Nature_CogEnhance_Dec07

Nature_CogEnhance_Dec07 - Vol 450|20/27 December 2007...

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T oday there are several drugs on the market that improve memory, concen- tration, planning and reduce impulsive behaviour and risky decision-making, and many more are being developed. Doctors already prescribe these drugs to treat cogni- tive disabilities and improve quality of life for patients with neuropsychiatric disorders and brain injury. The prescription use of such drugs is being extended to other conditions, including shift-workers. Meanwhile, off-label and non-prescription use by the general public is becoming increasingly commonplace. Although the appeal of pharmaceutical cog- nitive enhancers — to help one study longer, work more effectively or better manage eve- ryday stresses — is understandable, potential users, both healthy and diseased, must consider the pros and cons of their choices. To enable this, scientists, doctors and policy-makers should provide easy access to information about the advantages and dangers of using cognitive- enhancing drugs and set out clear guidelines for their future use. To trigger broader discussion of these issues we offer the following questions, to which readers can respond in an online forum. Now, on to the questions. Should adults with severe memory and concentration problems from neuropsy- chiatric disorders be given cognitive- enhancing drugs? We believe the answer is a resounding yes. A large debilitating aspect of many neuropsy- chiatric disorders is cognitive impairment. Thus, cognitive-enhancing drugs are a useful therapy option for several disorders, includ- ing Alzheimer’s disease and Attention Deficit Hyperactivity Disorder (ADHD). Alzheimer’s disease is a neurodegenerative disease of the ageing mind character- ized by a decline in cognitive and behavioural functioning, and in particular learning and memory. There are, at present, no treatments for Alzheimer’s disease that can stop or reverse the decline in brain function, but cholineste- rase inhibitors are being used to ameliorate the impaired neural transmission in the cholin- ergic system. Such drugs aim to increase the levels of acetylcholine, a neurotransmitter important for maintaining attention and in forming new memories, and may have additional neuro-protective effects. Countries with ageing populations are seeing a surge in the number of people with Alzheim- er’s. The personal and social costs are stagger- ing and in the United Kingdom, economic costs associated with dementias 1 are estimated to rise to £10.9 billion (US$22 billion) by 2031. According to a report commissioned by the Alzheimer’s Research Trust in Cambridge, UK, treatment that would reduce severe cognitive impairment in older people by just 1% a year has been estimated to cancel out all predicted increases in long-term care costs due to the ageing population 1 . For all medications, the chief
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Nature_CogEnhance_Dec07 - Vol 450|20/27 December 2007...

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