● Medication: Dulaglutide (Trulicity)

○ Dose: 1.5 mg subcutaneous injection weekly for two years. Start 0.75mg once weekly for 4 weeks, then 1.5mg when minimal/no GI side effects

● Medication: Exanitide (Bydureon)

○ Dose: 2 mg subcutaneous injection weekly for one year. Comes only 2mg dose

● Medication: Liraglutide (Victoza)

○ Dose: 1.8 mg subcutaneous injection daily for one year. Start at lowest dose and titrate up.

● Summary: Only one study had participants with already diagnosed mild Alzheimer's disease (liraglutide). Dulaglutide has the best brain uptake. Doses from studies are the same as current weight loss doses."

● "Medicare coverage for GLP-1: Currently, Medicare allows coverage through Part D plans for GLP-1 drugs that the FDA has approved for T2DM and CVD. As of August 2024, Ozempic, Mounjaro, Rybelsus,and Wegovy are considered covered Part D drugs for the treatment of those conditions https://crsreports.congress.gov/product/pdf/IF/IF12758 Prior authorization will be needed"

○ Summary: GLP-1 agonists appear promising in the management of dementia. Early studies have shown neurocognitive benefits in those without dementia or early stage Alz type dementia, but future studies are needed and there are no official guidelines regarding their use for cognitive disorders. Starting a low dose with up titration minimizes side effects (though side effects in advanced age less known). Insurance coverage/drug cost remain significant barriers. (yt 12/8/2024)

References:

1. Ben's *Shocking* Self-Experiment With Semaglutide, The Surprising Facts About GLP-1 & Why GLP-1's May Not Be The Big, Scary Drugs You've Been Led To Believe, With Dr. Tyna Moore

2. https://www.uptodate.com/contents/epidemiology-pathogenesis-and-genetics-of-parkinson-disease?search=glp%201%20dementia&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1

3. mGLP-1 Drug Liraglutide May Protect Against Dementia | alz.org

4. All GLP-1 Agonists Should, Theoretically, Cure Alzheimer’s Dementia but Dulaglutide Might Be More Effective Than the Others

5. Inflammatory proteins associated with Alzheimer’s disease reduced by a GLP1 receptor agonist: a post hoc analysis of the EXSCEL randomized placebo controlled trial

6. Effect of dulaglutide on cognitive impairment in type 2 diabetes: an exploratory analysis of the REWIND trial - The Lancet Neurology

7. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes | New England Journal of Medicine

Version: GJ 12/5/2024