# Semaglutide and Cognitive Signs in Psychiatric Patients: 13,007 Records | This GLP Among 13,007 patients with psychiatric diagnoses, semaglutide was linked to fewer recorded cognitive signs than no treatment but not versus sitagliptin | how a score built from clinical notes works. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/semaglutide-and-recorded-cognitive-signs Updated: 2026-09-18 Published: 2026-09-16 [← Research](https://thisglp.com/research) Evidence # Semaglutide and Cognitive Signs in Psychiatric Patients: 13,007 Records Semaglutide starters had fewer recorded cognitive problems than three comparator groups, and no significant difference from the fourth, sitagliptin, which was the closest match. [This GLP Editorial Team](https://thisglp.com/about)September 20266 min readUpdated September 2026 Cognitive signs recorded over 12 months (lower is fewer) · semaglutide · 11.14 · sitagliptin · 12.52 · difference not significant · glipizide · 13.46 · empagliflozin · 13.69 · no antidiabetic drug · 14.91 · 13,007 patients, 1,261 of them on semaglutide. **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). ## Key takeaways - 13,007 adults with a psychiatric diagnosis who started an antidiabetic drug, 1,261 of them semaglutide. - The outcome is a 0-100 score built from cognitive signs a clinician recorded in routine notes. - Semaglutide scored 11.14 against 14.91 on no treatment — mean ratio 0.75, 95% CI 0.65 to 0.85. - Against sitagliptin, the other incretin-system drug here, the difference was not significant. - Effect sizes looked similar across disorders but held consistently only in major depression. Before any of the numbers, what was measured: not a cognitive test, but whether somebody writing up an appointment noted a problem with memory, attention or orientation. That is a real signal and it is also a record of how often a person was seen and how carefully they were written up — the sort of measurement question that decides what [a comparison can be asked to carry](https://thisglp.com/research/do-glp1-drugs-cause-gout). ## The setup Adults with any psychiatric diagnosis in a multicenter US electronic health record, each with at least one clinician-rated cognitive assessment in the year before starting an antidiabetic drug and at least one in the year after. [\[1\]](https://thisglp.com/research/semaglutide-and-recorded-cognitive-signs#ref-1) Scores run 0 to 100, where 0 means no signs recorded and 100 means signs across every domain. Mean age 62.0, 48.4% women. Semaglutide starters were compared against four alternatives: sitagliptin, empagliflozin, glipizide and no antidiabetic treatment at all. ## What the four comparisons gave Against no treatment, semaglutide scored 11.14 to 14.91, a mean ratio of 0.75, 95% CI 0.65 to 0.85, p = 0.00002 after Bonferroni correction. Against glipizide, 0.83. Against empagliflozin, 0.81. Against sitagliptin: 11.14 to 12.52, a mean ratio of 0.89, 95% CI 0.77 to 1.02, p = 0.50. Not significant. The comparator that did not separate Sitagliptin is a DPP-4 inhibitor, which works by preventing the breakdown of the body’s own incretin hormones — the same system semaglutide acts on from the other end. It is the closest thing in this list to an active control, and it is the one comparison where the difference disappeared. That is compatible with an incretin effect rather than a semaglutide effect, and it is compatible with the other three gaps being about who gets which drug. The study cannot tell those apart. ## The weakest arm gives the biggest number “No antidiabetic treatment” produced the largest ratio, and it is the arm to trust least. Somebody with a psychiatric diagnosis and no antidiabetic prescription differs from somebody just started on one — in how sick they are, how engaged with care, and how often anybody writes anything down about them. That is the standing problem with a comparison drawn from records rather than built by randomization, and it runs the same way every time: it flatters the treated group, the way [three significant differences vanished once the groups were made comparable](https://thisglp.com/research/glp1-shoulder-surgery-adjustment) elsewhere in this section. ## Where it held and where it did not Associations were strongest for memory and for broader cognitive function. Across the disorder groups the effect sizes looked similar, but statistical significance held consistently only in major depression. The authors’ own closing line asks for randomized trials to establish whether any of this is causal or useful, which is the correct request and worth more than the headline ratio — and it is the same request [every observational result on this site](https://thisglp.com/research/does-a-glp1-affect-surgery-outcomes) ought to end with. ## What a reader should take Not a reason to buy anything. Nobody in this study was taking semaglutide for cognition, and no seller on this site sells it for that. What is worth keeping is the shape: an outcome assembled from clinical notes, four comparators, and a result that survives three of them and not the closest one. When a finding depends on which comparator you pick, the comparator is the finding — the same lesson as [a trial that gave two answers depending on what it was measured against](https://thisglp.com/research/glp1-adolescent-suicidality-comparators). ## Frequently asked Does semaglutide improve cognition? This study cannot say. It found fewer clinician-recorded cognitive signs than with no treatment, glipizide or empagliflozin, and no significant difference from sitagliptin, and the authors ask for randomized trials. What was actually measured? A 0 to 100 composite built from cognitive signs and symptoms recorded in routine clinical assessments — not a cognitive test administered for the study. Why does the sitagliptin result matter most? Because sitagliptin also acts on the incretin system, making it the closest active comparator in the study. It is the one comparison where semaglutide did not separate. Who was in the study? 13,007 adults with a psychiatric diagnosis, mean age 62, starting an antidiabetic drug, of whom 1,261 started semaglutide. ## Sources 1. \[1\] De Giorgi R, et al. (2026). Cognitive signs and symptoms in people with a psychiatric diagnosis on semaglutide: a retrospective cohort study of 13 007 patients in the USA BMJ Mental Health. [PMID 42624612](https://pubmed.ncbi.nlm.nih.gov/42624612/) ## Where to get it ### Best GLP-1 injections Every injectable seller we can verify, with the price each one publishes and an honest read of what the trials measured. [Compare providers →](https://thisglp.com/best/compounded-semaglutide) ## More in Evidence - [ 150 minutes · Weekly activity goal · 2 days · Muscle strengthening · Adapt · Symptoms and ability ### Exercise on Ozempic: Building Strength Without Ignoring Symptoms ](https://thisglp.com/research/exercise-on-ozempic) - [ STEP 1, semaglutide 2.4 mg vs placebo, % change at 68 weeks · LDL cholesterol · −2.5% vs +1.3% · Total cholesterol · −3.3% vs +0.1% · HDL cholesterol · +5.2% vs +1.4% · Triglycerides · −21.9% vs −7.3% · Wegovy label, Table 13. Adults without diabetes. Ozempic doses are lower. ### Does Ozempic Lower Cholesterol? 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