The Pharmaceutical Journal
Vol 280 No 7505 p691-693
7 June 2008

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Cognitive enhancement in the pharmacy

As bodies like the British Medical Association and the UK Government’s Office for Science grapple with how to respond to the increasing demand for cognitive enhancers, what should pharmacists be considering?
Danielle Turner reports

Healthcare ethics and law series

see also Enhancing capacities: right or wrong? (PDF 60K)

SUMMARY

Be it having cup of coffee to kick-start the morning or completing the fiendish sudoku in The Times, the chances are that most people will have experimented with trying to improve their mental performance. Certainly, pharmacists will be familiar with the plethora of nutraceuticals and dietary supplements claiming to improve cognition.

Effective cognitive performance requires the co-ordinated involvement of numerous neuronal pathways and neurotransmitter systems — all readily manipulable with drugs. Cognitive enhancement refers to the use of pharmacological agents to improve mental functioning.

Functions such as memory, attention, problem-solving and mental flexibility are key nootropic targets. These capabilities are crucial for the successful execution of many everyday procedures, such as prioritising tasks and using important information.

Most cognitive enhancers have been developed by the pharmaceutical industry to target conditions, such as Alzheimer’s disease, Korsakoff’s syndrome and schizophrenia, with the aim of ameliorating the debilitating effects of impaired cognition. Brain disorders cause a substantial human and economic burden to communities, healthcare systems, caregivers and wider society.

Critically, there are many disorders, such as schizophrenia, where the cognitive difficulties are now known to be the core limiting factor to full rehabilitation (eg, returning to work) and acceptable quality of life, even after the more florid clinical symptoms have remitted.

Frequently the benefits of cognitive enhancers in healthy individuals are discovered as a result of psychological studies. For example, in the laboratory where I work research aimed at identifying cognitive enhancers for therapeutic use, led to the discovery that a single dose of modafinil (100–200mg; licensed for the treatment of narcolepsy) can induce reliable improvements in short-term memory and planning abilities in healthy adult male volunteers.

Studies such as these are useful for profiling the psychological effects of a drug, free from any confounding disease that might be present in a patient population. They also enable a greater understanding of the neurochemical mechanisms of cognitive abilities, such as memory and attention.

Although this work in healthy volunteers is vital in furthering our understanding of underlying brain mechanisms, it is also the most contentious owing to the ethical issues that arise when drugs that enhance functions of the healthy brain are found.

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