The investigators propose a proof of concept RCT (randomized clinical trial), testing the
efficacy of intranasal insulin (INI) with semaglutide, a combination therapy with strong
biological plausibility to benefit impaired cognition through vascular mechanisms, in older
adults with MetS (metabolic syndrome) and MCI (Mild Cognitive Impairment), who are enriched
for cerebrovascular disease and at high dementia risk. The study will focus on cognitive and
biological outcomes, allowing identification of relevant mechanisms.