For countless people crippled by nerve pain, gabapentin has meant sleep, mobility, and a return to something like normal life. That’s what makes these findings so unsettling. In the Case Western Reserve analysis, patients who repeatedly filled prescriptions showed a significantly higher likelihood of developing dementia over time. It’s not proof of direct harm, but it’s enough to raise alarms about a pill once considered routine. Researchers stress that the story is more complicated than a single villain. Chronic pain itself, reduced movement, depression, poor sleep, and other medications all intertwine with brain health. Experts urge patients not to suddenly abandon treatment, but to start asking harder questions: Is gabapentin still necessary? Are there safer alternatives, lifestyle changes, or lower doses? The real danger may not be the pill alone, but the silence surrounding its long-term cost.