A medicine widely used to treat type 2 diabetes and obesity has been linked to fewer memory and thinking problems in people with psychiatric disorders.
The study, led by researchers at the University of Oxford and supported by our Biomedical Research Centre (BRC), found that people starting semaglutide had lower cognitive symptom scores over the following 12 months than those receiving two other commonly used diabetes medicines or no antidiabetic treatment.
Cognitive problems affect between one-third and two-thirds of people with psychotic and mood disorders. They can involve memory, attention, orientation and other thinking abilities, affecting people’s everyday lives, but effective treatments remain limited.
Published in BMJ Mental Health, the study analysed de-identified electronic health records from 13,007 adults in the USA with a psychiatric diagnosis. Of these, 1,261 had started semaglutide. The researchers examined routine assessments in which clinicians recorded whether patients showed difficulties with memory, attention, orientation or other cognitive functions.
The researchers compared semaglutide with three other medicines used to treat type 2 diabetes: empagliflozin, glipizide and sitagliptin. They also modelled a no-treatment comparison using information from people who stopped taking antidiabetic medication during the follow-up period.
Over 12 months, cognitive symptom scores were 17% lower with semaglutide than with glipizide, 19% lower than with empagliflozin, and 25% lower than with no antidiabetic treatment.
The study found the strongest links between semaglutide and improvements in memory-related symptoms, with the clearest findings seen in people with major depressive disorder.
Riccardo De Giorgi, Senior Clinical Researcher at the University of Oxford Department of Psychiatry and lead author, said: “Cognitive problems are among the most difficult aspects of mental illness to treat, and they can have a profound impact on people’s everyday lives. What I find particularly interesting here is that the association was strongest for memory and broader cognitive functions, and was most consistent in people with depression. The similarity between semaglutide and sitagliptin is also intriguing. The two drugs act differently but both involve the GLP-1 system, raising the possibility that this pathway, perhaps together with improvements in metabolic health, could help explain the cognitive effects we observed”.
The researchers used NeuroBlu, a database of de-identified electronic health records collected during routine care by mental healthcare organisations in the USA. Their analysis accounted for changes in treatment and other clinical factors over time.
Dr Maxime Taquet, Associate Professor at the University of Oxford Department of Psychiatry who supervised the study, said: “The results are particularly exciting because many people with psychiatric conditions also have diabetes. Our findings suggest that both diabetes and cognitive problems might be treated with the same drug. There is virtually no treatment for cognitive problems in people with severe mental illness, and our study might point to a first potential treatment. Our study is observational and will therefore need to be confirmed with a clinical trial.”
As an observational study, the research identifies associations but cannot show that semaglutide caused the lower cognitive symptom scores. The findings were based on routine clinician assessments rather than standardised cognitive testing, and treatment information came from prescription records, which could not confirm whether medicines were dispensed or taken as prescribed. Randomised clinical trials using objective cognitive tests are needed to confirm the results.
The findings relate to an older group of adults, with an average age of 62, who had psychiatric diagnoses and were prescribed antidiabetic medication in routine care. It is not yet known whether similar findings would apply to younger people, those without diabetes or people receiving semaglutide primarily for weight management.
The original research paper, Cognitive signs and symptoms in people with a psychiatric diagnosis on semaglutide: a retrospective cohort study of 13,007 patients in the USA, by Riccardo De Giorgi, Nadia Lipunova, Elgan Mathias, Fei Shang and Maxime Taquet, was published in BMJ Mental Health.
