Semaglutide linked to lower cognitive decline risk and reduced nicotine cravings

• A study from the University of Oxford examined semaglutide, a medication used to treat type 2 diabetes and obesity, better known under the brand names Ozempic or Wegovy.
• The researchers wanted to find out whether semaglutide causes neurological or psychological issues in people who are prescribed semaglutide for type 2 diabetes treatment.
• The study found that the medication does not contribute to an increased risk for either of these issues.
• The scientists found that semaglutide actually provides some benefits in these areas – specifically, participants who used semaglutide had a lower risk for dementia and reduced nicotine dependency.

Semaglutide is a GLP-1 medication used to treat type 2 diabetes and obesity. Researchers are looking into the other benefits semaglutide can have, and have recently found that it can reduce the risk of cardiovascular death.

A recent study led by Dr. Riccardo De Giorgi , a clinical lecturer in adult psychiatry at the University of Oxford in the United Kingdom, examined whether semaglutide contributed to neurological or psychological problems.

The research team found that of thousands of patients taking semaglutide, none of them were at an increased risk for developing issues such as depression or anxiety.

Additionally, these medications were linked to a reduced the risk of dementia and also less craving for nicotine.

The study is published in eClinicalMedicine , part of The Lancet Discovery Science .

Increasing scrutiny of semagltudide’s health effects

Millions of people in the United States have obesity. According to the National Institutes of Health (NIH) , around 42% of people meet the criteria for obesity, which is having a body mass index (BMI) of 30 or higher.

Obesity can contribute to many health issues, including developing type 2 diabetes and heart disease. Doctors recommend that people who have obesity or type 2 diabetes make lifestyle changes, and sometimes they prescribe medications to help with weight loss.

One medication that has become increasingly popular in the U.S. is semaglutide, which is the active ingredient in Ozempic and Wegovy . While they both have the same active ingredient, the dosing may differ.

Doctors prescribe Ozempic to people who have type 2 diabetes, whereas Wegovy is typically geared towards people with obesity or people who have a body mass index (BMI) of 27 or higher, signifying overweight, and certain preexisting conditions.

Some common side effects of semaglutide include:

• nausea
• diarrhea
• vomiting
• headache
• constipation.

Semaglutide can rarely cause severe side effects such as pancreatitis, gallstones, and gastroparesis ( stomach paralysis ).

Does semaglutide cause neurological issues?

Researchers are curious about other possible side effects and benefits of semaglutide, which led to the University of Oxford team examining the medical records of people taking the medication.

“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,” the researchers write in the study paper.

After accessing more than 100 million patient records, the scientists found more than 20,000 people taking semaglutide. The researchers compared these patient records to those of patients taking sitagliptin , empagliflozin , or glipizide , which are commonly prescribed to treat type 2 diabetes.

They were interested in whether people developed certain neurological or psychological issues within 12 months of being prescribed the medications. They compared 22 such outcomes between semaglutide and the other three medications.

Some outcomes they considered included cognitive deficit, dementia, migraine, insomnia, nicotine misuse, depression, and anxiety.

After comparing the semaglutide group to groups taking sitagliptin, empagliflozin, or glipizide, the researchers found that semaglutide was associated with a lower risk for most of the 22 outcomes they compared.

With the exception of a higher risk of migraine compared to glipizide, semaglutide showed no increased risk for psychiatric or neurological outcomes.

The medication was found to be associated with a lower risk of cognitive problems compared to people taking sitagliptin or glipizide.

Why might semaglutide reduce nicotine cravings?

Some other areas the researchers found semaglutide to be beneficial in compared to sitagliptin include dementia, depression, and ischemic stroke.

When looking at nicotine dependency, the scientists learned that semaglutide reduced nicotine cravings compared to glipizide or empagliflozin.

Furthermore, the researchers learned that semaglutide was associated with a reduced all-cause mortality rate compared to the other three medications.

However, this association “must be interpreted cautiously since linkage between the TriNetX U.S. Collaborative Network and death registry is incomplete,” note the researchers.

When speculating why semaglutide was generally more beneficial than the other medications, the researchers suggested that the “anti-inflammatory mechanisms” of semaglutide may be a factor.

Additionally, they said 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.”

What other benefits might semaglutide bring?

Deborah B. Horn, DO, MPH , a medical weight-loss management physician with UTHealth Houston, spoke with Medical News Today about the study. Horn did not participate in the research.

“In the trials for both diabetes and obesity using semaglutide and other GLP-1s, we have seen improvements in other diseases and one common thread appears to be a reduction in inflammation,” Horn pointed out.

She noted that the mechanisms behind these improvements are unknown, but noted a possibility that could be explored.

“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,” Horn explained. “There may also be anti-inflammatory pathways that are affected which could result in these neurocognitive/dependence improvements.”

Nevertheless, she also said more research is necessary but finds the potential for semaglutide and other GLP-1 medications promising.

“The next step will be to develop clinical trials to test these ideas,” commented Horn. “If found to be true, this will broaden the treatment approaches for GLP-1s beyond diabetes, obesity, and cardiovascular risk reduction.

Clifford Segil, DO , a neurologist at Providence Saint John’s Health Center in Santa Monica, CA, also spoke with MNT about the study. Segil is not affiliated with the research.

“Medications like semaglutide and tirzepatide cause people to eat less and not be hungry,” he explained. “Research is ongoing to see if these medications are causing people to consume less alcohol, tobacco, caffeine, and other addictive substances.”

Segil noted that high blood sugar “is not directly associated with cognitive decline and memory loss.”

“There is nothing to indicate normal blood sugar being neuroprotective as patients without diabetes get dementia,” he also pointed out.

However, he explained that high blood sugar levels can contribute to heart attacks and strokes and lead to “vascular dementia or multi-infarct dementia.”

“Research has shown that calorie restriction may be associated with longevity. I look forward to seeing research on the calorie restriction caused by these medications to see if they increase people’s lifespans in the long run.”

– Clifford Segil, DO