Cognitive performance enhancement -
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Main article: Modafinil. Main article: Methylphenidate. See also: Food safety and Health policy. Upper photo of modafinil tablets acquired via the Internet; below photo is a mail order pharmacy dispenser. European Neuropsychopharmacology.
doi : PMID S2CID Journal of Cognitive Enhancement. August Brain Sciences. ISSN PMC Pharmacological Reviews. Human Brain Mapping. Pharmacological Research. Frontiers in Systems Neuroscience. Clinical Neurophysiology Practice. ISSN X. Proceedings of the National Academy of Sciences.
Bibcode : PNAS.. Medizinische Monatsschrift für Pharmazeuten. Long-term meditation has been found to mitigate signs of brain aging 74 , 75 and improve well-being in OA Moreover, these practices do not offer quantifiable metrics of success or performance feedback during the learning phases — factors that are important for maintaining engagement with an intervention Further, traditional meditation is difficult to personalize because it is not adaptive or tailored to individuals, making it overly challenging for some novices.
Although recent studies have tested the delivery of website-accessible 79 and mobile 80 meditation programs, these online practices tend to duplicate the procedures of traditional meditation and consequently have faced similar hurdles to implementation.
In addition, while meditation apps on mobile devices have become increasingly ubiquitous 81 , studies to date have either failed to characterize their effects on cognition or have shown equivocal results An example of an approach to achieving a closed-loop digital meditation is MediTrain 83 , which was designed with the goal of improving focused, sustained attention.
This digital approach to meditation personalizes the experience to the real-time abilities of individuals, provides both punctuated and continuous feedback, and includes adaptivity that increases the challenge level as the user improves.
Following several studies demonstrating a positive impact of MediTrain on attention in younger populations 83 , 84 , 85 , a large-scale, fully remote trial of this digital intervention is being conducted in OA using a mobile RCT platform Fig.
Interestingly, another modern, technology-enabled approach to meditation relies on neurofeedback from EEG signals recorded from a consumer device and has led to similar improvements in cognitive control These new technologically enabled types of meditation may open the door for personalization of treatments, with some forms for example, neurofeedback versus performance-based feedback working better for specific individuals.
First, recruitment is conducted entirely remotely through social-media outreach, online advertisements, agreements with senior living centers, and direct mail campaigns. Next, OA are sent a link to visit a mobile RCT portal where they complete informed consent and eligibility forms on their computers or mobile devices.
They then complete baseline cognitive assessments, demographic questionnaires, and surveys of real-life behaviors and conditions, and those data are input into machine-learning algorithms that predict which digital intervention is most appropriate for each person, and randomization is done in a stratified manner.
Once assigned to an arm, OA complete the digital intervention at home while data are collected remotely. Finally, advanced device or cloud-based analytics allow for rapid analysis of results in real time, accelerating the pace of research and discovery.
These results can then be interpreted by researchers or visualized and presented to the participants as a performance dashboard, enabling them to monitor their own progress. The OA population is extremely heterogeneous Increasing age is associated with the risk of detrimental physiological or sensory changes, as well as increased risk of chronic diseases for example, diabetes, cancer, heart disease, and cognitive impairment.
At the same time, chronological age is not always a good predictor of functional capacity, with some individuals over the age of 80 continuing to work and travel, while other younger individuals are unable to.
This variability in older populations is often overlooked when developing cognitive therapeutics, thus limiting the potential efficacy of interventions in some populations. Further, within trials of cognitive interventions, there is often pronounced variability in treatment responses that is ignored when reporting group averages, suggesting the need for additional personalization tactics.
We propose that these differences represent meaningful heterogeneity, such that there is likely not a one-size-fits-all solution for cognitive enhancement in OA. A critical step to developing personalized interventions is identification of biomarkers that predict intervention success for a particular individual 88 , Some of the most promising personalization results come from studies that have used advanced neuroimaging methods to uncover neural factors that predict treatment success in an individual.
Much of this work in OA has focused on metrics related to magnetic resonance imaging MRI , spanning individual brain regions to large-scale brain-network properties 89 , Although much of the work using structural brain region predictors for example, volume 91 , 92 , 93 and thickness 94 has been largely inconclusive, more recently one common organizing principle of functional brain networks — modularity — has emerged as a potential unifying predictor of outcomes across a variety of interventions Modularity may be a biomarker of cognitive plasticity that predicts treatment outcomes across interventions Although much of this work in OA has focused on MRI-related metrics, parallel findings in younger adults have identified electroencephalogram EEG -based markers that predict treatment outcomes Extending such EEG findings to OA will be an important next step as affordable, consumer-grade home EEG devices continue to increase in quality and ease of use, paving the way for at-home neural diagnostics that can be used to tailor intervention strategies or parameters to individuals.
Although it is clear that individual differences play an important role in intervention responsiveness 88 , 99 , there are several lines of future work that will translate our understanding of these differences to developing personalized interventions.
First, there is a need to better understand biomarkers of treatment outcomes. Second, it is likely that multiple biomarkers that span demographics, cognition, and neural profiles have interacting, and potentially additive, effects on predicting outcomes.
Large-sample RCTs that incorporate machine learning will be critical in developing multimodal models that elucidate these predictive effects.
Indeed, ongoing work is using an online citizen science approach to recruit tens of thousands of volunteers to validate and personalize cognitive enhancement technologies , and machine learning is now being used to optimize non-invasive brain-stimulation protocols for different individuals We anticipate a future of personalized digital therapeutics in which individuals are pre-assigned optimal training parameters, thus maximizing treatment outcomes for everyone.
An example of a technology-based, non-pharmacological strategy for enhancing cognition in aging that has benefited from a precision-medicine approach is non-invasive brain stimulation NIBS.
Of particular interest is the coupling of NIBS with cognitive challenges; the hypothesis is that targeted neural networks are selectively activated by task engagement and then further modulated by brain stimulation, resulting in synergistic neuro-enhancing effects that drive greater cognitive improvement This raises the possibility that NIBS could be used to augment any closed-loop, cognitive therapeutic approaches by enhancing the underlying neuroplasticity, thus leading to even greater cognitive enhancement.
Two forms of NIBS methodologies are transcranial direct current stimulation tDCS and transcranial alternating current stimulation tACS. These techniques modulate neuronal transmembrane potentials by delivering weak electrical currents tDCS and tACS , , , thereby altering plasticity in the stimulated brain regions , Although the application of NIBS is generally thought to be a safe, non-pharmacological approach that has shown potential to counteract age-associated cognitive decline , crucial questions surrounding the heterogeneity of effects remain unaddressed.
First, optimal stimulation protocols and regimes need to be established. The direction and magnitude of effects of NIBS are strongly influenced by the prevailing brain states in targeted regions at the time of stimulation , Thus, the timing of the stimulation while a cognitive task is administered during the stimulation is critical.
Second, inter-individual variability exists in response to NIBS, with efficacy of NIBS being related to degree of education , genotype , pre-intervention performance , and the magnitude of the electric fields that reach the targeted brain area , which underscores the importance of individualizing stimulation parameters.
In summary, an effective use of NIBS to induce cognitive enhancement in aging brains likely requires an integration of optimal stimulation protocols and individually tailored stimulation parameters to more precisely target the specific functional networks that underlie cognitive functions most in need of improvement.
Testing hypotheses about the factors that predict or moderate treatment responses in the remarkably heterogenous OA population requires large and diverse cohort samples. Such large-scale studies are also needed to move the field beyond findings from relatively small studies towards the real-world validation of cognitive therapeutic technologies.
An emerging solution is to leverage modern, mobile technology for example, the Internet, wireless mobile devices, and cloud-based analytical and storage servers to facilitate the recruitment of larger, more diverse, representative cohorts into clinical trials while minimizing costs.
The need for such a solution has been augmented by the COVID pandemic, which has led to an even greater necessity for new, creative tools for improving public mental health in the setting of such unpredictable conditions.
New digital health technologies also hold promise for altering the landscape of how RCTs are conducted Fig. Indeed, it is now clear that mobile technology can be especially powerful in improving research-participant access, especially to those living in rural areas or members of minority ethnic groups, while simultaneously reducing the expense and time course of such trials Most of these research platforms have been designed to assist with enrolling participants, collecting data, and applying human resources for data interrogation, rather than complex study coordination.
However, we believe that the next phase of this field will use technology for more than data collection, but also to make easily interpretable data more actionable for both researchers and participants. Indeed, there is an important value in developing technology not only to collect data, but also to accelerate the pace of research and enhance the security of data collected remotely for example, through cloud-based analytics and storage.
Relevant to this discussion, more OA are embracing new technology every year. The clear trend is toward increased adoption of mobile technologies, making it important to study and refine digital interventions for enhancing cognition now, so they can reach as many OA as possible.
Critically, the percentage of the population that owns a mobile device is equally distributed among white, Black, and Hispanic people , , Thus, fully remote trials of digital therapeutics have the potential to greatly increase the ability to disseminate these interventions at scale and to reach drastically more diverse study populations than would be expected from a trial that requires participants to come into a medical or research center.
One step toward addressing this goal is making such tools easily accessible. Research has demonstrated that telemedicine and mobile approaches show comparable efficacy to in-person treatment , resulting in substantial interest in using mobile apps as an alternative care-delivery platform.
Such digital approaches to cognitive enhancement have the potential for breaking down barriers to access, especially in underserved or hard-to-reach populations of OA We have reviewed several approaches in which technology can aid in the personalization of cognitive enhancement in aging, but other emerging technologies also offer exciting new avenues for innovation.
Elements such as art, music, story, challenge, and competition could be dynamically manipulated to maximize engagement and compliance to further personalize experiences. Key to such an approach will be collection of large amounts of data and the application of machine-learning and artificial-intelligence techniques to create robust and dynamic predictive models of the factors that moderate treatment responses at the individual level.
There are a host of new accessible mobile technologies that can be leveraged to collect ecologically valid data as individualized baseline signatures and ongoing diagnostic monitoring of OA in the real-world and in real-time In addition to cognitive enhancement, technology is transforming the broader landscape of mental health and high-quality, personalized care for healthy OA who are living longer with each generation.
Technologies that attempt to modify and support real-life behaviors have advanced at a tremendous pace in recent years. For example, several methods have been developed to combat loneliness, anxiety, and depression, which are common in OA Examples include online and mobile delivery of established clinical treatments, such as cognitive behavioral therapy ; VR paradigms for fostering greater feelings of connectedness and boosting mood ; artificial-intelligence-driven voice-activated technologies for example, Alexa that not only help with organization and access to news and media, but also increase connectedness through human—machine conversations ; and therapeutic robots in the form of appealing animals that help OA cope with anxiety and memory loss These technologies are exciting and add to the emerging ecosystem of methods that can be tailored to the specific needs of an individual.
The impact of these therapeutic technologies could be augmented through combinatorial approaches as discussed above and by the incorporation of closed-loop systems for example, a robotic companion that receives passive physiological signals from a wearable device and uses those data to guide its real-time engagement with its OA companion.
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Centre Leenaards de la Mémoire, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Laboratory of Neuroimaging of Aging LANVIE , University of Geneva, Geneva, Switzerland.
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Barcelonaβeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain. Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
You can also search for this author in PubMed Google Scholar. Andrea Brioschi Guevara and Melanie Bieler conceptualized this Paper, drafted the manuscript for intellectual content, and approved the manuscript.
Gael Chételat, Jean-François Démonet, Daniele Altomare, Giovanni B Frisoni and Federica Ribaldi conceptualized this Paper, revised the manuscript for intellectual content, and approved the manuscript. Marcelo Berthier, Chantal Csajka, Alessandra Dodich, Carlo Miniussi and Sophie Dautricourt drafted specific parts of the manuscript, revised the manuscript for intellectual content, and approved the manuscript.
Philip Scheltens and José Luis Molinuevo revised the manuscript for intellectual content, and approved the manuscript.
Correspondence to Andrea Brioschi Guevara. JLM is currently a full-time employee of Lundbeck and has previously served as a consultant or an advisory boards for the following for-profit companies, or has given lectures in symposia sponsored by the following for-profit companies: Roche Diagnostics, Genentech, Novartis, Lundbeck, Oryzon, Biogen, Lilly, Janssen, Green Valley, MSD, Eisai, Alector, BioCross, GE Healthcare, ProMIS Neurosciences.
PS has received consultancy fees paid to the institution from AC Immune, Alkermes, Alnylam, Anavex, Biogen, Brainstorm Cell, Cortexyme, Denali, EIP, ImmunoBrain Checkpoint, GemVax, Genentech, Green Valley, Novartis, Novo Noridisk, PeopleBio, Renew LLC, Roche.
He serves on the board of the Brain Research Center. JFD has received consultancy fees from Biogen and OM Pharma; unrestricted grants from OM Pharma; and has collaboration agreements with Siemens and MindMaze.
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Skip to main content. Search all BMC articles Search. Download PDF. Review Open access Published: 11 October Protocols for cognitive enhancement. A user manual for Brain Health Services—part 5 of 6 Andrea Brioschi Guevara 1 na1 , Melanie Bieler 1 na1 , Daniele Altomare ORCID: orcid.
This article has been updated. Abstract Cognitive complaints in the absence of objective cognitive impairment, observed in patients with subjective cognitive decline SCD , are common in old age.
Background Forgetfulness is one of the most common worries among the elderly. Cognitive, mental, or physical training CMPT Here we considered as a CMPT intervention any training that had a potential impact on cognition, including cognitive intervention, physical activity and mental training e.
Cognitive interventions and physical training Cognitive intervention is a powerful mean to stimulate brain plasticity, as it showed not only an impact on behavior but also on the brain [ 13 , 14 , 15 ]. Mindfulness meditation Meditation refers to a set of emotional and attentional regulatory training exercises [ 18 , 19 ], encompassing different practices, such as focused attention, open monitoring, and loving-kindness meditations [ 19 ].
Non-invasive brain stimulation Non-invasive brain stimulation NIBS includes different methods aimed at inducing transient changes in brain activity and consequent variations in behavioral responses. Full size image. Methods Search strategy and selection criteria A systematic approach has been used to review CMPT interventions see Figure S1 and S2 in Supplementary Material.
Table 1 Experimental design of the selected studies Full size table. Table 2 CMPT interventions Full size table. Table 4 Efficacy of CMPT experimental interventions Full size table.
The demographic change in industrial countries, with Cognitive performance enhancement sedentary lifestyles, Organic mindfulness practices a Enhanxement impact on mental health. Normal and pathological Coggnitive leads to cognitive deficits. This development poses major challenges on national health systems. Therefore, it is necessary to develop efficient cognitive enhancement strategies. Here, we outline insufficiently explored fields in exercise-cognition research and provide a classification approach for different motor-cognitive training regimens.Cognitive performance enhancement -
Volume 7, Issue All submissions are peer-reviewed. The Editor-in-Chief, supported by the Associate Editors, perform a first check of a submission to ensure that it reaches a threshold of quality and appropriateness to the journal to be sent for peer-review.
A minimum of two expert peer reviewers will assess each submission. These in turn speak to a host of possible translational questions focused on both identifying existing activities that could potentially serve as interventions e.
Yet, despite the richness of the existing literature, there remain substantial open questions throughout the field, including those focused on the relationship between the specifics of behavioral training interventions and the behavioral outcomes e.
as well the neural substrates that underlie these processes. In this special issue, we seek articles spanning the broad field of perceptual learning, ranging from basic experimental findings, computational models, and translational applications of perceptual learning, to review papers that present conceptual advances in the field, summarize recent developments and discuss the future of perceptual learning research.
We are interested in submissions that address aspects of perceptual learning in all sensory modalities, research methods, and model systems. Journal of Cognitive Enhancement welcomes special issues.
The Editor-in-Chief may appoint Guest Editors for a certain topic, or potential Guest Editors may propose special issue topics to the Editor-in-Chief. All special issue proposals must include the name and details of the guest editors, a detailed explanation of the topic, and proposed schedule.
Editor-in-Chief has discretion to accept or reject a special issue proposal. The Guest Editor s will oversee the peer review process for each submission to the special issue.
The peer review process for special issue submissions and non-special issue submissions are identical. A minimum of two expert peer reviewers will assess each submission, and reviews will be single blind. The Journal of Cognitive Enhancement is happy to announce its new Editor-in-Chief, C.
Shawn Green. Green is a Professor in the Psychology Department at University of Wisconsin-Madison, and is currently an Associate Editor at Technology, Mind, and Behavior and is a former Associate Editor of Journal of Cognitive Enhancement.
vary strongly according to active ingredient or specific technology used, tested cognitive function, personal factors such as typical level of baseline performance , and several other factors Dresler et al. For example, the effects of Methylphenidate seem to be limited to certain cognitive functions, such as memory, while Modafinil was shown to better enhance cognition in sleep-deprived individuals than in well-rested individuals Kredlow et al.
Moreover, and importantly here, what basic research reveals about human performance in experimental and controlled settings may not hold in real-world settings, as there are neither specific criteria established for determining ecological validity nor methods for ensuring that complex, real-life factors are considered.
Take the example of memory improvement via pharmaceuticals versus memory improvement via mnemonic methods. Research might show hypothetically that cognitive enhancement pills and mnemonic methods are able to improve memory retrieval to a similar or identical degree.
But it has been shown that the pills can negatively affect mood i. This suggests the importance of developing finer-grain assessments of outcomes beyond those of primary interest, like memory or concentration.
From a more holistic social and psychological standpoint, the outcomes of each intervention expand far beyond the single cognitive function tested to include individual and societal short- and long-term outcomes e. Refusing the use of enhancement technologies in the case of, for example, a pilot on a difficult flight or of a surgeon doing a complicated surgery may result in other forms of stigmatization, such as blame for the outcomes of the flight or the surgery or coercion to use cognitive enhancement, as the availability of the technology may create expectations for its use, especially in high-stake situations Sample et al.
In ethical debates, some proponents of cognitive enhancement claim that the outcomes obtained via cognitive enhancement technology are equivalent to those obtained via other methods of improving cognitive performance Greely et al.
Contrary to this view, some opponents of cognitive enhancement describe enhancement as a categorically immense departure from other methods of self-improvement, such that they represent radical threats to human nature, human culture, or both Fukuyama, ; Sandel, But is the non- equivalence of outcomes established?
Perhaps the outcomes are equivalent in terms of a measured ability to carry out a given task e. The honest answer is that we have limited evidence to directly support the views on either side of the debate. It is important to know if the consequences of cognitive enhancement on human behavior and social interactions differ in such a way that, for example, users of enhancement behave or are treated differently in these situations due to the potential effects e.
It would also be paramount to know if cognitive enhancement use leads to outcomes measurable by both objective and subjective methods beyond cognition, such as financial reward, reduced or increased stress, and other predictors of well-being Häusser et al.
When choosing between two different methods e. Moving forward, we need more experimental studies that will assess not only the primary effects of cognitive enhancement use, but its social and psychological repercussions as well.
Experimental psychology studies could comprehensively examine the effects of cognitive enhancers on different aspects of task performance, including whether improvement in one domain e.
There is much work to be done to move beyond general claims regarding enhancement of broad areas of cognition e. Also, as we know, experimental lab studies do not necessarily reliably predict real-world behaviors and, therefore, studies on the effects of cognitive enhancement should be conducted outside of the laboratory.
Data should also be systematically collected in various settings e. Longitudinal observational studies with control groups could also be used to examine the effects of long-term cognitive enhancement use. See Table 1 for a non-exhaustive list of research questions, specific examples of potential studies that could be done, as well as corresponding methodological and substantial challenges.
Shedding light on real-world psychological and social outcomes of cognitive enhancers will not settle in itself ethical debates, unless ethics is narrowed down to the consideration of consequences irrespective of other dimensions involved.
However, better data could help to either substantiate concerns about the outcomes of cognitive enhancement technology or invalidate them.
One consideration moving forward is that experimental designs in which researchers provide participants with enhancers require careful ethics evaluations as there are risks associated with providing participants with enhancement methods such as pills that have been developed and often only approved for treatment purposes.
The known risk profiles already established for the use of certain substances for treatment purposes may not apply when cognitive enhancement is used. The possibility of, for example, increased cognitive enhancement use over time and the corresponding likelihood of addiction, for example, would need to be examined in the context of cognitive enhancement use specifically.
Barriers to conducting meaningful and representative research on cognitive enhancement Brown, ; Forlini et al. There are also foreseeable difficulties recruiting healthy subjects, difficulties securing funding, and the difficulty of justifying research in pediatric contexts given current research ethics guidelines d'Angelo et al.
Surveying populations of existing non- users does not entail the same risks, but the usefulness of such studies for testing causal relationships is restricted. The kinds of actions we choose to carry out, given a goal and a socio-cultural context, and the specific decision-making processes involved are crucial yet complex components of human psychology and behavior.
To achieve the goal of improved cognitive functioning, there exist several distinct methods ranging from taking stimulant drugs to genetic engineering, each with potentially different associated intentions and motivations see discussion about the Agent in the next section and other psychological, social, and situational factors.
For example, studying for an exam with the help of a tutor involves interacting with another person, paying them for their services, and actively listening to them. Studying with the help of cognitive enhancers involves procuring the necessary pill s legally or illegally , taking the pill s , and so on.
In the second case, the situation from which an improved exam score may arise is very different from the first on social, financial, legal, and procedural levels, such that the deeds differ in numerous ways even if the outcomes may be similar.
Agent-related factors such as the motivation why someone would choose to take cognitive enhancement pills rather than hire a tutor or consequence-related factors such as the persistence or reversibility of the enhancement effects are factors that in a sense may change the nature and the evaluation of the deed itself because they change its meaning to the agent and have different implications.
Additionally, there could be differences in the conditions of use, such as the difficulty and legality of obtaining an enhancer or whether the enhancer is invasive such as a pill or non-invasive such as a brain stimulation headband Medaglia et al. Consider the analogous problem of performance enhancement in sports.
Intensive training is looked upon more favorably than Erythropoietin EPO. These two methods are judged differently within the given context of competitive sports, where there are certain expectations and rules Schermer, and where performance gain by anything short of physical and psychological training would likely be considered a form of cheating Schelle et al.
Here, performance enhancement is widely perceived as an unethical method of achieving the goal of better performance, as it creates an unfair advantage over others unless everyone has access to enhancement , because others have to put in more time and effort.
But even with equal access, EPO use violates some of the intrinsic values in the context of competitive sports e. Proponents of cognitive enhancement may advance strategies to actively neutralize the ethical salience of the different methods of achieving a goal by, for example, suggesting that certain current legally controlled or prohibited cognitive enhancers e.
Enhancement as a method could then be considered equivalent to other methods Greely et al. But again, a comprehensive and rigorous analysis of this equivalence of methods should come in support of these arguments; though equal and legal access to cognitive enhancers may solve a justice-related issue, there would remain issues related to the differences in terms of the motivational, psychological, procedural, and other aspects of enhancement.
Furthermore, there are interactions between the agent user and the deed method as well as practical socio-political questions of how to distribute enhancers safely and fairly e. By the same token, those claiming that enhancement is condemnable in itself need to provide strong arguments and evidence supporting the notion that such a deed is intrinsically immoral or that the aspects listed above do in fact differ significantly between methods and affect the user in a meaningful way.
Even though ethical debates repeatedly evoke this issue, there is a dearth of evidence concerning different aspects of this debate. For example, surveys and experiments aimed at uncovering attitudes towards cognitive enhancers often inquire about safety, coercion, and fairness unfair access, cheating, etc.
Some of the more recent research suggests that methods sometimes do matter and sometimes do not, and that understanding how and why they matter is challenging.
For example, the acceptability of using different technologies e. Some studies indicate that characteristics of the enhancement methods e. Likewise, though willingness to use a substance-based enhancer has been found not to change across different types of substances with similar characteristics e.
Other research found that the attitudes of physicians to prescribing different cognitive enhancers towards those cognitive enhancers, varies Franke et al.
These diverging findings point to the complexity of the issue. Yet the debate remains sometimes Manichean Buchanan, On one side of the debate, the importance of methods is discounted: only the goals and end-results—not the methods—matter Greely et al.
At the other end of the spectrum, some argue that the methods used have overwhelming importance and are condemnable in themselves Sandel, This latter view is in line with the deontological ethics tradition in which certain acts have intrinsic value e. This kind of thinking is also reflected in formal norms and laws e.
Nevertheless, there is limited comparative analysis available of the impact of different methods of performance enhancement on actual human behavioral, psychological, and social factors. A fair amount of research is based on projected intents, not actual behaviors Sattler et al.
From a sociological and psychological standpoint, methods of enhancement matter because they shape the psychological context in which outcomes emerge Rauthmann et al. This does not mean that all novel methods of human performance enhancement negatively impact users on a psychological or social level; it simply means that the potential for these effects situational, social, psychological, etc.
cannot be discounted and should be systematically considered when making decisions about how new performance enhancement technologies should be used. To advance understandings of these aspects of human cognitive enhancement, we need prospective studies comparing users of cognitive enhancement technology e.
This kind of evidence is crucial in getting to the crux of the worries expressed in ethical debates and explore interactions between the deed, agent user , and consequences. Moreover, experimental surveys using vignettes could assess public and expert judgments of different enhancement methods and related existing and requested formal norms.
Ecologically relevant studies or direct observation in clinical or real-world settings would be useful complements. See Table 2 for more discussion about strategies to examine the non- equivalence of methods. Understanding the different impacts of methods of enhancement is difficult, because methods do not stand separately from their context of use and the intents and knowledge about the methods themselves, the consequences of their use, etc.
of agents users. Likewise, simply claiming an equivalence or non-equivalence between methods of enhancement forecloses genuine investigation into and discussion about the real impact of enhancement technology on human social and psychological practices, acknowledging here that deeds might be hard to separate from their implications.
Too often, technology is approved or rejected based on its alleged intrinsic worth without much analysis of potential opportunity costs or of its broader impact on other existing practices and technologies Buchanan, Take for example the historical opposition to all kinds of technological innovation e.
This opposition was often fueled by the fear of a loss Juma, The flipside is that intrinsic value is sometimes attributed to all kinds of new technologies e. Both attitudes are not ideal and need to be cross-checked by scientific evidence.
As these examples demonstrate, the evaluation of the equivalence of methods can change over time and across situations, with changing values, social attitudes, and evolving understandings of the methods.
This makes re-evaluations in certain intervals useful. To investigate and understand the true importance of enhancement methods, though, one must first grant that methods of enhancement are an important component of behavior, then study them accordingly.
Agency and the motivations underlying human performance enhancement matter from an ethical standpoint. Consider the differences between a situation in which the intention of the user of a performance enhancement technology is to gain advantage over other students in a competitive university entry exam and a situation in which the same technology is used to achieve a heroic feat with noble and altruistic intent that might save the lives of many people e.
These distinct motivations would likely entail very different moral evaluations; academic and legal institutions, peers, and society in general will treat each situation differently, indicating that regardless of whether intent should matter when it comes to cognitive enhancement use, it does matter.
Furthermore, the effects of the use of cognitive enhancers on agent motivation are also crucial to understand. One robust finding is that intrinsically motivated actions—actions performed for their own sake and for the sake of self-satisfaction, i.
It is possible that some altruistic intrinsically motivated behaviors rely on distinct neural pathways, indicting an important difference between actions performed in deeper connection with intrinsic values and extrinsically motivated actions Moll et al.
Perhaps someone using cognitive enhancement to achieve a high grade on a university entrance exam will mainly be able to satisfy their extrinsic motivations, whereas someone who is studying and preparing for the exam without enhancement will likely reap more self-satisfaction from the process in and of itself.
The receipt of an external reward e. This argument and like-minded ones warrants investigation into whether this increased motivation would also ultimately augment well-being, as would more intrinsically motivated actions. An unintended consequence of pill-induced motivation on agency could be that intrinsic motivation to perform tasks generally declines and that pills become essential in motivating particular action, akin to a phenomenon of addiction.
Individuals might face a trade-off between greater attainments of outcomes and their sense of agency or self-efficacy. This could, in the end, reduce their well-being and autonomy by involuntarily increasing the motivation to work harder to realize unmotivating tasks Bavelier et al.
Currently, we do not have an in-depth understanding of the impact of enhancement technology on motivation and, more broadly, on agents users. However, we know that users of cognitive enhancers in the form of drugs tend to be motivated by increases in performance at work and in educational settings Sattler et al.
Furthermore, other studies have suggested that stress, lower-than-average performance, low intrinsic motivation, peer influence, procrastination, and other factors tend to increase the willingness for enhancer use Sattler et al.
Some users may also be self-medicating e. Motivations could be influenced by hyperbolic media discourse about cognitive enhancers Partridge et al. These findings speak to the centrality of human intents and motivations in debates about enhancement technology.
Unfortunately, a commonplace rhetorical strategy used in debates about enhancement is to minimize and sometimes dismiss the ethical importance of agency and agent motivations and, instead, bring attention to the consequences of actions.
Some proponents of moral enhancement, for example, claim without regard for the methods of enhancement and their differences or their potential side effects on agency that enhancement is essentially necessary for the end-goal of human well-being Savulescu, This strategy relies on a narrow understanding of what brings happiness and fulfilment to flourishing individuals Yaden et al.
However, other scholars take the opposite route and tend to boil down the ethics of enhancement only to its motivational aspects such that the outcomes do not seem to matter Sandel, This idea is embedded in several legal traditions including Anglo-American criminal law.
For example, the doctrine of mens rea guilty mind is part of the evaluation of the criminal responsibility of someone who has committed a criminal act. Likewise, people are usually interested in what is revealed about the person and their dispositions through their acts, and this is well-reflected in ethics theories that focus on agent characteristics MacIntyre, In this sense, cognitive enhancement is often viewed negatively because it suggests unvirtuous behavior Sandel, Public opinion, as well as ethical analysis, may come up with different justifications or condemnations regarding various motives, and this might guide reactions towards the user, demands regarding policies, and user behavior.
Furthermore, motivations to enhance need to be examined more carefully in light of their actual contribution to flourishing. Further examination of the motivations of those using cognitive enhancement, as well as the effects of cognitive enhancement on human motivation, is crucial from the standpoint of human psychology, sociology, and behavioral science.
Agent motivation and other factors should also be examined in the case of addiction, which may impair agency itself both self-attributed agency and agency attributed by others , as well as the ability to form and act on motivations.
Some of this research could be accomplished by studies in behavioral neuroscience focusing on the mechanisms and neural pathways of different types of motivation, so that concrete and consequential differences between forms of motivation and their potential consequences can be pinpointed.
Psychological studies could assess whether the intuitive notion that self-satisfaction is valuable applies to the case of cognitive enhancement and whether individuals using cognitive enhancement get the same sense of self-satisfaction from accomplishments as those who do not use it.
Other studies could further establish the importance of social factors, such as perceptions of moral situations given agent intentions. Potential effects of cognitive enhancement on human motivation need to be investigated to inform enlightened and rational policy decisions.
Experimental studies have been used to assess, for example, the impact of incentives on intrinsic motivation in many different contexts; although research ethics need to be carefully considered, such studies could be conducted in the context of cognitive enhancement and its effect on task involvement and intrinsic, as well as extrinsic, motivation to work on target tasks.
Additionally, large-scale longitudinal survey studies may offer opportunities to prospectively assess the impact of cognitive enhancers on those who have started or will start using them and the relationships between motivations for their use and the lived stress, social and economic pressures, culturally formed framings, and goals of potential users.
Further, interview-based and narrative social science research could help generate a deeper understanding of the impact of cognitive enhancers on actual users in comparison to non-users, while taking into account different values, orientations, and cultural backgrounds Groeneveld et al.
See Table 3 for suggestions for research on agency and agent user motivations. Research has provided some understanding of the motivations an individual may have for using cognitive enhancers, while mechanisms behind personal and situational drivers and hurdles, as well as their interplay, are still far from being sufficiently understood Sattler, ; Sattler et al.
For the testing of causal hypotheses, experimental and longitudinal research is the medium of choice. However, assessing such motivations in situ might be difficult.
Moreover, we have a very incomplete understanding of the effects of cognitive enhancers on human motivations. Shedding light on these matters may either alleviate or bolster worries that cognitive enhancers will radically change the structure of human motivation and thwart ideals of human excellence and achievement.
Thus, effects on human motivation should not be presumed or discounted; the possibility that cognitive enhancement may be found to, for example, have no significant effect on motivational or other factors, should not preclude the need to test out whether this is the case empirically.
The growth of biotechnology and neuroscience yields numerous possibilities for the development of cognitive enhancement. So far, debates about these possibilities involve important claims about the psychological and social outcomes of enhancement consequences , the importance of enhancement methods used to attain a particular goal deeds , and the role of agency and agent user motivations.
These claims often stand as assumptions because they have not been sufficiently investigated. Yet, they are extremely important according to the ADC model that we have used as a heuristic to describe the ethical dimensions of cognitive enhancement. We have argued for 1 the study of a broad range of social and psychological outcomes associated with cognitive enhancers in addition to biological and health outcomes ; 2 investigation into the importance of the specific enhancement methods used, as they may have different social and psychological implications; and 3 greater consideration of agency and the role of agent motivation and its relationship to user well-being.
These three components should not be investigated in isolation; their mutual dependency must be fully considered if a more realistic and comprehensive picture is sought. Importantly, regardless of study design, rigorous and scientific analyses must be based on open-mindedness about aspects of and arguments about cognitive enhancement regarding outcomes, deeds, and agent motivations — not only those which support a certain view or those valued in a given research protocol.
An analysis based only on a priori favorable or unfavorable opinions about these aspects can succumb to biases e. Extensive research into these aspects is imperative if we are to assess the ethics of the non- use of cognitive enhancers in an evidence-based and integrative manner and inform future policy making as well as technology development.
Defendable and rational policies concerning cognitive enhancement need to rely on strong and objective evidence exposing all aspects of cognitive enhancement, including its biological, legal, social, and psychological aspects. Eliana Neophytou, Laurie A.
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This development poses major challenges on national health systems. Therefore, it is necessary to develop efficient cognitive enhancement strategies. Here, we outline insufficiently explored fields in exercise-cognition research and provide a classification approach for different motor-cognitive training regimens.
We suggest to classify motor-cognitive training in two categories, I sequential motor-cognitive training the motor and cognitive training are conducted time separated and II simultaneous motor-cognitive training motor and cognitive training are conducted sequentially.
In addition, simultaneous motor-cognitive training may be distinguished based on the specific characteristics of the cognitive task. If successfully solving the cognitive task is not a relevant prerequisite to complete the motor-cognitive task, we would consider this type of training as IIa motor-cognitive training with additional cognitive task.
In contrast, in ecologically more valid IIb motor cognitive training with incorporated cognitive task , the cognitive tasks are a relevant prerequisite to solve the motor-cognitive task.
We speculate that incorporating cognitive tasks into motor tasks, rather than separate training of mental and physical functions, is the most promising approach to efficiently enhance cognitive reserve.
Further research investigating the influence of motor -cognitive exercises with different quantitative and qualitative characteristics on cognitive performance is urgently needed.
A crucial aspect of human living is motion. While the control of movements requires cognitive processes, moving probably influences cognition and its underlying processes structures , too Hamacher et al. Cognition is a term covering a wide range of mental abilities that are necessary to percept, process, and interact with our environment Bostrom and Sandberg, ; Borson, Therefore, intact cognitive processes are fundamental for human living.
Across the life span, cognitive performance is influenced and changed by many factors. Normal aging is associated with a decline of cognitive functions such as processing speed and memory Albert, ; Park et al.
Moreover, old age is also a risk factor for developing neurological diseases like dementia Fiest et al. Dementia has a negative impact on the cognitive performance of an individual and reduces the autonomy as well as the quality of life Andersen et al.
Remarkably, dementia is a major contributor to health care costs Hurd et al. Furthermore, the neuropathological signs of dementia aggravate with physical inactivity Scherder et al.
Physical inactivity and sedentary behavior are associated with reduced cognitive functions Falck et al. Unfortunately, the average time people are physically inactive in daily life has increased substantially in the last decades in western countries Owen et al.
Taken together, the proportion of individuals with poorer cognitive capacities will increase in the next years, which makes it necessary to develop effective cognitive enhancement strategies Colzato, that serve to enhance the cognitive reserve [defined as individual differences in how people process tasks; detailed description of term and concept could be found in Stern , ] and the resilience against neurodegeneration Nithianantharajah and Hannan, ; Stern, , Moreover, regardless of whether physical exercise is conducted in a single acute exercise bout Chang et al.
Furthermore, it is speculated that regular physical activity and physical exercising prevent cognitive decline and neurological diseases Ahlskog, ; Sofi et al. However, which exact prerequisites e. Often, aerobic cardiovascular exercises like cycling, walking, or running are used in interventions to enhance cognitive fitness, especially in the elderly Roig et al.
For instance, a 6-month walking intervention leads to an increased hippocampal volume and improved memory performance in seniors Erickson et al. Remarkably, preceding aerobic exercises boost performance in an alter reaction-time test Pontifex et al.
Interestingly, physical and motor fitness coordinative abilities are both related to cognitive performance in older individuals Voelcker-Rehage et al. For instance, a month aerobic exercise intervention led to increased activation in sensori-motor networks while coordinative training increased activation in the visual—spatial network during an executive function test Voelcker-Rehage et al.
An exercise type that demands a high level of coordinative abilities is dancing Dhami et al. Participating in a 6-month dancing intervention enhanced attentional performance to a higher degree than participating in a fall prevention or Tai Chi Chuan program Coubard et al.
Additionally, in Parkinson disease dancing led to higher improvements in physical and cognitive functions than aerobic exercise Hashimoto et al.
Regular dancing has been associated with a lower risk of dementia Verghese et al. Similar to chronic exercise, acute bouts of different exercise types have divergent effects on cognitive performance.
Acute physical exercise with a high coordinative demand leads, in comparison to a purely aerobic exercise, to higher scores in attention tests Budde et al.
Taken together, acute and chronic physical exercises with high cognitive coordinative demands enhance cognitive performance. The beneficial effect of cognitively demanding exercises supports the recommendation of Pesce who proposes to shift the focus of exercise—cognition research from quantitative e.
Remarkably, it has been speculated that the combination of physical and cognitive exercise also known as motor-cognitive training could evoke a higher cognitive enhancement than cognitive or physical exercise alone Kraft, ; Fissler et al.
The reasons why combined physical and cognitive exercise may be more effective than physical or cognitive training alone as well as the underlying neurophysiological mechanism are elucidated in the next section. To understand the beneficial effects of combined physical and cognitive exercises, it is advisable to consider our evolutionary past.
From an evolutionary perspective, the human body and its organic systems exhibit a high adaptability to environmental constraints Raichlen and Alexander, Moreover, over centuries the human physiology was adapted to an active lifestyle which ensured human survival, for example, through foraging, hunting, and fishing Raichlen and Alexander, In industrialized nations, an increasing sedentary lifestyle Owen et al.
In contrast, the foraging activities e. Such cognitive processes e. These considerations suggest that the combination of physical and cognitive challenges are essential to preserve or enhance the neural capacity which, in turn, ensures that cognitive processes function well Kempermann et al.
A possible physical exercise-induced mechanism, which promotes neuroplasticity is the enhanced release of neurotrophic factors such as the brain-derived neurotrophic factor BDNF Knaepen et al. BDNF is associated with synaptogenesis and neurogenesis which may foster improved cognition Cotman et al.
Notably, an increased level of BDNF was observed during physical exercises and up to 60 min after cessation of the acute bout of physical exercises Knaepen et al.
While physical exercises induce neurophysiological processes that are fundamental for transient neuroplasticity e. The integration in functional brain circuits seems to be crucial in order to stabilize the by motor-cognitive training induced neuroplastic changes.
In addition to neuroplasticity, the stabilization of central nervous structures is likewise important to ensure good brain function Kasai et al. FIGURE 1. As shown in the framework in Figure 2 , motor and cognitive exercises can be combined in several ways.
In the first stage, we categorize motor and cognitive exercises based on their temporal order, which is a key factor for the effectiveness of the intervention Roig et al. FIGURE 2. In sequential or subsequent motor-cognitive training, both the motor training and the cognitive training are each conducted at separate time points on the same day prior to or after a bout of physical exercises or at separate days Tait et al.
Commonly, the motor component of simultaneous motor-cognitive exercises compromises aerobic, resistance, balance, flexibility training, or a combination of them for review see Lauenroth et al. In sequential motor-cognitive training interventions, the cognitive training was mainly focused on attention, memory, or multiple cognitive domains for review see Lauenroth et al.
An advantage of sequential motor-cognitive training compared to simultaneous motor-cognitive training is the absence of 1 possible dual-task costs [performance decrements in the motor task, the cognitive task, or in both tasks that may occur when two tasks are solved simultaneously Hamacher et al.
However, drawbacks of a sequential motor-cognitive training are the unknown appropriate load characteristics frequency, length, duration, type of exercise, and the temporal order of the cognitive intervention and the motor intervention for favorable cognitive outcomes Lauenroth et al.
For instance, the best benefit of an acute bout of motor exercises on cognitive performance was observed 11—20 min after cessation of the motor exercises Chang et al. In contrast, another study reported that performing motor exercises 4 h after learning resulted in higher cognitive performance as compared to learning immediately afterward van Dongen et al.
Hence, it remains unclear whether cognitive training should be performed prior to or after motor exercises. Interestingly, a recent review that compared the effects of sequential with simultaneous motor-cognitive training, reported that the simultaneous training significantly improved cognitive performance in various populations, whereas the sequential training yield inconclusive results Tait et al.
The latter finding may be explained by the fact that up to day it is unknown what time interval between motor and cognitive exercises is optimal see Figure 1. Different time intervals may activate different neurobiological pathways Tait et al.
Based on these findings, simultaneous motor-cognitive training seems a more promising and time-efficient approach to foster cognitive functions than sequential training regimens. Simultaneous motor-cognitive training or motor-cognitive dual-task training is defined as training where both motor training and cognitive training are performed at the same time Lauenroth et al.
Simultaneous motor-cognitive training can be further classified regarding the supposed demands of the cognitive task see Figure 2. We suggest to differentiate the two types of the supposed demands of cognitive tasks in simultaneous motor-cognitive training, which are presented in the following.
Distractor means that the additional cognitive task is not a relevant prerequisite to successfully complete the motor-cognitive task task nonrelevant ; e. Hence, this form of motor cognitive training can be described as Moving while Thinking. We argue that incorporating the cognitive task s into the motor task s is more beneficial in terms of stabilizing neuroplasticity effects than using the cognition task as a distractor.
Below, we will outline several reasons why this might be the case:. For example, it was observed that the integration of the cognitive task into physical activity enhanced cognitive learning in children more than performing physical activity unrelated to the cognitive task Toumpaniari et al.
Given that even neurophysiological parameters are affected by individual preferences and expectations regarding the exercise intervention Crabbe and Dishman, ; Schneider et al. For example, for an intervention to be effective, the adherence rate compliance to the training must be high.
The latter is largely influenced by the subjectively experienced meaningfulness perceived importance of the intervention with respect to individual situation of the training Trombly, ; Carlson et al.
As a cognitive task that is incorporated into a motor task closely resembles real-life situations, it is likely that such a combination is regarded as meaningful and, therefore, results in a high degree of adherence and in training success.
As physical fitness effectively enhances cognitive functions Bherer et al. Moreover, given that the adaptions of the brain are task-specific Dahlin et al. These considerations suggest that the cognitive task should be incorporated into the motor task.
In the context of our supermarket example remembering and walking to the respective goods can be combined. This approach is schematically depicted in Figure 2. Such prioritization effects giving priority either to the cognitive or the motor task are known to influence motor and cognitive performance Yogev-Seligmann et al.
Theoretically, such prioritization-related effects could evoke distinct undesired adaptation processes. Also, it is assumed that multisensory training environments better approximate all-day settings which are ecologically more valid and therefore provide an optimal basis for cognitive processes such as learning Shams and Seitz, Apart from a real-world setting as outlined for the proposed supermarket task, virtual reality environments offer the opportunity to combine cognitive and motor tasks without the need to construct a complex scenery Tarr and Warren, ; Bruin et al.
Those video games, that are also a type of physical exercise task, can be classified within our proposed framework as simultaneous motor-cognitive training because they pose motor and cognitive demands simultaneously Pichierri et al.
However, as expectations always prove the rule, motor-cognitive tasks with an additional cognitive task are sometimes also common in a modern world [e. Nevertheless, we argue that this circumstance does not challenge our proposed framework; however, one would have to adapt the training characteristics if the aim is to improve the use of a smartphone while walking.
We conclude that further exercise-cognition research is strongly needed, and we recommend that the major goals of this research should be:. I The identification of optimal qualitative e. Hence, participating subjects in future studies should be intensively screened and stratified into subgroups based on measures of physical fitness e.
Furthermore, other potential moderators such as genotypic factors should be assessed if possible Buford and Pahor, ; Barha et al. For more detailed information on exercise prescriptions, we refer to the articles of Hofmann and Tschakert , Mann et al.
II In order to prove whether the incorporation of cognitive tasks into acute or chronic exercise interventions as described, for example, in Figure 2 is more effective regarding the enhancement of cognitive performance than I a sole motor training, II a sole cognitive training, III a sequential motor-cognitive training, or IV simultaneous motor-cognitive training with a non-task-relevant secondary cognitive task and in order to verify or identify further underlying, causal mechanisms, future work should elaborate on detailed modeling of neurobehavioral effects of motor-cognitive exercise interventions.
Since physical exercises influence cognitive performance on multiple levels Stillman et al. FH and DH wrote the manuscript.
LS and NM reviewed the drafted versions. All authors have read and approved the final version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Metrics details. Cognitice complaints in enhaancement absence Perflrmance objective cognitive impairment, observed in patients with subjective cognitive decline Cgonitiveare common in old age. The first step to Liver health promotion Caffeine and focus decline is to use techniques known to improve Cognitive performance enhancement, i. We aimed to provide clinical recommendations to improve cognitive Liver health promotion in cognitively unimpaired individuals, by using cognitive, mental, or physical training CMPTnon-invasive brain stimulations NIBSdrugs, or nutrients. We made a systematic review of CMPT studies based on the GRADE method rating the strength of evidence. CMPT have clinically relevant effects on cognitive and non-cognitive outcomes. The quality of evidence supporting the improvement of outcomes following a CMPT was high for metamemory; moderate for executive functions, attention, global cognition, and generalization in daily life; and low for objective memory, subjective memory, motivation, mood, and quality of life, as well as a transfer to other cognitive functions. Neuroenhancement or cognitive enhancement is the experimental Liver health promotion enhancfment pharmacological ebhancement non-pharmacological methods intended to performaance cognitive and affective abilities in Type diabetes prevention strategies Liver health promotion who do not have a mental Cognitive performance enhancement. Pharmacological neuroenhancement agents may include compounds thought Cognktive be nootropicssuch as Cognitive performance enhancement[1] [3] caffeine[4] [5] and other drugs used for treating people with neurological disorders. Non-pharmacological measures of cognitive enhancement may include behavioral methods activities, techniques, and changes[7] non-invasive brain stimulationwhich has been used with the intent to improve cognitive and affective functions, [8] and brain-machine interfaces. There are many supposed nootropics, most having only small effect sizes in healthy individuals. The most common pharmacological agents in neuroenhancement include modafinil and methylphenidate Ritalin. Stimulants in general and various dementia treatments [10] or other neurological therapies [11] may affect cognition.
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