Neuroenhancement#Conventional methods and foundational strategies

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There are many supposed nootropics, most having only small effect sizes in healthy individuals. Neuroenhancement's most common pharmacological agents include modafinil and methylphenidate (Ritalin). Stimulants in general and various dementia treatments{{cite journal |last1=Weiergräber |first1=Marco |last2=Ehninger |first2=Dan |last3=Broich |first3=Karl |title=Neuroenhancement and mood enhancement – Physiological and pharmacodynamical background |journal=Medizinische Monatsschrift für Pharmazeuten |date=1 April 2017 |volume=40 |issue=4 |pages=154–164 |pmid=29952165 |issn=0342-9601}} or other neurological therapies{{cite journal |last1=Marazziti |first1=Donatella |last2=Avella |first2=Maria Teresa |last3=Ivaldi |first3=Tea |last4=Palermo |first4=Stefania |last5=Massa |first5=Lucia |last6=Della Vecchia |first6=Alessandra |last7=Basile |first7=Lucia |last8=Mucci |first8=Federico|title=Neuroenhancement: state of the art and future perspectives |journal=Clinical Neuropsychiatry |date=June 2021 |volume=18 |issue=3 |pages=137–169 |doi=10.36131/cnfioritieditore20210303|pmid=34909030 |pmc=8629054 }} may affect cognition.

Neuroenhancement may also occur from:

• mood ('mood enhancement'){{cite journal |last1=Daubner |first1=Johanna |last2=Arshaad |first2=Muhammad Imran |last3=Henseler |first3=Christina |last4=Hescheler |first4=Jürgen |last5=Ehninger |first5=Dan |last6=Broich |first6=Karl |last7=Rawashdeh |first7=Oliver |last8=Papazoglou |first8=Anna |last9=Weiergräber |first9=Marco|title=Pharmacological Neuroenhancement: Current Aspects of Categorization, Epidemiology, Pharmacology, Drug Development, Ethics, and Future Perspectives |journal=Neural Plasticity |date=13 January 2021 |volume=2021 |pages=1–27 |doi=10.1155/2021/8823383 |pmid=33519929 |pmc=7817276 |language=en |issn=1687-5443|doi-access=free }}
• motivation{{cite journal |title=Drugs, games, and devices for enhancing cognition: implications for work and society |year=2016 |doi=10.1111/nyas.13040 |url=https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/nyas.13040|last1=Brühl |first1=Annette B. |author-link2=Barbara Sahakian|last2=Sahakian |first2=Barbara J. |journal=Annals of the New York Academy of Sciences |volume=1369 |issue=1 |pages=195–217 |pmid=27043232 |bibcode=2016NYASA1369..195B |s2cid=5111793 }}
• sociability (e.g., talking-related or empathy){{cite journal |last1=Buckner |first1=Julia D. |last2=Morris |first2=Paige E. |last3=Abarno |first3=Cristina N. |last4=Glover |first4=Nina I. |last5=Lewis |first5=Elizabeth M.|title=Biopsychosocial Model Social Anxiety and Substance Use Revised |journal=Current Psychiatry Reports |date=17 April 2021 |volume=23 |issue=6 |page=35 |doi=10.1007/s11920-021-01249-5 |pmid=33864136 |s2cid=233261493 |language=en |issn=1535-1645}}
• creativity
• cognitive endurance{{cite book |last1=Tennison |first1=Michael N. |last2=Moreno |first2=Jonathan D. |title=The Routledge Handbook of Neuroethics |url=https://www.taylorfrancis.com/chapters/edit/10.4324/9781315708652-12/neuroenhancement-therapy-national-defense-contexts-michael-tennison-jonathan-moreno |chapter=Neuroenhancement and Therapy in National Defense Contexts|year=2017 |pages=150–165 |doi=10.4324/9781315708652-12 |isbn=978-1-315-70865-2 }}
• psychological resilience{{cite book |last1=Budde |first1=Henning |last2=Wegner |first2=Mirko |title=The Exercise Effect on Mental Health: Neurobiological Mechanisms |date=17 April 2018 |publisher=CRC Press |isbn=978-1-4987-3953-5 |url=https://books.google.com/books?id=6SJWDwAAQBAJ |language=en}}

Enhancers are multidimensional and can be clustered into biochemical, physical, and behavioral enhancement strategies.{{cite journal |last1=Dresler |first1=Martin |last2=Sandberg |first2=Anders |last3=Bublitz |first3=Christoph |last4=Ohla |first4=Kathrin |last5=Trenado |first5=Carlos |last6=Mroczko-Wąsowicz |first6=Aleksandra |last7=Kühn |first7=Simone |last8=Repantis |first8=Dimitris |title=Hacking the Brain: Dimensions of Cognitive Enhancement |journal=ACS Chemical Neuroscience |date=20 March 2019 |volume=10 |issue=3 |pages=1137–1148 |doi=10.1021/acschemneuro.8b00571 |pmid=30550256 |pmc=6429408 |language=en |issn=1948-7193}}

{{main|Modafinil}}

Approved for treating narcolepsy, obstructive sleep apnea, and shift work sleep disorder, modafinil is a wakefulness-promoting drug used to decrease fatigue, increase vigilance, and reduce daytime sleepiness. Modafinil improves alertness, attention, long-term memory, and daily performance in people with sleep disorders.{{Cite journal |last1=Okechukwu |first1=Chidiebere Emmanuel |last2=Okechukwu |first2=Chidubem Ekpereamaka |last3=Torre |first3=Giuseppe La |date=2022-10-02 |title=Effectiveness of bright light exposure, modafinil and armodafinil for improving alertness during working time among nurses on the night shift: A systematic review |url=https://www.tandfonline.com/doi/full/10.1080/20479700.2022.2054508 |journal=International Journal of Healthcare Management |language=en |volume=15 |issue=4 |pages=336–346 |doi=10.1080/20479700.2022.2054508 |issn=2047-9700|hdl=11573/1625188 |s2cid=247814079 |hdl-access=free }}

In sustained sleep deprivation, repeated use of modafinil helped individuals maintain higher levels of wakefulness than a placebo, but did not help attention and executive function.{{cite journal|last=Repantis|first=Dimitris|author2=Schlattmann, Peter|title=Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review|journal=Pharmacological Research |year=2010 |volume=62 |doi=10.1016/j.phrs.2010.04.002 |issue=3|pages=187–206|pmid=20416377}} Modafinil may impair one's self-monitoring ability; a common trend found in research studies indicated that participants rated their performances on cognitive tests higher than it was, suggesting an "overconfidence" effect.

{{Main|Methylphenidate}}

Methylphenidate (MPH), also known as Ritalin, is a stimulant that is used to treat attention-deficit hyperactivity disorder (ADHD). MPH is abused by a segment of the general population, especially college students.

A comparison between the sales of MPH to the number of people for whom it was prescribed revealed a disproportionate ratio, indicating high abuse. MPH may impair cognitive performance.{{Cite journal |last1=Chien |last2=Chien |last3=Liu |last4=Wu |last5=Chang |last6=Wu |date=2019-10-24 |title=Effects of Methylphenidate on Cognitive Function in Adults with Traumatic Brain Injury: A Meta-Analysis |journal=Brain Sciences |language=en |volume=9 |issue=11 |pages=291 |doi=10.3390/brainsci9110291 |pmid=31653039 |issn=2076-3425 |doi-access=free |pmc=6895997 }}

Studies are too preliminary to determine whether there are any cognitive-enhancing effects of agents such as memantine or acetylcholinesterase inhibitors (examples: donepezil, galantamine).

Common drugs intended for neuroehancement are typically well-tolerated by healthy people. These drugs are already in mainstream use to treat people with different kinds of psychiatric disorders.

Assessment to determine potential adverse effects are drop-out rates and subjective rating. The drop-out rates were minimal or non-existent for donepezil, memantine, MPH, and modafinil. In the drug trials, participants reported the following adverse reactions to use of donepezil, memantine, MPH, modafinil or caffeine:{{Cite journal |last1=Becker |first1=Maxi |last2=Repantis |first2=Dimitris |last3=Dresler |first3=Martin |last4=Kühn |first4=Simone |date=October 2022 |title=Cognitive enhancement: Effects of methylphenidate, modafinil, and caffeine on latent memory and resting state functional connectivity in healthy adults |journal=Human Brain Mapping |language=en |volume=43 |issue=14 |pages=4225–4238 |doi=10.1002/hbm.25949 |issn=1065-9471|doi-access=free |pmid=35670369 |pmc=9435011 }} gastrointestinal complaints (nausea), headache, dizziness, nightmares, anxiety, drowsiness, nervousness, restlessness, sleep disturbances, and insomnia, diuresis.{{Cite journal |last1=Repantis |first1=Dimitris |last2=Bovy |first2=Leonore |last3=Ohla |first3=Kathrin |last4=Kühn |first4=Simone |last5=Dresler |first5=Martin |date=February 2021 |title=Cognitive enhancement effects of stimulants: a randomized controlled trial testing methylphenidate, modafinil, and caffeine |journal=Psychopharmacology |language=en |volume=238 |issue=2 |pages=441–451 |doi=10.1007/s00213-020-05691-w |issn=0033-3158|doi-access=free |pmid=33201262 |pmc=7826302 |hdl=21.11116/0000-0007-453B-A |hdl-access=free }} The side effects normally ceased in the course of treatment. Various factors, such as dosage, timing and concurrent behavior, may influence the onset of adverse effects.

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Neurostimulation methods are being researched and developed. Results indicate that details of the stimulation procedures are crucial, with some applications impairing rather than enhancing cognition and questions are being raised about whether this approach can deliver any meaningful results for cognitive domains. Stimulation methods include electrical stimulation, magnetic stimulation, optical stimulation with lasers, several forms of acoustic stimulation, and physical methods like forms of neurofeedback.

Applications of augmented reality technologies may affect general memory enhancement, extending perception and learning-assistance.{{cite journal |last1=Schneider |first1=Felicitas |last2=Horowitz |first2=Alan |last3=Lesch |first3=Klaus-Peter |last4=Dandekar |first4=Thomas |title=Delaying memory decline: different options and emerging solutions |journal=Translational Psychiatry |date=21 January 2020 |volume=10 |issue=1 |page=13 |doi=10.1038/s41398-020-0697-x |pmid=32066684 |pmc=7026464 |language=en |issn=2158-3188}}{{cite journal |last1=Moreno |first1=Jonathan |last2=Gross |first2=Michael L. |last3=Becker |first3=Jack |last4=Hereth |first4=Blake |last5=Shortland |first5=Neil D. |last6=Evans |first6=Nicholas G. |title=The ethics of AI-assisted warfighter enhancement research and experimentation: Historical perspectives and ethical challenges |journal=Frontiers in Big Data |date=2022 |volume=5 |page=978734 |doi=10.3389/fdata.2022.978734 |pmid=36156934 |pmc=9500287 |issn=2624-909X|doi-access=free }}{{additional citation needed|date=March 2023}} The Internet may be considered a tool for enabling or extending cognition.{{cite journal |last1=Smart |first1=Paul |title=Extended Cognition and the Internet |journal=Philosophy & Technology |date=1 September 2017 |volume=30 |issue=3 |pages=357–390 |doi=10.1007/s13347-016-0250-2 |pmid=32010552 |pmc=6961510 |language=en |issn=2210-5441}}{{cite book |last1=Smart |first1=Paul R. |chapter=The Web-Extended Mind |title=Philosophical Engineering |date=22 November 2013 |pages=116–133 |doi=10.1002/9781118700143.ch8 |publisher=John Wiley & Sons, Ltd |isbn=978-1-118-70014-3 |language=en}}{{cite journal |last1=Smart |first1=Paul R. |title=Human-extended machine cognition |journal=Cognitive Systems Research |year=2018 |volume=49 |pages=9–23 |doi=10.1016/j.cogsys.2017.11.001 |s2cid=4327856 |url=https://eprints.soton.ac.uk/415609/1/hemcv2.pdf |language=en}} However, it is not "a simple, uniform technology, [n]either in its composition, [n]or in its use" and, as "an informational resource, currently fails to enhance cognition", partly due to issues that include information overload, misinformation and persuasion.{{cite journal |last1=Voinea |first1=Cristina |last2=Vică |first2=Constantin |last3=Mihailov |first3=Emilian |author-link4=Julian Savulescu|last4=Savulescu |first4=Julian |title=The Internet as Cognitive Enhancement |journal=Science and Engineering Ethics |date=1 August 2020 |volume=26 |issue=4 |pages=2345–2362 |doi=10.1007/s11948-020-00210-8 |pmid=32253711 |pmc=7417391 |language=en |issn=1471-5546}}

{{See also|Food safety|Health policy}}

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Quality standards, validation and authentication, sampling and lab testing are commonly substandard or absent for products thought to be cognitive enhancers, including dietary supplements.{{cite news |title=Prohibited, unlisted, even dangerous ingredients turn up in dietary supplements |url=https://www.washingtonpost.com/health/contaminated-supplements-unexpected-ingredients/2021/06/25/5d2227ec-bd62-11eb-83e3-0ca705a96ba4_story.html |access-date=24 April 2022 |newspaper=Washington Post}}{{cite web |last1=Eisenstein |first1=Michael |title=Setting Standards for Supplements |url=https://www.scientificamerican.com/custom-media/setting-standards-for-supplements/ |website=Scientific American |access-date=19 March 2023 |language=en}}{{cite journal |last1=Glisson |first1=James K. |title=Dietary Supplements: Safety Issues and Quality Control |journal=Archives of Internal Medicine |date=14 March 2011 |volume=171 |issue=5 |pages=476–7; author reply 477 |doi=10.1001/archinternmed.2011.53|pmid=21403052 }}{{cite web |title=Are Dietary Supplements Safe? |url=https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/complementary-and-integrative-medicine/dietary-supplements/safety.html |website=www.cancer.org |access-date=19 March 2023 |language=en}}

Neuroenhancement products or methods are used with the intent to:

• improve well-being{{cite journal |last1=Marois |first1=Alexandre |last2=Lafond |first2=Daniel |title=Augmenting cognitive work: a review of cognitive enhancement methods and applications for operational domains |journal=Cognition, Technology & Work |date=1 November 2022 |volume=24 |issue=4 |pages=589–608 |doi=10.1007/s10111-022-00715-1 |s2cid=252372408 |language=en |issn=1435-5566}}
• possibly encourage societal productivity{{cite journal |last1=Mohamed |first1=Ahmed Dahir |title=Neuroethical issues in pharmacological cognitive enhancement |journal=WIREs Cognitive Science |date=September 2014 |volume=5 |issue=5 |pages=533–549 |doi=10.1002/wcs.1306 |pmid=26308743 |language=en |issn=1939-5078|doi-access=free }}{{cite book |last1=Saritas |first1=Ozcan |title=Emerging Technologies for Economic Development |date=2019 |publisher=Springer International Publishing |isbn=978-3-030-04370-4 |pages=243–259 |chapter-url=https://link.springer.com/chapter/10.1007/978-3-030-04370-4_11 |language=en |chapter=Emerging Technologies, Trends and Wild Cards in Human Enhancement|series=Science, Technology and Innovation Studies |doi=10.1007/978-3-030-04370-4_11 |s2cid=169759910 }}
• increase incentives to develop potential therapies for various brain diseases, such as Alzheimer's disease.

Neuroenhancement products are mentioned in entertainment productions, such as Limitless (2011), which may to some degree probe and explore opportunities and threats of using such products.{{cite journal|author=Zwart H.|year=2014|title=Limitless as a neuro-pharmaceutical experiment and as a Daseinsanalyse: on the use of fiction in preparatory debates on cognitive enhancement|journal=Medicine, Health Care and Philosophy|volume=17|issue=1|pages=29–38|doi=10.1007/s11019-013-9481-5|pmid=23585022|s2cid=29893291|url=http://www.filosofie.science.ru.nl/PDF%20library%20HZ/Limitless.pdf|access-date=2016-05-07|archive-date=2019-05-04|archive-url=https://web.archive.org/web/20190504083912/https://www.filosofie.science.ru.nl/PDF%20library%20HZ/Limitless.pdf|url-status=dead}}

In general, people under the age of 25 feel that neuroenhancement agents are acceptable or that the decision to use them is to be made individually.{{cite journal |vauthors=Sattler S, Sauer C, Mehlkop G, Graeff P| year = 2013 | title = The Rationale for Consuming Cognitive Enhancement Drugs in University Students and Teachers | journal = PLOS ONE | volume = 8| issue = 7| pages = e68821| doi = 10.1371/journal.pone.0068821 | pmid=23874778 | pmc=3714277| bibcode = 2013PLoSO...868821S | doi-access = free }} Healthcare officials and parents feel concerned due to safety factors, lack of complete information on these agents, and possible irreversible adverse effects; such concerns may reduce the willingness to take such agents.{{cite journal |vauthors=Sattler S, Wiegel C | year = 2013 | title = Cognitive test anxiety and cognitive enhancement: the influence of students' worries on their use of performance-enhancing drugs | journal = Substance Use and Misuse | volume = 48 | issue = 3| pages = 220–32 | doi = 10.3109/10826084.2012.751426 | pmid = 23302063 | s2cid = 34698382 }}

A 2024 study based on a representative sample of more than 20,000 adults in Germany showed that around 70% of those surveyed had taken substances with the aim of improving mental performance within a year, without a medical prescription.{{cite journal|vauthors=Sattler S, van Veen F, Hasselhorn F, El Tabei L, Fuhr U, Mehlkop G|year=2024|title= Prevalence of Legal, Prescription, and Illegal Drugs Aiming at Cognitive Enhancement across Sociodemographic Groups in Germany|journal= Deviant Behavior|pages= 1–35|doi=10.1080/01639625.2024.2334274|doi-access= free}} The consumption of caffeinated drinks, such as coffee and energy drinks, was widespread (64% of users), expressly with the aim of improving performance, followed by dietary supplements and home remedies, such as ginkgo biloba (31%). Around 4% stated that they had taken prescription drugs for cognitive enhancement (lifetime prevalence of 6%), corresponding to around 2.5 million users in Germany.

A 2016 German study among 6,454 employees found a rather low life-time prevalence of cognitive enhancement prescription drug use (namely 3%), while the willingness to take such drugs was found in 10% of respondents.{{cite journal |vauthors=Sattler S, Schunck R | year = 2016 | title = Associations Between the Big Five Personality Traits and the Non-Medical Use of Prescription Drugs for Cognitive Enhancement | journal = Frontiers in Psychology | volume = 6 | page = 1971 | doi = 10.3389/fpsyg.2015.01971 |pmid=26779083|pmc=4700267| doi-access = free }} A survey of some 5,000 German university students found a relatively low 30-day prevalence of 1%, while 2% of those sampled used such drugs within the last 6 months, 3% within the last 12 months, and 5% of others used the drugs over their lifetimes. Of those students who used such substances during the last 6 months, 39% reported their use once in this period, 24% twice, 12% three times, and 24% more than three times. Consumers of neuroenhancement drugs are more willing to use them again in the future due to positive experiences or a tendency towards addiction.{{cite journal|vauthors=Sattler S, Mehlkop G, Graeff P, Sauer C |year=2014|title=Evaluating the drivers of and obstacles to the willingness to use cognitive enhancement drugs: the influence of drug characteristics, social environment, and personal characteristics|journal=Substance Abuse Treatment, Prevention, and Policy |volume=9|page=8|doi=10.1186/1747-597X-9-8|pmid=24484640|pmc=3928621 |doi-access=free }}

• Alertness
• Cognitive development
• Cosmetic pharmacology
• Deep brain stimulation
• Intelligence amplification
• Neurohacking
• Neuromarketing
• Neuroregeneration
• Performance enhancement
• Transcranial magnetic stimulation

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