Metformin and the ageing brain: what biomarkers can and cannot tell us

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13 Nov 2026 0 comments

Antidiabetic drugs are purported to benefit cognitive ageing, indirectly through effects on neuroinflammation, central insulin resistance and cerebrovascular function or directly through amyloid-β metabolism and tau phosphorylation. Metformin, whose mechanism of action remains largely unknown, is of particular interest as a neuroprotective and, more broadly, anti-ageing drug. In the paper by Abanto et al,1 the authors ask whether fluid biomarkers accompany the association between metformin use and cognition.

They compared metformin users and non-users in two cohorts: 2443 participants with diabetes from the National Alzheimer’s Coordinating Center (NACC) databse and 1074 with endocrine or metabolic disorders from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Outcomes were cognitive scores, cerebrospinal fluid (CSF) amyloid-β 42 (Aβ42), tau and phosphorylated tau (p-tau), and plasma neurofilament light chain (NfL). Bias was limited by adjustment for demographics and disease duration, robust variance estimation, propensity weighting and matching and many sensitivity analyses, including adjustment for body...