Cognitive Enhancers

Cognitive enhancers, also known as ‘smart drugs’ or ‘brain doping’, are used to enhance cognitive functions including short-term memory, concentration, comprehension and alertness. There is little hard evidence on the prevalence of these drugs but studies have shown that students remain one of the most frequent brain dopers, followed by athletes and other occupational users (e.g. surgeons).

People have tried to enhance their cognitive functions both in a natural manner and by using drugs for many years. These natural products are often referred to as ‘nootropics’, which are generally non-prescribed compounds including vitamins, herbs and other supplements (e.g. creatine, DHA). However, in most cases little evidence exists to support their effectiveness in healthy people.

In contrast to a nootropic, a smart drug is generally a prescribed medication or off-label drugs to treat some kind of mental or cognitive disorder. The most common are drugs such as dextroamphetamine (e.g. Adderall) or methylphenidate (Ritalin) in the stimulant class used to treat symptoms related to ADHD. Studies evaluating the effects vary considerably and frequently yield conflicting results in terms of cognitive enhancements. Some studies find positive effects, other show no benefits and still others even indicate a reduction in performance. For instance, this systematic review found that methylphenidate has a positive effect on long-term memory consolidation, but no significant effects on attention, mood or executive functions were found. Although these drugs seem to have effects on cognition, the impact in real world settings is still ambiguous.

There have been very few studies on the unintended effects of these types of drugs when used to enhance cognitive functions for non-medical reasons. The evidence available is mostly based on their use as medicines. For instance, dextroamphetamine and methylphenidate have well-established physical and psychiatric harms including adverse effects on appetite, mood stability, cardiac function, mood swings, anxiety and sleep issues. Rare effects, with prolonged use, include reduced weight gain and growth. A drug that has been considered relatively ‘safe’ as a cognitive enhancer is Modafinil (e.g. Provigil). A recent systematic review showed that Modafinil has little side effects but only worked depending on the task at hand (e.g. executive function). Yet, another review on the safety of Modafinil led to its restricted use after it was linked to serious skin reactions and psychiatric harms. Therefore, monitoring the use of cognitive enhancing drug is warranted to better understand the harms from their non-medical use.