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Tashiro et al

In clinical trials, tirzepatide and semaglutide have also been associated with a small but slightly increased risk of gallbladder disease, including gallstones

One observed a positive association between liraglutide use at 12 weeks and improved MMSE in 47 adults with T2DM, which correlated with increased task (verbal fluency)-based activation of the dorso-lateral prefrontal and orbitofrontal cortex, while several other cognitive tests were not affected 45

The science is real

It's not always true that the doctor has complete control to prescribe off-label, but I think it's a reasonable way to think about it