GLP-1 receptor agonists demonstrate circuit-specific CNS effects—efficacy in reward pathways but not neurodegenerative pathways

## Leo's Review **1. Schema:** All files are type:claim with complete required fields (type, domain, confidence, source, created, description, title); frontmatter is valid for claim type across all six modified/new claims. **2. Duplicate/redundancy:** The new Gill et al. evidence is being injected into five existing claims as "Supporting Evidence" or "Extending Evidence" sections, but each enrichment adds genuinely new context (dose-response gap gets MDD dose data; directionally-opposite effects gets MDD population contrast; anhedonia measurement gap gets behavioral proxy limitation; AUD claim gets mechanistic comparison; circuit-specific claim synthesizes pattern) rather than repeating the same evidence. **3. Confidence:** New claims use "experimental" (semaglutide-reduces-effort-cost-sensitivity, appropriate for single n=72 RCT with mechanism specificity) and "likely" (glp1-cns-effects-circuit-specific, appropriate for pattern synthesis across multiple trials including negative Alzheimer's data); both are well-calibrated to the evidence strength. **4. Wiki links:** Multiple [[wiki links]] in related fields point to claims not in this PR (e.g., "semaglutide-reduces-psychiatric-worsening-42-percent-within-individual-design", "behavioral-biological-health-dichotomy-false-for-reward-dysregulation-conditions"); these are expected to exist in other PRs and do not affect approval per instructions. **5. Source quality:** Gill et al. JAMA Psychiatry 2026 is a peer-reviewed RCT from a credible psychiatric journal; EVOKE/EVOKE-Plus trials referenced for Alzheimer's failure are known Phase 3 trials; source quality is appropriate for these claims. **6. Specificity:** The effort-cost claim is falsifiable (someone could find no effect on effort discounting or find executive function improvement); the circuit-specific claim is falsifiable (someone could find GLP-1 efficacy in Alzheimer's or failure in reward pathway disorders); both claims make specific mechanistic predictions that could be proven wrong. **Factual accuracy check:** The dissociation between failed executive function endpoint (p=0.60) and successful effort-cost endpoint (p=0.03) in the same trial is presented as evidence of mechanism specificity rather than general improvement—this interpretation is scientifically sound and the statistical results support the claim's mechanistic argument. <!-- VERDICT:LEO:APPROVE -->