Cognitive Enhancement

Pharmacologic, Environmental and Genetic Factors

Shira Knafo, César Venero

• Publisher: Academic Press
• Year: 2014
• Print ISBN:
  9780124170421
• eBook ISBN:
  9780124171251
• Topic: Medicine
• Subtopic: Neurology

Cognitive Enhancement: Pharmacologic, Environmental and Genetic Factors addresses the gap that exists in research on the topic, gathering multidisciplinary knowledge and tools that help the reader understand the basics of cognitive enhancement. It also provides assistance in designing procedures and pharmacological approaches to further the use of novel cognitive enhancers, a field that offers potential benefit to a variety of populations, including those with neurologic and psychiatric disorders, mild aging-related cognitive impairment, and those who want to improve intellectual performance. The text builds on our knowledge of the molecular/cellular basis of cognitive function, offering the technological developments that may soon enhance cognition. Separate sections cover enhancement drugs, environmental conditions, and genetic factors in terms of both human and animal studies, including both healthy/young and aging/diseased individuals. - Provides a multidisciplinary knowledge, enabling a further understanding of cognitive enhancement - Offers coverage of the pharmacologic, environmental, and genetic factors relevant to the topic - Discusses cognitive enhancement from the perspective of both healthy and diseased or aging populations - Topics are discussed in terms of both human and animal studies

Chapter 1

What is Cognitive Enhancement?

Veljko Dubljević^1,2,3, César Venero⁴, and Shira Knafo^{5 1}Neuroethics Research Unit, Institut de Recherches Cliniques de Montréal (IRCM), Montréal, Canada ²Department of Neurology and Neurosurgery, McGill University, Montreal, Canada ³International Centre for Ethics in the Sciences and Humanities, University of Tübingen, Germany ⁴Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain ⁵IKERBASQUE, Molecular Cognition Laboratory, Unidad de Biofísica CSIC-UPV/EHU, Campus Universidad del País Vasco, Leioa, Spain

Abstract

“Cognitive enhancement” is commonly associated with drug use or the use of devices to improve cognition, technologies that have on the whole been established in laboratory animals or through a history of use in humans. In this chapter we aim to clarify the concept underlying “cognitive enhancement” and to provide a brief overview of the current use of this term in the academic literature, distinguishing the strategies to enhance cognitive function under normal conditions and the therapeutic strategies aimed at overcoming cognitive impairment. In addition, we will briefly review the various approaches to cognitive enhancement later described in this book.

Keywords

Brain power; Cognitive enhancement; Life style; Technology; Therapy

General Definition of Cognitive Enhancement

The term “cognitive enhancement” is currently associated with a wide range of existing, emerging, and visionary biomedical technologies that intend to improve the cognitive status of animals and human beings. As such, it offers the promise (or threat) of drastically changing the lives of citizens. Among the technologies proposed for use in humans are drugs that boost “brain power,” neuroimplants that may interface with computers or artificial means of augmenting cognition, new brain stimulation technologies to alleviate pain and control mental focus, and highly sophisticated prosthetic applications to provide specialized sensory input or mechanical output (e.g., STOA, 2009). Most of these technologies have either been established in animal models (e.g., Warwick, 2008) or they have already been used in humans (e.g., Dubljevic, 2013a). In this chapter, we will clarify what is meant by the term “cognitive enhancement” as it is currently used in the academic literature and provide an overview of the different issues addressed in this book.

In the most general sense, cognitive enhancement can be considered as the improvement in performance related to cognitive tasks. The term “cognitive enhancement” is usually used without clarifying any of the nuances associated with its meaning, yet it refers to a wide range of practices and assumptions that impinge on other concepts. Indeed, this term is often defined distinctly in different spheres, and for example, public health and epidemiological studies usually describe the use of drugs for cognitive enhancement as the “non-medical use of prescription drugs,” “drug misuse,” or even “drug abuse” (e.g., De Santis et al., 2008; Franke et al., 2010). On the other hand, contributions in the interdisciplinary bioethics literature regarding cognitive enhancement (e.g., Harris, 2011), as well as in neuroscientific (e.g., Greely et al., 2008) and clinical journals (Larriviere et al., 2009), generally have a more positive attitude toward the effects of cognitive enhancers, as reflected in their preferred examples (coffee, education, etc.).

Different Classes of Cognitive Enhancement

The general definition of cognitive enhancement is usually articulated by its proponents, and although chiefly considered through the application of medical tools, it may involve a wider range of approaches (e.g., computer technology, education, etc.). For example, “cognitive enhancement” is commonly considered to be applied in healthy individuals, although this term has also been used historically in Alzheimer’s research (see Chapter 9) and in research into neuropsychiatric illnesses involving cognitive impairment, such as schizophrenia and depression (see Chapter 10). In these pathologies, cognitive enhancement clearly refers to possible therapeutic interventions to improve the memory or cognitive function of patients. Thus, it is a term that is often used nonspecifically and, sometimes, academic contributions consider both contexts together. This makes the normative implications harder to define and, to some extent, may confuse the specific scientific questions underlying both these contexts. That is why “general improvement in cognitive performance” is sometimes differentiated from “maintenance of cognitive performance” and from “augmented cognitive performance.”

Lifestyle Use versus Therapeutic Use of Cognitive Enhancers

In a more technical sense, cognitive enhancement could be defined as the use of pharmaceutical drugs (see Chapters 3 and 11) or devices (see Chapters 11 and 12) for non–health-related improvement of cognition. This definition has the virtue of dissociating contexts that are socially encouraged from those that are legitimately discouraged or even prohibited. The preventive, curative, rehabilitative, and compensatory uses of pharmaceutical drugs and devices are important elements in meeting health needs. By contrast, the use of medical means to gain competitive advantage is an issue that might cause social problems (please refer to Chapter 13 in which ethical issues are discussed) and, as such, the distinction between therapy and enhancement is largely context dependent.

The concept of therapy was taken to be fairly unproblematic for a long time, yet once people realized the potential of certain technologies, they began to consider the conceptual differences between, say, vaccination and enhancement. That is not to say that new technologies have blurred the boundary themselves; rather, our attitude has shifted from taken-for-granted to the need to explain. This is why it is useful to set apart the concept of enhancement that explicitly excludes medical needs from the therapeutic uses of the same technology (i.e., preventive, curative, rehabilitative, and compensatory). In this sense, it is also useful to clarify the extent of moral unease felt about enhancement and the appropriate regulatory response of the state (see Dubljevic, 2012a,b for a longer argument). For example, when a given technology or social practice is not yet proved to be detrimental per se but it might cause social problems if unregulated, the appropriate response is some form of discouragement (see Dubljevic, 2013a,b).

However, notions other than cognitive enhancement have also been used to capture the concept of nonmedical drug use to improve performance. For example, “lifestyle use” of drugs may in part reflect pharmaceutical drug use that does not correspond to a medical condition or need in the traditional sense of the term but rather, to the demand for greater performance or a modified lifestyle. It may be claimed that references to the use of cognitive enhancement in the scientific literature obscure a longer history of nonmedical drug use to enhance performance. Indeed, a group of Australian authors (Bell et al., 2012) argued that the use of drugs for enhancement may even cross the border of illegal drug use (e.g., cocaine and amphetamines). This consideration adds normative implications as prohibition would be the assumed regulatory response, which might not be fully justifiable on judicial grounds. For this reason, the use of medical drugs to enhance cognitive function by healthy adults, such as Adderall (amphetamine) and Ritalin (methylphenidate, see Chapter 11), or devices such those involving transcranial direct current stimulation (tDCS, see Chapter 12), has to be dissociated from both the therapeutic drug use and the leisure use of illegal substances.

The Aspects of Cognition Being Enhanced

A further issue is to understand exactly what is improved by cognitive enhancement (i.e., what capacity). The naive and undifferentiated term “cognitive enhancement” (as well as more popular terms for such enhancers, such as “smart drugs”) suggests that the use of said stimulants generally improves cognition, or even IQ. However, it is important to note that current evidence is contradictory with respect to the possible “enhancement” caused by currently available cognitive enhancers (see, e.g., Ilieva et al., 2013). This has led some to conclude that the label “cognitive enhancement” may be a misnomer (see Vrecko, 2013). Accordingly, much like a drug undergoing clinical trials cannot properly be called a “treatment” or “therapy” before its effectiveness has been proved, prescription stimulants should not be called “cognitive enhancers” until there is scientific proof that they actually increase cognitive function or IQ. Many of the “smart drugs” have not been tested in the same way or with the same rigor for enhancement as they were for the original therapeutic applications (see Chapters 9, 10, and 11), and recent reviews have highlighted the limited evidence supporting claims of enhancement (see, e.g., Repantis et al., 2010). Obviously, we need a stricter definition of specific aspects of cognitive enhancement. Improved cognitive function (such as IQ, working memory, etc.), for which there is currently insufficient evidence, should be referred to as “augmented cognitive performance” and, as such, distinguished from “maintained cognitive performance.” “Maintained cognitive performance” refers to the prolongation of normal cognitive activity and a dampening of the effects of fatigue and sleep deprivation, for which there is strong evidence (see, e.g., Estrada et al., 2012; Lagarde, 1995).

“General improved performance” has been analyzed as a descriptive that can be applied to cognitive enhancement, and it has been rejected as unspecific, since it does not distinguish even the therapeutic use of drugs and devices. On the one hand, “augmented cognitive performance” can be applied to healthy adults using drugs or devices to improve general IQ, working memory, or accuracy of recall, thereby achieving significantly better levels of cognitive functioning. On the other hand, “maintained cognitive performance” refers to the use of drugs or devices that serve to maintain normal levels of cognitive activity for longer periods of time, while reducing the impairment associated with fatigue and sleep deprivation. While the evidence supporting the former remains somewhat controversial, current “cognitive enhancers” undoubtedly provide such maintenance effects, although some issues regarding safety remain unclear.

Are Today’s “Cognitive Enhancers” Truly Efficient?

It is currently not easy to define improvement in cognition. For an individual interested in enhancement, the effect depends on the expectations of a subjective improvement in performance in real-life settings, whereas a regulatory review body usually requires controlled laboratory settings to assess claims of improved cognition. Since the benefits of cognitive enhancers should by definition not involve the response to a clear pathology, lesion, or identified behavioral or mental health problem, establishing the basal measures ...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Contributors
• Chapter 1. What Is Cognitive Enhancement?
• Chapter 2. Signaling Pathways Involved in Cognitive Enhancement
• Chapter 3. Molecular Mechanisms of Drug-Induced Cognitive Enhancement
• Chapter 4. Role of Environment, Epigenetics, and Synapses in Cognitive Enhancement
• Chapter 5. Transgenic Mice with Enhanced Cognition
• Chapter 6. The Use of Viral Vectors to Enhance Cognition
• Chapter 7. Advancing Fear Memory Research with Optogenetics
• Chapter 8. Can Stem Cells Be Used to Enhance Cognition?
• Chapter 9. Alzheimer’s Disease and Mechanism-Based Attempts to Enhance Cognition
• Chapter 10. Pharmacological Treatment of Cognitive Dysfunction in Neuropsychiatric Disorders
• Chapter 11. Cognitive Enhancement in Humans
• Chapter 12. The Use of Transcranial Direct Current Stimulation for Cognitive Enhancement
• Chapter 13. Cognitive Enhancement: Ethical Considerations and a Look into the Future
• Index
• Color Plates