At some point, we could all use a bit of performance enhancement for the noggin — something to help us ace that test, command the room or nail a project under deadline.
Yes, there’s a pill for that — in fact, there are several. Drugs shown to modestly boost cognitive performance include stimulants used to treat attention-deficit/hyperactivity disorder (ADHD), medications prescribed for dementia, and a compound marketed as an alertness enhancer for shift workers and for people with narcolepsy or sleep apnea.
And let’s not forget two time-tested stimulants that offer some enhancement without prescription: caffeine and nicotine.
But if you’re smart enough to wish you could be smarter, you’re smart enough to ask tough questions about “cognitive enhancement.” In addition to wondering what works, you’ll want to know how these cognitive enhancers work, and how well.
And don’t forget to ask: What’s the downside? (Because there’s always a downside.)
The answers probably won’t make you want to run out to get a prescription. Even the drugs that work best have only modest, temporary effects. And most come with side effects, not to mention issues of ethical fairness.
The first thing to know is that cognition draws upon a complex mix of skills. To think well — or better — requires motivation, attention, perseverance and complex reasoning. And it requires several very different memory skills — including recalling words (verbal memory), holding multiple items briefly in the mind (working memory), and envisioning the physical or social context of a past experience (episodic memory).
In principle, tweaking any one of these skills might make you do better at some tasks. In reality, researchers have noticed that sometimes a pharmaceutically induced improvement in one mental skill comes at the cost of degradation in others.
Tests, for example, show that methylphenidate — better known as the ADHD drug Ritalin — improves attention and working memory. But, as with coffee (which slightly boosts working memory), the drug can induce jitters and palpitations. That’s a downside if your mental task involves fine motor skills.
The dementia drug rivastigmine (marketed as Exelon) can improve learning of motor tasks in healthy seniors and the making of associations between symbols and digits. But it can impair verbal and visual episodic memory.
And bromocriptine (Parlodel), used to treat symptoms of Parkinson’s disease, can enhance working memory of locations and spatial relationships. But in healthy young subjects, it also degrades certain complex reasoning skills.
Scientists also can’t conclude that improved performance of one or two narrow mental skills in the lab translates into better performance in real-life situations.
One recent study tested the effect of Ritalin, caffeine and the stay-awake drug modafinil (marketed as Provigil) on the performance of ranked chess players. (Chess is not exactly a “real-world” intellectual task, but it calls on a wide range of mental skills.) All three drugs ever-so-slightly improved players’ chances of winning a game against a computer program set to their skill level.
The improvement was subtle — essentially, the equivalent of giving a player the opening move. But over many games, the authors reckoned the edge from 20 milligrams of Ritalin or 200 milligrams of Provigil could elevate a player’s ranking substantially in the competitive world of tournament chess.
It had a key trade-off, though. Players who got Ritalin or Provigil also played more deliberately — and those who were slower and more methodical players to begin with were more likely to mismanage their time and lose when taking the drug.
Similar findings come from the lab of Cambridge University professor Barbara Sahakian, a neuroscientist who has pioneered work in cognitive enhancement. In sleep-deprived doctors, for instance, taking Provigil reduced impulsive behavior and the kind of rigid thinking people sometimes resort to when tired and under pressure.
“They were better at problem solving, but they seemed to take a little longer doing it,” Sahakian says.
Finally, most of these drugs have negatives that can’t be ignored. Many dementia drugs alter the chemical acetylcholine; their very modest cognitive-enhancing effects can come with dizziness, nausea, headache and vomiting. Stimulants like Ritalin can bring on sleeplessness, appetite loss and increased blood pressure — and carry real danger of abuse. Provigil, which has the most robust evidence as a cognitive enhancer (it tweaks attention, working memory and episodic memory), has the fewest downsides and lowest abuse risk.
Today’s cognitive enhancers seem able to alter performance at the margins. While that should prompt soul-searching about fairness and safety, neither is likely to dissuade the intellectually ambitious, says New York University bioethicist Arthur L. Caplan.
But he says we should think long and hard about a future that may offer profound intellectual enhancement, altering how users think, experience the world and react to those around them.
“This is not like someone getting a vaccine and enhancing his immune system,” Caplan says. “We define ourselves by our brains. If that shifts radically, that spells trouble for our personhood.”