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A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was performed (20052025)

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Observational evidence further supports a context-dependent effect of metformin, as data from the National Alzheimers Coordinating Center database found that metformin use was associated with improved memory performance, but this benefit was not observed in APOE-4 carriers 90 , suggesting that metformin may be protective in individuals with DM2 but not in those with certain genetic predisposition factors for AD, such as APOE-4, which is the strongest genetic risk factor for sporadic AD 91

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For someone on a 0.25mg weekly dose, that is a 40-60% dosing error from a nearly invisible syringe misread

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