While the 1990s saw the first systematic attempts to enhance cognitive performance, whether in normal subjects of all ages or in individuals who suffered from either strokes or a dementing process, in fact drugs such as the stimulants have been used for cognitive enhancement for decades. The term ‘cognitive enhancer’ now refers to the action of a drug that in some way improves cognitive performance, with memory being the performance most commonly looked at. An older term for this group of drugs was the nootropics. A looser term is smart drugs.
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Cognitive enhancement and the dementias
The initial goal in this field has been to find drugs to treat or ameliorate dementia. More recently efforts have broadened out to include, on the one hand, drugs that might limit the consequences of having a stroke or might be neuroprotective and, on the other hand, drugs that might enhance age-associated decline in memory. It is quite probable that drugs that are cognitively enhancing will not in any meaningful way treat or reverse any of the dementing processes. Conversely, agents that bring a dementing process to a halt are unlikely otherwise to be cognitive enhancers. There is accordingly a fault-line down the middle of this section, with on the one side the treatment of dementia and on the other cognitive enhancement.
In part, at least, for pharmacoeconomic reasons, many of the larger pharmaceutical companies have in recent years been moving out of the antidepressant, neuroleptic and anxiolytic fields and into the area of neuroprotection and cognitive enhancement. 1 It is worth bearing in mind, however, as with all other agents considered in this book, that any treatments that come out of such research programmes should be looked at closely by all of those involved in their clinical use because there is no such thing as a drug working on the brain that affects only one set of behaviours. The example of the antidepressants and sexual functioning is worth bearing in mind here (see Section 8). It is not inconceivable that a new generation of neuroprotective agents will be as useful in the management of schizophrenia as they may be for dementia. The people best placed to discover this will be drug takers and those closely involved in their care, such as nursing staff.
THE DEMENTIAS
Part of the problem in finding drugs that may be effective for dementia is that our ideas about what constitutes dementia have been undergoing radical change in recent years. It was traditional to distinguish between Alzheimer’s dementia, or senile dementia of the Alzheimer type (SDAT), and multi-infarct dementia (MID), which is theoretically caused by stroke. These are usually small strokes, which insidiously pick off brain tissue to the point where an individual’s cognitive function is compromised.
Stage 1
