Neuroenhancement's Mainstream Moment May Be Here

John Watson

Disclosures

March 09, 2017

In This Article

Searching for a Mental Edge

Trying to lend our brains a little more power is as societally entrenched as a morning cup of coffee. Yet in recent years, the quest for new ways of achieving this has become considerably more intense. Led by a loose assortment of pharmacologic researchers, Silicon Valley entrepreneurs, and an ad hoc community of layperson "biohackers" open to self-experimentation with their brain chemistry, the field of neuroenhancement (also known as cognitive enhancement, among other terms) is gaining a foothold in the public consciousness.

The end goal of this work is the creation of nootropics, an umbrella term for chemical compounds that can augment the positive aspects of mental functioning with negligible or no negative side effects. Nootropics are not meant to address limitations in cognitive functioning brought about by disease or aging—though studies in these indications are numerous as well—so much as they are meant to improve performance in otherwise healthy individuals, who could conceivably take them like a daily vitamin.

The offshoot of the neuroenhancement movement that has likely received the most media attention is the trend of students repurposing attention-deficit/hyperactivity disorder prescriptions to improve their academic performance.[1] However, this belies the extent to which neuroenhancement has already breached the mainstream, to the point that in 2009 the American Academy of Neurology (AAN) offered ethical and legal guidance to neurologists approached by patients "without a diagnosed illness asking for medications with the goal of improving their memory, cognitive focus, or attention span."[2]

Controversy continues as to whether pharmaceuticals that may have ancillary neuroenhancing qualities—two of the more popular being modafinil and piracetam—should ever be extended to healthy people. As that debate progresses, many have shifted their focus to producing nootropics that use unregulated compounds. This is transforming the neuroenhancement movement from a niche concern to one with potentially wider-ranging implications for consumers and clinicians alike.

Science or Hype?

Searching for the word "nootropic" on PubMed or ClinicalTrials.gov will uncover relevant published and ongoing studies numbering into the thousands. The bulk of this research is of a relatively low level of quality, drawing from limited patient numbers and often with no comparative arms.

"Absent any randomized controlled trials involving the nootropic of interest, any claims of efficacy should be viewed with caution," said Daniel Larriviere MD, JD, vice-chair of the department of neurology at the Ochsner Neuroscience Institute in New Orleans, Louisiana, and coauthor of the AAN's 2009 guidance document.

Indeed, the margins of what defines a nootropic are currently wide enough to fit all variety of compounds. This has drawn the interest of a supplements industry rarely bashful about substituting hype for science, whose products are often adorned with questionable "brain-boosting" claims.

However, there is also a growing number of randomized controlled trials (RCTs) reporting tangible efficacy for certain chemicals in otherwise healthy subjects. Unsurprisingly, the ancient standby of caffeine is a pillar of contemporary, nonpharmaceutical nootropic research. Its effects when coupled with the amino acid L-theanine, which naturally occurs in tea, have been shown to lead to faster reaction times and increased performance on attention tasks.[3,4] A meta-analysis of RCTs looking at extract from the Bacopa monnieri herb determined that it produced statistically significant trends towards improved cognition and decreased choice reaction times.[5] Another plant extract, Rhodiola rosea, has exhibited antifatigue effects in an RCT.[6]

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