Semaglutide—an obesity and type 2 diabetes medication better known by its brand names Ozempic and Wegovy—has been linked to a lower cognitive decline risk and reduced nicotine cravings.

The finding comes from a University of Oxford study that sought to determine if semaglutide causes neurological or psychological issues in people who were prescribed the medication for type 2 diabetes treatment. Not only did the medication not contribute to an increased risk for either issue, but it was actually found to provide some benefits in both areas. In addition, a study published in the November 11, 2023 edition of the New England Journal of Medicine found that semaglutide can also reduce the risk of cardiovascular death.

The Research on Semaglutide and Cognitive Decline

The research team looked at more than 100 million patient records and found 20,000 people taking semaglutide. They compared those records to those of people taking three other type 2 diabetes medications: glipizide, sitagliptin, and empagliflozin. Combining the groups, they compared 22 outcomes to see if anyone developed neurological or psychological issues within one year of being prescribed the drugs.

After looking at the potential outcomes—which included everything from migraines, insomnia, and nicotine misuse to depression, anxiety, and cognitive deficit, they found:

• Compared to the people taking glipizide, sitagliptin, or empagliflozin, the patients taking semaglutide had a lowered risk for most of the 22 outcomes.

• Semaglutide showed no increased risk for psychiatric or neurological outcomes with one exception: people taking semaglutide had a higher risk of migraine compared to those taking glipizide.

• Semaglutide was associated with a lower risk of cognitive problems compared to glipizide or sitagliptin.

• Semaglutide was more beneficial compared to sitagliptin for depression, dementia, and ischemic stroke.

• Compared to the other three diabetes meds, semaglutide was associated with a reduced all-cause mortality rate.

• Semaglutide reduced nicotine cravings better than glipizide or empagliflozin.

The “why” behind lowering risks

So, how does semaglutide lower cognitive decline risk and reduce nicotine cravings?

Although more research needs to be done, the scientists wrote in the study paper that they the clinical evidence suggests that these medications “have neurobiological activity, including protection against neuronal degeneration and inflammation, as well as modulation of dopamine-related reward mechanisms.” They continue to explain that semaglutide and other GLP-1 medications “regulate dopaminergic pathways underlying reward sensitivity, which are at least partly responsible for their weight-loss action and their putative activity against addictive behavior.”

UTHealth Houston medical weight-loss management physician Deborah B. Horn, who was not involved in the study, has some ideas as to why semaglutide provides such benefits. “There are GLP-1 receptors in the reward center of the brain which may suggest a pathway for reducing addictive behaviors like smoking or drinking,” she says. “There may also be anti-inflammatory pathways that are affected which could result in these neurocognitive/dependence improvements.”

GLP-1, which stands for “glucagon-like peptide-1” is a hormone that regulates appetite, blood sugar and digestion. This receptor is found in the brain and pancreas, where it helps control blood sugar levels by increasing insulin secretion.

The University of Oxford study was published in eClinicalMedicine, part of The Lancet Discovery Science.

MBJ

Wendy Burt-Thomas writes about the brain, mental health and parenting.

Check out the original research:

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00305-5/fulltext