Popular weight-loss drugs may offer benefits that extend beyond metabolism, potentially helping preserve memory and other cognitive abilities.
Medications used to treat obesity and type 2 diabetes may also influence memory and other cognitive abilities. But whether drugs such as semaglutide and tirzepatide can actually protect the brain remains uncertain, particularly after major clinical trials failed to demonstrate a benefit in patients with early Alzheimer’s disease.
In Novo Nordisk’s EVOKE and EVOKE+ trials, semaglutide did not slow Alzheimer’s progression, even though it produced changes in several biological markers associated with the disease. Researchers from the University of Gothenburg and the University of Copenhagen have now examined the broader evidence in a review published in Science, exploring whether these medications could still help preserve cognitive function in other groups of patients.
Why Weight-Loss Drugs Could Affect Memory
GLP-1 medications influence biological processes involved in both metabolism and brain function. Animal experiments suggest they can affect learning and memory, but studies involving humans have produced inconsistent results. Analyses of patient health records have linked GLP-1 treatment to a reduced risk of dementia among people with type 2 diabetes, although these observational findings cannot establish that the drugs directly provide protection.
The potential benefits may differ depending on the cause of cognitive difficulties. People with obesity or type 2 diabetes sometimes experience problems with attention, planning, and mental processing speed. These difficulties are frequently associated with metabolic disturbances and poor vascular health, raising the possibility that treatments targeting these underlying problems could help maintain cognitive abilities.
Stina Börchers, the review’s first author and a researcher affiliated with both universities, believes that identifying the right patients and treatment timing will be essential.
“We need to find out whether these treatments can help people with obesity or diabetes preserve their cognitive abilities, particularly if treatment begins before cognitive problems become established. It is also important to identify which patients might benefit,” says Stina Börchers.
Understanding How Metabolic Treatments Influence the Brain
A central unanswered question is whether any cognitive benefits arise from direct effects on the brain, improvements in metabolic health, or both. Better regulation of blood sugar and other metabolic processes could indirectly support brain function, while GLP-1 signaling may also influence neural processes more directly. Separating these mechanisms could help researchers determine which effects are most relevant to preserving cognition.
Christoffer Clemmensen, the review’s senior author and a research group leader at the University of Copenhagen, sees an opportunity to use increasingly advanced obesity medications to investigate these connections.
“Obesity medicines are becoming increasingly sophisticated, offering new opportunities to understand how metabolic regulation influences brain function. By disentangling the direct and indirect effects of these drugs on the brain, we may ultimately be able to develop treatments specifically aimed at preserving cognitive function,” says Christoffer Clemmensen.
The Next Step Toward Protecting Cognitive Health
The researchers are calling for clinical trials that measure memory and other cognitive abilities from the beginning of treatment. Such studies could help establish whether these medications preserve cognitive function, which patients are most likely to benefit, and whether starting treatment before cognitive difficulties appear makes a difference.
They also caution that potential benefits must be weighed against risks in older or frail patients. Rapid weight loss and declining muscle mass can reduce physical functioning, potentially limiting the overall advantages of treatment. Future studies will need to account for these effects when assessing whether obesity medications can support long-term brain health.
Reference: “Obesity pharmacotherapies and cognition” by Stina Börchers, Giulia Mazzini, Henrik Zetterberg and Christoffer Clemmensen, 5 November 2026, Science.
DOI: 10.1126/science.aek9987
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