Cognitive Enhancement: Unanswered Questions About Human Psychology and Social Behavior

To enhance or not to enhance: A debate about cognitive enhancement from a psychological and neuroscientific perspective

The enhancement of humans' core cognitive abilities-such as intelligence-is a frequently debated topic in scientific and public discourse. Different enhancement methods such as cognitive trainings, smart drugs, and brain stimulation techniques have been proposed and tested to enhance human's cognition. In this narrative review, we summarize the main psychological and neuroscientific findings regarding those cognitive enhancement methods. We thereby distinguish passive (e.g., smart drugs) and active enhancement methods (e.g., working memory training)-which require different levels of agency. While for both forms of enhancement there is no (or only little) empirical evidence on their effectiveness to improve overall cognitive abilities, passive methods entail severe risks. Thus, we criticize promoting an overly optimistic view on especially passive enhancement. Furthermore, we highlight which individuals might be willing to enhance themselves, related motivational aspects of cognitive enhancement, and ethical considerations thereof. To raise awareness for the (in)effectiveness and risks of passive and active enhancement, we propose a category framework that distinguishes cognitive enhancement from clinical methods to treat disorders or diagnosed deficits and introduces important dimensions thereof. Finally, we present open questions for psychological and neuroscientific research which should become part of enhancement debates. Taken together, our narrative review provides a broad overview and critical assessment of enhancement-related topics such as effectiveness and risks of enhancement methods, motivational aspects to apply enhancement, and societal implications of cognitive enhancement.

Prospectively identifying risks and controls for advanced brain-computer interfaces: A Networked Hazard Analysis and Risk Management System (Net-HARMS) approach

The introduction of advanced digital technologies continues to increase system complexity and introduce risks, which must be proactively identified and managed to support system resilience. Brain-computer interfaces (BCIs) are one such technology; however, the risks arising from broad societal use of the technology have yet to be identified and controlled. This study applied a structured systems thinking-based risk assessment method to prospectively identify risks and risk controls for a hypothetical future BCI system lifecycle. The application of the Networked Hazard Analysis and Risk Management System (Net-HARMS) method identified over 800 risks throughout the BCI system lifecycle, from BCI development and regulation through to BCI use, maintenance, and decommissioning. High-criticality risk themes include the implantation and degradation of unsafe BCIs, unsolicited brain stimulation, incorrect signals being sent to safety-critical technologies, and insufficiently supported BCI users. Over 600 risk controls were identified that could be implemented to support system safety and performance resilience. Overall, many highly-impactful BCI system safety and performance risks may arise throughout the BCI system lifecycle and will require collaborative efforts from a wide range of BCI stakeholders to adequately control. Whilst some of the identified controls are practical, work is required to develop a more systematic set of controls to best support the design of a resilient sociotechnical BCI system.

Cognitive Enhancers Consumption: Prevalence, Knowledge, and Determinants of Use Among Medical Students in Egypt, Sudan, and Jordan

BACKGROUND

Cognitive Enhancers (CE) are central nervous system stimulant substances known to improve cognitive functions. Due to high-perceived stress and academic pressure, CEs are becoming increasingly popular among medical students. As a result, they are more likely to misuse these substances.

OBJECTIVES

This study aims to estimate the prevalence of CE consumption, compare the prevalence between countries and genders, and identify characteristics associated with CE consumption among students at medical schools in Egypt, Sudan, and Jordan.

METHOD

A population-based survey study was conducted among medical students from Egypt, Sudan, and Jordan. An online self-reported questionnaire was used to collect data. Frequencies and percentages were calculated to represent participant distribution across categories. Chi-square was used for categorical variables comparisons. All tests were two-tailed, considering p < 0.05 statistically significant. Demographic characteristics, reasons for use, types of CE used, and side effects were compared by country and gender.

RESULTS

A total sample of 1399 participated in the questionnaire, most of whom were females 824 (58.9%). Overall, 1236 (88.3%) were CE consumers, and 163 (11.7%) were non-consumers. Of the respondents who used CE, 814 (58.2%) reported using them daily. There was a statistically significant difference between the consumption of CE and the source of acquisition, nationality, and residence status regarding gender.

CONCLUSIONS

Our findings suggest that CE use is increasing among medical students in Egypt, Sudan, and Jordan. Efficient support, stress management programs, and awareness symposia may help reduce the misuse of these substances. Future longitudinal studies are still required.

Neurobiology and systems biology of stress resilience

Stress resilience is the phenomenon that some people maintain their mental health despite exposure to adversity or show only temporary impairments followed by quick recovery. Resilience research attempts to unravel the factors and mechanisms that make resilience possible and to harness its insights for the development of preventative interventions in individuals at risk for acquiring stress-related dysfunctions. Biological resilience research has been lagging behind the psychological and social sciences but has seen a massive surge in recent years. At the same time, progress in this field has been hampered by methodological challenges related to finding suitable operationalizations and study designs, replicating findings, and modeling resilience in animals. We embed a review of behavioral, neuroimaging, neurobiological, and systems biological findings in adults in a critical methods discussion. We find preliminary evidence that hippocampus-based pattern separation and prefrontal-based cognitive control functions protect against the development of pathological fears in the aftermath of singular, event-type stressors [as found in fear-related disorders, including simpler forms of posttraumatic stress disorder (PTSD)] by facilitating the perception of safety. Reward system-based pursuit and savoring of positive reinforcers appear to protect against the development of more generalized dysfunctions of the anxious-depressive spectrum resulting from more severe or longer-lasting stressors (as in depression, generalized or comorbid anxiety, or severe PTSD). Links between preserved functioning of these neural systems under stress and neuroplasticity, immunoregulation, gut microbiome composition, and integrity of the gut barrier and the blood-brain barrier are beginning to emerge. On this basis, avenues for biological interventions are pointed out.

"In the spectrum of people who are healthy": Views of individuals at risk of dementia on using neurotechnology for cognitive enhancement

Neurotechnological cognitive enhancement has become an area of intense scientific, policy, and ethical interest. However, while work has increasingly focused on ethical views of the general public, less studied are those with personal connections to cognitive impairment. Using a mixed-methods design, we surveyed attitudes regarding implantable neurotechnological cognitive enhancement in individuals who self-identified as having increased likelihood of developing dementia (n=25; 'Our Study'), compared to a nationally representative sample of Americans (n=4726; 'Pew Study'). Participants in Our Study were additionally shown four videos showcasing hypothetical neurotechnological devices designed to enhance different cognitive abilities and were interviewed for more in-depth responses. Both groups expressed comparable degrees of worry and acknowledgement of potential ethical ramifications (all ps>0.05). Compared to the Pew Study, participants in Our Study expressed slightly higher desire (p<0.01), as well as higher acknowledgment for potential impacts on productivity (p<0.05). Ultimately, participants in Our Study were more likely to deem the device morally acceptable (56%; compared to Pew Study, 25.2%; p=0.0001). Interviews conducted in Our Study allowed participants to supply additional nuance and reasoning to survey responses, such as giving examples for increased productivity, perceived downsides of memory enhancement, or concerns regarding potentially resulting inequality. This study builds upon and adds to the growing focus on potential ethical issues surrounding neurotechnological cognitive enhancement by centering stakeholder perspectives, highlighting the need for inclusive research and consideration of diverse perspectives and lived experiences to ensure inclusive dialogue that best informs ethical and policy discussions in this rapidly advancing field.

Adapting Ourselves, Instead of the Environment: An Inquiry into Human Enhancement for Function and Beyond

Technology enables humans not only to adapt their environment to their needs but also to modify themselves. Means of Human Enhancement - embodied technologies to improve the human body's capabilities or to create a new one - are the designated means of adapting ourselves instead of the environment. The debate about these technologies is typically fought on ethical soil. However, alarmist, utopian, and science fiction scenarios distract from the fact that Human Enhancement is a historical and pervasive phenomenon incorporated into many everyday practices. In the vein of disentangling conceptual difficulties, we claim that means of Human Enhancement are either physiologically or psychologically embodied, rendering the merging with the human user their most defining aspect. To fulfill its purpose, an enhancement must pass the test-in-the-world, i.e., assisting with effective engagement with a dynamic world. Even if failing in this regard: Human Enhancement is the fundamental and semi-targeted process of changing the users relationship with the world through the physical or psychological embodiment of a hitherto external object and/or change of one's body. This can potentially change the notion of being human. Drawing on a rich body of theoretical and empirical literature, we aim to provide a nuanced analysis of the transformative nature of this phenomenon in close proximity to human practice. Stakeholders are invited to apply the theory presented here to interrogate their perspective on technology in general and Human Enhancement in particular.

Cognitive Enhancement as Transformative Experience: The Challenge of Wrapping One's Mind Around Enhanced Cognition via Neurostimulation

In this paper, the authors explore the question of whether cognitive enhancement via direct neurostimulation, such as through deep brain stimulation, could be reasonably characterized as a form of transformative experience. This question is inspired by a qualitative study being conducted with people at risk of developing dementia and in intimate relationships with people living with dementia (PLWD). They apply L.A. Paul's work on transformative experience to the question of cognitive enhancement and explore potential limitations on the kind of claims that can legitimately be made about individual well-being and flourishing, as well as limit the kind of empirical work-including the authors' own-that can hope to enlighten ethical discourse. In this paper, the authors advance the following theses: (1) it is sometimes reasonable to characterize cognitive enhancement as a transformative experience; (2) the testimonies of people intimately acquainted with dementia may still be relevant to evaluating cognitive enhancement even though cognitive enhancement may be a transformative experience; and (3) qualitative studies may still be useful in the ethical analysis of cognitive enhancement, but special attention may need to be given to how these are conducted and what kind of insights can be drawn from them.

Identifying risk controls for future advanced brain-computer interfaces: A prospective risk assessment approach using work domain analysis

Brain-computer interface (BCI) technologies are progressing rapidly and may eventually be implemented widely within society, yet their risks have arguably not yet been comprehensively identified, nor understood. This study analysed an anticipated invasive BCI system lifecycle to identify the individual, organisational, and societal risks associated with BCIs, and controls that could be used to mitigate or eliminate these risks. A BCI system lifecycle work domain analysis model was developed and validated with 10 subject matter experts. The model was subsequently used to undertake a systems thinking-based risk assessment approach to identify risks that could emerge when functions are either undertaken sub-optimally or not undertaken at all. Eighteen broad risk themes were identified that could negatively impact the BCI system lifecycle in a variety of unique ways, while a larger number of controls for these risks were also identified. The most concerning risks included inadequate regulation of BCI technologies and inadequate training of BCI stakeholders, such as users and clinicians. In addition to specifying a practical set of risk controls to inform BCI device design, manufacture, adoption, and utilisation, the results demonstrate the complexity involved in managing BCI risks and suggests that a system-wide coordinated response is required. Future research is required to evaluate the comprehensiveness of the identified risks and the practicality of implementing the risk controls.

Do Medical Universities Students Use Cognitive Enhancers while Learning?—Conclusions from the Study in Poland

Background: Stress and everyday problems may impact memory and cognition. Therefore, many people use cognitive enhancers (CEs), sold for prescription, as over-the-counter drugs, or dietary supplements, believing they may help with everyday functioning. Our study was designed to answer whether taking CEs is common among Medical University students and to identify which substances are mainly used. Methods and Results: An anonymous online questionnaire was answered by 479 students of Medical (88%) and Dentistry (12%) Faculties in Poland. Women constituted the majority of respondents (63%). CEs were used by 53% of respondents, with the most frequent being caffeine, ginseng, nicotine, theanine, ginkgo, and lecithin. Some persons used CEs that are available only with a prescription. The most important reasons for the use of CEs were to increase arousal and improve concentration (mentioned by 81% and 73%, respectively). Over 65% of students experienced some undesired/adverse effects after taking CEs, with tachycardia being the most common, followed by sleep disturbances (reported by 51% and 40%, respectively). Conclusions: More than half of the respondents from the Medical and Dentistry Faculties reported using CEs, despite their unproven efficacy and not-well-established safety. This raises significant concern about the knowledge of young persons regarding CEs and should encourage universities to undertake educational actions.

Cooperative behavior in the workplace: Empirical evidence from the agent-deed-consequences model of moral judgment

Introduction

Moral judgment is of critical importance in the work context because of its implicit or explicit omnipresence in a wide range of work-place practices. The moral aspects of actual behaviors, intentions, and consequences represent areas of deep preoccupation, as exemplified in current corporate social responsibility programs, yet there remain ongoing debates on the best understanding of how such aspects of morality (behaviors, intentions, and consequences) interact. The ADC Model of moral judgment integrates the theoretical insights of three major moral theories (virtue ethics, deontology, and consequentialism) into a single model, which explains how moral judgment occurs in parallel evaluation processes of three different components: the character of a person (Agent-component); their actions (Deed-component); and the consequences brought about in the situation (Consequences-component). The model offers the possibility of overcoming difficulties encountered by single or dual-component theories.

Methods

We designed a 2 × 2 × 2-between-subjects design vignette experiment with a Germany-wide sample of employed respondents (N = 1,349) to test this model.

Results

Results showed that the Deed-component affects willingness to cooperate in the work context, which is mediated via moral judgments. These effects also varied depending on the levels of the Agent- and Consequences-component.

Discussion

Thereby, the results exemplify the usefulness of the ADC Model in the work context by showing how the distinct components of morality affect moral judgment.

Public attitudes towards neurotechnology: Findings from two experiments concerning Brain Stimulation Devices (BSDs) and Brain-Computer Interfaces (BCIs)

This study contributes to the emerging literature on public perceptions of neurotechnological devices (NTDs) in their medical and non-medical applications, depending on their invasiveness, framing effects, and interindividual differences related to personal needs and values. We conducted two web-based between-subject experiments (2×2×2) using a representative, nation-wide sample of the adult population in Germany. Using vignettes describing how two NTDs, brain stimulation devices (BSDs; NExperiment 1 = 1,090) and brain-computer interfaces (BCIs; NExperiment 2 = 1,089), function, we randomly varied the purpose (treatment vs. enhancement) and invasiveness (noninvasive vs. invasive) of the NTD, and assessed framing effects (variable order of assessing moral acceptability first vs. willingness to use first). We found a moderate moral acceptance and willingness to use BSDs and BCIs. Respondents preferred treatment over enhancement purposes and noninvasive over invasive devices. We also found a framing effect and explored the role of personal characteristics as indicators of personal needs and values (e.g., stress, religiosity, and gender). Our results suggest that the future demand for BSDs or BCIs may depend on the purpose, invasiveness, and personal needs and values. These insights can inform technology developers about the public's needs and concerns, and enrich legal and ethical debates.

Effort–Reward Imbalance at Work and Prescription Drug Misuse—Prospective Evidence from Germany

This study examines how work stress affects the misuse of prescription drugs to augment mental performance without medical necessity (i.e., cognitive enhancement). Based on the effort–reward imbalance model, it can be assumed that a misalignment of effort exerted and rewards received increases prescription drug misuse, especially if employees overcommit. To test these assumptions, we conducted a prospective study using a nationwide web-based sample of the working population in Germany (N = 11,197). Effort, reward, and overcommitment were measured at t₁ and the 12 month frequency of prescription drug misuse for enhancing cognitive performance was measured at a one-year follow-up (t₂). The results show that 2.6% of the respondents engaged in such drug misuse, of which 22.7% reported frequent misuse. While we found no overall association between misuse frequency and effort, reward, or their imbalance, overcommitment was significantly associated with a higher misuse frequency. Moreover, at low levels of overcommitment, more effort and an effort–reward imbalance discouraged future prescription drug misuse, while higher overcommitment, more effort, and an imbalance increased it. These findings suggest that a stressful work environment is a risk factor for health-endangering behavior, and thereby underlines the importance of identifying groups at risk of misusing drugs.

Benefits and Harms of 'Smart Drugs' (Nootropics) in Healthy Individuals

'Smart drugs' (also known as 'nootropics' and 'cognitive enhancers' [CEs]) are being used by healthy subjects (i.e. students and workers) typically to improve memory, attention, learning, executive functions and vigilance, hence the reference to a 'pharmaceutical cognitive doping behaviour'. While the efficacy of known CEs in individuals with memory or learning deficits is well known, their effect on non-impaired brains is still to be fully assessed. This paper aims to provide an overview on the prevalence of use; putative neuroenhancement benefits and possible harms relating to the intake of the most popular CEs (e.g. amphetamine-type stimulants, methylphenidate, donepezil, selegiline, modafinil, piracetam, benzodiazepine inverse agonists, and unifiram analogues) in healthy individuals. CEs are generally perceived by the users as effective, with related enthusiastic anecdotal reports; however, their efficacy in healthy individuals is uncertain and any reported improvement temporary. Conversely, since most CEs are stimulants, the related modulation of central noradrenaline, glutamate, and dopamine levels may lead to cardiovascular, neurological and psychopathological complications. Furthermore, use of CEs can be associated with paradoxical short- and long-term cognitive decline; decreased potential for plastic learning; and addictive behaviour. Finally, the non-medical use of any potent psychotropic raises serious ethical and legal issues, with nootropics having the potential to become a major public health concern. Further studies investigating CE-associated social, psychological, and biological outcomes are urgently needed to allow firm conclusions to be drawn on the appropriateness of CE use in healthy individuals.

Neuroenhancements in the Military: A Mixed-Method Pilot Study on Attitudes of Staff Officers to Ethics and Rules

Utilising science and technology to maximize human performance is often an essential feature of military activity. This can often be focused on mission success rather than just the welfare of the individuals involved. This tension has the potential to threaten the autonomy of soldiers and military physicians around the taking or administering of enhancement neurotechnologies (e.g., pills, neural implants, and neuroprostheses). The Hybrid Framework was proposed by academic researchers working in the U.S. context and comprises “rules” for military neuroenhancement (e.g., ensuring transparency and maintaining dignity of the warfighter). Integrating traditional bioethical perspectives with the unique requirements of the military environment, it has been referenced by military/government agencies tasked with writing official ethical frameworks. Our two-part investigation explored the ethical dimensions of military neuroenhancements with military officers – those most likely to be making decisions in this area in the future. In three workshops, structured around the Hybrid Framework, we explored what they thought about the ethical issues of enhancement neurotechnologies. From these findings, we conducted a survey (N = 332) to probe the extent of rule endorsement. Results show high levels of endorsement for a warfighter’s decision-making autonomy, but lower support for the view that enhanced warfighters would pose a danger to society after service. By examining the endorsement of concrete decision-making guidelines, we provide an overview of how military officers might, in practice, resolve tensions between competing values or higher-level principles. Our results suggest that the military context demands a recontextualisation of the relationship between military and civilian ethics.

Concept generation of cognitive enhancement: healthcare professionals' approach towards the impact and utilization of cognitive enhancers in academic context

Cognitive enhancers (CEs) encompass a wide range of drugs, including prescription medications for attention deficit disorders and pharmacological compounds for cognitive enhancement. It is well-documented that the students are the leading cohort of CEs users. Exploring how healthcare professionals perceive the use of CEs for academic accomplishments is significant to understand their encouragement of CE use. Hence, the purpose of the current study was to look at healthcare professionals' attitudes and perceived understanding about the usage of CEs in academic contexts. The study was a quantitative cross-sectional research design conducted in different healthcare and academic settings of Karachi. The respondents were approached either through social media platforms or the official email addresses of their working organizations. Data were collected through a web link of an online questionnaire that included four sections; inquiring about the respondents' demographics characteristics, their knowledge about CEs, their attitudes towards the use and impact of CEs, and their inclination to use a hypothetical prescription-only CE. The response rate of the study was 73.3%. The majority of the respondents negated to permit university students to using CEs for cognitive boost (n = 360, 67.1%), to concentrate (n = 406, 75.7%), to increase vigilance (n = 394, 73.5%) or to mitigate the effects of other medicines (n = 312, 58.2%). The pharmacists were more likely to refute that using CEs by the students is safe (pharmacists 10.8% vs. physicians 8.3%, p=<0.001), beneficial (pharmacists 12.7% vs. physicians 5.3%, p=<0.001), or necessary (pharmacists 17.6% vs. physicians 12.8%, p=<0.001). The major reasons for not encouraging the use of CEs were fear of misuse (n = 510, 95.1%), safety concerns (n = 495, 92.3%), and their consideration for CE as unnecessary medical intervention (n = 441, 82.2%). The findings indicated that overall, respondents have a clear consensus of not letting university students use CEs for cognitive improvement or any other purpose implying that cognitive enhancement is not yet a common or approved medical practice by the healthcare professionals in Pakistan.

Towards an understanding of how stress and resources affect the nonmedical use of prescription drugs for performance enhancement among employees

Based on assumptions of the Job Demands-Resources model, we investigated employees’ willingness to use prescription drugs such as methylphenidate and modafinil for nonmedical purposes to enhance their cognitive functioning as a response to strain (i.e., perceived stress) that is induced by job demands (e.g., overtime, emotional demands, shift work, leadership responsibility). We also examined the direct and moderating effects of resources (e.g., emotional stability, social and instrumental social support) in this process. We utilized data from a representative survey of employees in Germany (N = 6454) encompassing various job demands and resources, levels of perceived stress, and willingness to use nonmedical drugs for performance enhancement purposes. By using Structural Equation Models, we found that job demands (such as overtime and emotional demands) and a scarcity of resources (such as emotional stability) increased strain, consequently directly and indirectly increasing the willingness to use prescription drugs for cognitive enhancement. Moreover, emotional stability reduced the effect of certain demands on strain. These results delivered new insights into mechanisms behind nonmedical prescription drug use that can be used to prevent such behaviour and potential negative health consequences.