabapentin or pregabalin exposure was significant in all subgroups except for the strata having depression or head injury. The risk of dementia development was higher in the younger group (age <50 years) than that in the older group. We excluded the following older adults from analysis: (1) those in their first year of eligibility for prescription drug coverage (aged 65 years) to avoid incomplete medication records; (2) those with a prescription for our study drug (gabapentin) or non-study drug (pregabalin) in the 180 days prior to the index date, to restrict the analysis Other studies have shown that the use of an anticholinergic medication can worsen dementia in people who are already experiencing cognitive decline. But not all studies have such clear-cut findings. For example, even though diphenhydramine (Benadryl) has strong anticholinergic activity, current research isn’t clear on whether diphenhydramine Especially in older adults, gabapentin is prescribed to treat behavioral and psychological symptoms of dementia (BPSD) (Kim et al., 2008). Several studies have reported that gabapentin has a deleterious effect on cognition (Leach et al., 1997; Meador et al., 1999; Shem et al., 2018). The multivariate-adjusted hazard ratio of risk of dementia for gabapentin or pregabalin exposure versus the matched non-exposed group was 1.45 (95% confidence interval [CI], 1.36-1.55). The risk of dementia increased with higher cumulative defined daily doses during the follow-up period. Gabapentin use was significantly associated with decline in cognitive and functional status among older adults with initially normal cognition. Further studies are needed to examine the association. The evidence of gabapentin and dementia is mixed, with two studies looking at hundreds of thousands of people and coming to completely different conclusions. Long-term Gabapentin therapy for chronic pain is not associated with a differential risk of dementia across dosage levels, irrespective of age or gender. Further study into its potential cognitive impacts is essential.
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