Neuroenhancement in Healthy Adults, Part I: Pharmaceutical Cognitive Enhancement: A Systematic Review

Micoulaud, Fond G

doi:10.4172/2155-9627.1000213

J Clinic Res Bioeth

2015

DOI: 10.4172/2155-9627.1000213

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Neuroenhancement in Healthy Adults, Part I: Pharmaceutical Cognitive Enhancement: A Systematic Review

Fond G Micoulaud¹

Abstract: The term neuroenhancement refers to improvement in the cognitive, emotional and motivational functions of healthy individuals through inter alia, the use of drugs. This popular topic attracts attention both from the general public and the scientific community. Our objective is to summarize in a synthetic review the data of randomized placebo-controlled trials that assessed cognitive effects of administration of neuroenhancers in non-sleep-deprived healthy adults compared to placebo. The major outcomes were att… Show more

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Cited by 7 publications

References 192 publications

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Benefits and Harms of ‘Smart Drugs’ (Nootropics) in Healthy Individuals

Schifano

Catalani

Sharif

et al. 2022

Drugs

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Smart drugs' (also known as 'nootropics ' and 'cognitive enhancers' [CEs]) are being used by healthy subjects (i.e. students and workers) typically to improve memory, attention, learning, executive functions and vigilance, hence the reference to a 'pharmaceutical cognitive doping behaviour'. Whilst the efficacy of known CEs in individuals with memory or learning deficits is well known, their effect on non-impaired brains is still to be fully assessed. This paper aims to provide an overview on the prevalence of use; putative neuroenhancement benefits and possible harms relating to the intake of the most popular CEs (e.g. amphetamine-type stimulants, methylphenidate, donepezil, selegiline, modafinil piracetam, benzodiazepine inverse agonists, and unifiram analogues) in healthy individuals. CEs are generally perceived by the users as effective, with related enthusiastic anecdotal reports. However, their efficacy in healthy individuals is uncertain and any reported improvement temporary. Conversely, since most CEs are stimulants, the related modulation of central noradrenaline, glutamate, and dopamine levels may lead to cardiovascular, neurological and psychopathological complications. Furthermore, CEs' use can be associated with paradoxical short-and long-term cognitive decline; decreased potential for plastic learning; and addictive behaviour. Finally, the non-medical use of any potent psychotropic raises serious ethical and legal issues, with nootropics having the potential to become a major public health concern. Further studies investigating CE-associated social, psychological, and biological outcomes are urgently needed to allow firm conclusions to be drawn on the appropriateness of CE use in healthy individuals. Key points• Cognitive enhancers (CEs) are extensively and increasingly being used by healthy active subjects, with student use having been reported in the range of 1.3-33% across studies, with variations depending on country and definition of cognitive doping. However, their efficacy on non-impaired brains is uncertain and any reported improvement is temporary. • Conversely, since most CEs are stimulants, the modulation of central neurotransmitter pathways could lead to severe complications and can be associated with paradoxical short-and long-term cognitive decline; decreased potential for plastic learning; and addictive behaviour. • Finally, non-medical use of CEs raises serious ethical and legal issues, and CEs have the potential to become a major public health concern

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Benefits and Harms of ‘Smart Drugs’ (Nootropics) in Healthy Individuals

Schifano

Catalani

Sharif

et al. 2022

Drugs

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Use of Cognitive Enhancers by Portuguese Medical Students: Do Academic Challenges Matter?

Miranda

Barbosa

2022

Acta Med Port

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Introduction: Nonmedical use of prescription drugs and other substances for cognitive enhancement in the academic environment has been documented in several studies. However, the prevalence among Portuguese university students is unknown. We aimed to assess the prevalence and academic contexts of the use of cognitive enhancers of a sample of Portuguese medical students.Material and Methods: An online questionnaire about the use of cognitive enhancers was completed by 1156 participants, who were either medical students (group 1) or newly qualified physicians applying for the Portuguese medical licensing exam (group 2).Results: Coffee was the most frequently used substance for cognitive enhancement purposes in both groups, whereas nonmedical use of prescription drugs for cognitive enhancement was lower in undergraduate students (5%) and higher in licensing exam applicants (14%). Methylphenidate (35%) and modafinil (10%) were the most consumed prescription substances and they were mainly used to enhance attention (83%) and memory (44%). Use of prescription drugs for cognitive enhancement was mainly associated with studying for medical school exams and the medical licensing exam. Most prescription drugs for cognitive enhancement were obtained through medical prescription (54%).Discussion: These results show a low consumption of prescription drugs for cognitive enhancement by Portuguese medical students. Licensing exam applicants show a higher consumption of almost every substance included in this study, which might be explained by the crucial role of the exam in defining their future career path and desire by students to improve the cognitive skills that determine exam success.Conclusion: Studying drugtaking behaviors in medical students and young doctors is relevant for public health and medical education, since they will soon be in charge of drugs prescription. Therefore, ethical and medical concerns raised by off label consumption of prescription drugs for cognitive enhancement purposes must be openly addressed.

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Cognitive enhancement with methylphenidate and modafinil: conceptual advances and societal implications

Dubljević¹,

Ryan²

2015

NAN

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"Cognition enhancement" (CE) drugs are pharmaceuticals taken by healthy people with the aim of sustaining attention, augmenting memory, or improving other cognitive capacities. This paper focuses on two CE drugs-methylphenidate and modafinil. It analyzes their mechanism of action, the evidence for their efficacy in nonsleep deprived individuals, and reviews their adverse effects. It then addresses the normative stances and social issues surrounding CE drug use. Currently, there is little evidence that either methylphenidate or modafinil provide any useful cognitive enhancement to well-rested users. However, it is very possible that future research may reveal cognitive benefits for these agents or for other pharmaceuticals. Public attitudes on CE mirror those evident in academic debate. Even though the majority seem to be opposed to enhancement based on issues of authenticity, utility, and fairness, a steady minority take the view that cognitive enhancer usage is both acceptable and fair. Current legal regimes do not adequately address the social phenomenon of CE use. While the United Nations Convention on Psychotropic Substances defines limits of methylphenidate use across the globe, no such guide exists for modafinil.

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Neuroenhancement in Healthy Adults, Part I: Pharmaceutical Cognitive Enhancement: A Systematic Review

Cited by 7 publications

References 192 publications

Benefits and Harms of ‘Smart Drugs’ (Nootropics) in Healthy Individuals

Benefits and Harms of ‘Smart Drugs’ (Nootropics) in Healthy Individuals

Use of Cognitive Enhancers by Portuguese Medical Students: Do Academic Challenges Matter?

Cognitive enhancement with methylphenidate and modafinil: conceptual advances and societal implications

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