Cognition Enhancers

Executive Summary The search for treatments for dementia, alongside other scientific and societal changes, has prompted the development of symptomatic treatments and disease-modifying drugs for people with degenerative brain diseases, mild cognitive impairment, and psychiatric diseases that involve cognition impairment. The enhancement of aspects of cognition, such as learning and memory, now seems possible for people with normal age-related decline and in healthy people, although so far the effects of these cognition enhancers are modest. The next two decades are likely to bring deeper knowledge of the mechanisms of learning, memory, and forgetting, together with an understanding of the relationship between changes in molecules, cells and brain circuits, and changes in cognition. Already, research efforts by the pharmaceutical industry are poised to deliver many more disease modifiers and putative cognition enhancers, though limitations exist in translating laboratory findings into effective interventions for human use. If effective interventions become available, their general use will bring health, social, ethical and regulatory issues. The widespread use of cognition enhancers for healthy people could have substantial impact and potentially become problematic – a minority may have abuse liability. Mechanisms do not exist currently to regulate cognition enhancers for non-medical purposes, though social changes together with commercial pressures mean that their use for enhancement is likely to be increasingly required, desired and accepted. Their use for disease-related impairments seems unlikely to cause concerns if cost-effective treatments are used to enhance function and quality of life. New challenges will include the development of biomarkers to allow early intervention and the targeting of therapies for the best effect on the individual. Definitions and scope of review 'Cognition enhancement' is the use of various strategies to boost cognitive functions – i.e. mental states that underpin information-processing tasks such as attention, memory, and selective forgetting. The term was originally used for the treatment of disease-associated cognitive impairment, such as in dementia and schizophrenia. Subsequently, the term expanded to encompass the use of interventions for mild cognitive impairment (MCI), currently defined as cognitive deficits that do not overtly impair function. MCI has a greater risk of progression to dementia than for age-related cognitive decline, which is probably synonymous with normal ageing (Figure 1). Now 'cognition enhancement' is applied to the use of interventions for normal ageing and in well people for non-medical purposes. Many agents are marketed to UK consumers as cognition enhancers or nootropics. This term describes substances thought …