By Kami McDonald, Student Pharmacist and Karen L. Kier, Pharmacist
ONU Healthwise Pharmacy

In 1970, Gordon Lightfoot released his chart topping gold record If You Could Read My Mind. Lightfoot was a prolific singer-songwriter with many major accomplishments in the music industry. Besides being honored on a Canadian stamp, Lightfoot was in the opening ceremonies for the 1988 Winter Olympics in Calgary, Canada. Bob Dylan praised Lightfoot for his ability to write beautiful lyrics.

If you could read my mind, would I be wondering about a medication developed to treat diabetes that could help prevent progressive conditions such as Alzheimer's disease?

An estimated 6.9 million Americans ages 65 and up live with Alzheimer's Disease (AD) which is projected to increase to 13.8 million by 2060. AD has no cure and very few medications including over the counter supplements have evidence to prevent the onset of AD.

A 2022 AARP survey of United States adults 50 years and older found we spend a total of $93 million every month on brain help supplements. A 2024 study published in the Journal of the Academy of Nutrition and Dietetics found about 40% of middle-aged adults spend $50 to $200 every year on brain supplements. In 2023, this totaled 3.21 billion dollars on brain health supplements. Despite this spending, the National Center for Complementary and Integrative Health indicates there is currently no direct evidence that brain supplements can improve or prevent cognitive decline in adults.

The FDA has approved three biologic medications to help in the treatment of early symptoms of AD. The first to be approved was Aducanumab (Aduhelm) in 2021, but the manufacturer voluntarily withdrew the drug from the market. The other two are lecanemab (Leqembi) and donanemab (Kisunla). These drugs target amyloid plaques in the brain that are thought to be responsible for causing AD. The drugs need to be given by intravenous infusion and must be closely monitored including watching for brain swelling and brain bleeding.

Because of the limited evidence for prevention of AD, healthcare professionals focus on risk factors for developing the condition. About 40% of these cases are linked to modifiable risk factors, which is why we target these risk factors in order to prevent or delay AD and related dementia.

Could a newer drug be a potential option?

Semaglutide (Ozempic, Wegovy, Rybelsus) is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) FDA approved for diabetes and weight loss, which are risk factors for AD. Semaglutide has shown benefit in helping manage cardiovascular disease, smoking cessation, alcohol overuse, and depression, which are risk factors.

There was a recent study using electronic health records of diabetes patients without an AD diagnosis. The aim was to determine if semaglutide is associated with a reduced risk of AD in a high-risk population, stratified by gender, age, and obesity. The trial compared semaglutide to other diabetes medications like insulin, DPP-4 inhibitors, and SGLT-2 inhibitors.

Out of 1,094,761 patients reviewed in this trial, 17,401 of the patients were initiated on semaglutide. The researchers reported patients initiated on the GLP-1 RA had a significantly decreased risk of receiving a first-time AD diagnosis. There was a three-year follow-up comparing these patients to those on other diabetes medications. The researchers reported semaglutide was associated with a 40 to 70% reduction in the risk of having a first-time diagnosis of AD compared to those on other diabetes drugs.

More research is needed to fully understand how semaglutide can help with the prevention or progression of AD. Reach out to your healthcare provider or a pharmacist at ONU HealthWise Pharmacy at 419-772-3784 to ask questions or inquire about future research in semaglutide's role in AD.