Fact checked by Nick Blackmer

• Interest in using GLP-1 medications to prevent dementia is growing, especially among people with higher genetic risk.
• Early research suggests these drugs may have protective effects, but they have not been shown to treat the disease.
• Experts say it’s too soon to use GLP-1s for prevention alone, and lifestyle changes remain the most proven approach.

“Grandpa might not remember who you are this visit.” 

Penn Holderness remembers hearing those words at 12 years old. Holderness’s grandfather had Alzheimer’s disease, an ultimately fatal form of dementia that affects an estimated 7 million Americans.

Over the years, two more grandparents, as well as Holderness’s uncle and both parents, went on to develop the disease. When the 51-year-old got genetic testing in May 2025, Holderness discovered he was also at high risk: he has two copies of the APOE4 gene, the strongest genetic risk factor for Alzheimer’s, giving him a 60% chance of developing the disease by age 85.

Desperate for options, Holderness, a family influencer, came across research on how GLP-1 medications had promise in helping prevent dementia. Though he wasn’t overweight, he sought an off-label prescription. He’s been microdosing tirzepatide since December.

“All I was before this was this stress ball that no matter what I do, I’m gonna forget who my wife and kids are,” Holderness told Health.

Where the Science Stands on GLP-1s and Dementia Prevention

In the past few years, researchers have linked GLP-1s to a growing list of benefits beyond treating obesity and type 2 diabetes. The drugs have been FDA-approved to prevent or treat various conditions, including sleep apnea and chronic kidney disease.

GLP-1s have also shown promise for brain health, prompting some people to seek them out solely to prevent or treat dementia. But these medications can be pricey and cause side effects like nausea and muscle loss, and experts caution that the research is still in the preliminary stages.

The biggest blow to GLP-1s and dementia research came last year, when drugmaker Novo Nordisk tested its GLP-1, semaglutide, in otherwise healthy patients with early-stage Alzheimer’s as part of its landmark “evoke” trials.

The research was inspired by earlier studies suggesting that people with obesity or type 2 diabetes who took GLP-1s had a lower risk of dementia independent of weight loss. But the evoke trials, which included nearly 4,000 patients who took either semaglutide or a placebo, clearly showed that the drug didn’t slow the disease’s progression.

Though disappointing, the results weren’t entirely surprising, said Simon Cork, PhD, senior lecturer in physiology at Anglia Ruskin University’s School of Medicine. “The clinical studies that have tried to show whether GLP-1 drugs can improve cognitive decline in patients with Alzheimer’s disease have so far failed to do so,” he told Health, but “that’s common with pretty much any Alzheimer’s drug.”

Still, the evoke trials had a silver lining: semaglutide appeared to improve Alzheimer’s-related biomarkers like p-tau buildup and inflammation. 

That finding aligns with researchers’ leading theory for how GLP-1s may prevent dementia. The drugs are known to reduce inflammation throughout the body, and if they can lower inflammation in the brain, it may help prevent the buildup of amyloid-beta and p-tau proteins linked to Alzheimer’s, explained Robyn Pashby, PhD, a clinical and medical psychologist and spokesperson for The Obesity Society.

Researchers are now exploring whether GLP-1s can prevent the disease before symptoms start. Cork recently led a meta-analysis of 30 studies investigating the effects of GLP-1s on Alzheimer’s pathology—namely the buildup of beta-amyloid and p-tau—to determine just that. Most of the studies were conducted in animals or cells because collecting this data in humans is difficult, but Cork said the results were promising.

“What we showed consistently across all of those studies was that… administering GLP-1 receptor agonists consistently decreases the accumulation of these key proteins,” Cork said. “It looks like these drugs are not able to treat active disease, but they do confer a protective benefit.”

Using GLP-1s Off-Label to Help Prevent Dementia

Despite the inconclusive science, some people are already taking GLP-1s to help prevent or slow dementia.

Many people with family histories “are willing to take calculated risks,” said Richard Hobbs, MD, a concierge medicine physician and founder of Elite Medicine who prescribed Holderness’s GLP-1.

Holderness is one of those people. With two copies of the APOE4 gene, he’s more likely to develop Alzheimer’s and begin experiencing symptoms at an earlier age, compared to those without the gene. 

He was already doing everything he could to lower his risk of Alzheimer’s disease: exercising regularly, sleeping well, eating a nutritious diet—even taking an omega-3 fish oil supplement and a cholesterol-lowering medication for the potential brain benefits. But Holderness said his genetics felt like a “ticking time bomb,” and he wanted to do more. 

"If there is even the least amount of evidence that [a GLP-1] might help it," Holderness said on his podcast, "it's a risk I'm willing to take."

Holderness isn’t the only one who’s looked to GLP-1s to mitigate their risk of Alzheimer’s. After posting about his experience on TikTok, users shared similar stories. 

“I am a double APOE4 carrier and I’ve been on tirzepatide for this exact reason for 2 years,” said one commenter. Added another: “Both my parents have dementia. I will be on a GLP1 forever.”

Anecdotally, people are using GLP-1s to treat existing Alzheimer’s, too. One Redditor, who described themselves as a 67-year-old man with Alzheimer’s but no obesity or type 2 diabetes, said they started taking a GLP-1 after noticing problems with short-term memory and difficulty performing tasks. After a couple months on a compounded version, the memory issues “got lifted overnight,” the user said, and friends and family later noticed the change. 

Should You Consider a GLP-1 for Dementia Prevention?

While the current research is encouraging, some experts said it's still too soon to recommend GLP-1s solely to protect against dementia. 

The science makes sense, said Ali Dehghani, DO, an internal medicine doctor at Case Western Reserve University, but the research isn't there yet. It's largely limited to animal or observational studies, which can’t prove cause and effect. Follow-up periods have also been short.

The high cost of the medication is another huge barrier, and insurance won’t cover an off-label prescription for dementia prevention. On the low end, the smallest doses of GLP-1s like Ozempic and Wegovy start at $149 a month, out-of-pocket.

GLP-1s can drastically change appetite and come with potential gastrointestinal side effects as well, such as vomiting and diarrhea. Older patients—who may be more interested in dementia prevention—are at a greater risk of frailty, which GLP-1s can exacerbate.

Experts also brought up concerns about microdosing GLP-1s, which could be enticing for people taking them solely for dementia prevention. “As clinicians, we would be hard-pressed to say that this would have any clinical benefit, because you’re underdosing the medication," Dehghani said.

Hobbs, the doctor who prescribed Holderness’s GLP-1, said it's hard to say whether the medication will make a difference for him. But with Holderness's elevated Alzheimer's risk, Hobbs was willing to take the chance.

“If somebody wants to microdose what I think is already a beneficial drug, for a condition that isn’t necessarily yet proven but may be helpful in the future, then I think there’s actually relatively low harm, especially at the microdosing level,” Hobbs told Health.

“Lots of us have very extensive family histories, myself included, and we don’t want Alzheimer’s,” Hobbs added.

Holderness emphasized that his decision to take a GLP-1 was personal and he’s not telling anyone else to try it. He’s been taking half the lowest dose of tirzepatide as a once-weekly injection, costing him $299 for a two-month supply. 

With the exception of some acid reflux when he eats too late or too much, the changes he’s seen over the past five months have largely been positive. 

“I definitely am not chowing down on McDonald’s at 10 o’clock anymore. Not that I do that a lot, but I think it regulated my need for food,” he said, noting that he’s also cut back on the evening glass of wine that used to be habitual for him. 

But the biggest benefit, he said, has been for his mental health. He still needs follow-up testing to see whether the GLP-1 has affected his brain markers, something he’ll get as part of an unrelated clinical trial he’s participating in to develop Alzheimer’s blood tests. But in the meantime, he’s worrying less, and his stress levels have plummeted. 

“I know that there is a ticking time bomb in my head,” Holderness said, but he feels like his doctors have given him “the means to defuse it.”

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Kristina Dawson