Cognitive enhancement: methods, ethics, regulatory challenges

Mapping cognitive function screening instruments for patients with heart failure: A scoping review

Background

Patients with heart failure (HF) often experience cognitive impairment, which negatively affects their quality of life. An effective screening tool is essential for nurses and healthcare professionals to assess cognitive function as part of HF management. Although many instruments exist, none are specifically designed for patients with HF.

Objective

This study aimed to map the instruments for screening cognitive function in patients with HF.

Design

A scoping review.

Data Sources

Articles published between 2019 and 2023 were searched in PubMed, ScienceDirect, and Google Scholar, with the last search conducted on 27 January 2024.

Review Methods

The review followed the scoping review framework by Arksey and O'Malley and adhered to PRISMA guidelines for scoping reviews.

Results

Of the 21 articles meeting inclusion criteria, six cognitive function screening instruments were used across various cognitive domains, effectively identifying cognitive impairment in both inpatient and outpatient HF settings. The Montreal Cognitive Assessment (MoCA) was the most frequently used tool, covering a broad range of cognitive domains. MoCA showed high efficacy with a kappa coefficient of 0.82, Cronbach's alpha reliability of 0.75, sensitivity of 90%, and specificity of 87%.

Conclusion

Instruments like MoCA, Mini-Cog, and TICS-m show promise for assessing cognitive function in patients with HF, each with specific strengths and limitations. MoCA is notable for its comprehensive coverage despite being time-consuming and having language barriers. Further research is needed to revalidate and improve the existing instruments. It is crucial for nurses and healthcare professionals to integrate these tools into regular patient management, highlighting the need for continued research in their application.

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.

Neurochemical Predictors of Generalized Learning Induced by Brain Stimulation and Training

Methods of cognitive enhancement for humans are most impactful when they generalize across tasks. However, the extent to which such "transfer" is possible via interventions is widely debated. In addition, the contribution of excitatory and inhibitory processes to such transfer is unknown. Here, in a large-scale neuroimaging individual differences study with humans (both sexes), we paired multitasking training and noninvasive brain stimulation (transcranial direct current stimulation, tDCS) over multiple days and assessed performance across a range of paradigms. In addition, we varied tDCS dosage (1.0 and 2.0 mA), electrode montage (left or right prefrontal regions), and training task (multitasking vs a control task) and assessed GABA and glutamate concentrations via ultrahigh field 7T magnetic resonance spectroscopy. Generalized benefits were observed in spatial attention, indexed by visual search performance, when multitasking training was combined with 1.0 mA stimulation targeting either the left or right prefrontal cortex (PFC). This transfer effect persisted for ∼30 d post intervention. Critically, the transferred benefits associated with right prefrontal tDCS were predicted by pretraining concentrations of glutamate in the PFC. Thus, the effects of this combined stimulation and training protocol appear to be linked predominantly to excitatory brain processes.

Unfreedom or Mere Inability? The Case of Biomedical Enhancement

Mere inability, which refers to what persons are naturally unable to do, is traditionally thought to be distinct from unfreedom, which is a social type of constraint. The advent of biomedical enhancement, however, challenges the idea that there is a clear division between mere inability and unfreedom. This is because bioenhancement makes it possible for some people's mere inabilities to become matters of unfreedom. In this paper, I discuss several ways that this might occur: first, bioenhancement can exacerbate social pressures to enhance one's abilities; second, people may face discrimination for not enhancing; third, the new abilities made possible due to bioenhancement may be accompanied by new inabilities for the enhanced and unenhanced; and finally, shifting values around abilities and inabilities due to bioenhancement may reinforce a pre-existing ableism about human abilities. As such, we must give careful consideration to these potential unfreedom-generating outcomes when it comes to our moral evaluations of bioenhancement.

Motivational Enhancement: What Ancient Technologies of the Self and Recent Biotechnologies Have in Common

Motivational enhancement of any kind can be conceived of either as a way to reduce the need for effort, or as a change in the subjective perception of effort. However, in both cases, effort is not all that matters. In the evaluation of praiseworthy conduct, the practical goals pursued by the subject, their dedication, and the discernment they exercise are equally important. I further argue that not only in terms of the general purpose, but also in terms of the means employed for human enhancement, we cannot, in fact, establish significant differences between the traditional technology of the self and biomedical technologies for enhancing motivation. There are two key features they all share. The traditional techniques of the self also aim at the gradual reduction of effort through their steady practice, and they are all mental conditioning and self-conditioning techniques based on repetition and training.

Repetitive transcranial magnetic stimulation (rTMS) as a tool for cognitive enhancement in healthy adults: a review study

As human beings, we have always sought to expand on our abilities, including our cognitive and motor skills. One of the still-underrated tools employed to this end is repetitive transcranial magnetic stimulation (rTMS). Until recently, rTMS was almost exclusively used in studies with rehabilitation purposes. Only a small strand of literature has focused on the application of rTMS on healthy people with the aim of enhancing cognitive abilities such as decision-making, working memory, attention, source memory, cognitive control, learning, computational speed, risk-taking, and impulsive behaviors. It, therefore, seems that the findings in this particular field are the indirect results of rehabilitation research. In this review paper, we have set to investigate such studies and evaluate the rTMS effectuality in terms of how it improves the cognitive skills in healthy subjects. Furthermore, since the most common brain site used for rTMS protocols is the dorsolateral prefrontal cortex (DLPFC), we have added theta burst stimulation (TBS) wave patterns that are similar to brain patterns to increase the effectiveness of this method. The results of this study can help people who have high-risk jobs including firefighters, surgeons, and military officers with their job performance.

Cognitive Enhancement and Social Mobility: Skepticism from India

Cognitive enhancement (CE) covers a broad spectrum of methods, including behavioral techniques, nootropic drugs, and neuromodulation interventions. However, research on their use in children has almost exclusively been carried out in high-income countries with limited understanding of how experts working with children view their use in low- and middle- income countries (LMICs). This study examines perceptions on cognitive enhancement, their techniques, neuroethical issues about their use from an LMICs perspective.Seven Indian experts were purposively sampled for their expertise in bioethics, child development and child education. In-depth interviews were conducted using a semi-structured topic guide to examine (1) understanding of CE, (2) which approaches were viewed as cognitive enhancers, (3) attitudes toward different CE techniques and (4) neuroethical issues related to CE use within the Indian context. All interviews were audio recorded and transcribed before thematic analysis.Findings indicate Indian experts view cognitive enhancement as a holistic positive impact on overall functioning and well-being, rather than improvement in specific cognitive abilities. Exogenous agents, and neuromodulation were viewed with skepticism, whereas behavioral approaches were viewed more favorably. Neuroethical concerns included equitable access to CE, limited scientific evidence and over-reliance on technology to address societal problems. This highlights the need for more contextually relevant neuroethics research in LMICs.

Weak transhumanism: moderate enhancement as a non-radical path to radical enhancement

Transhumanism aims to bring about radical human enhancement. In 'Truly Human Enhancement' Agar (2014) provides a strong argument against producing radically enhancing effects in agents. This leaves the transhumanist in a quandary-how to achieve radical enhancement whilst avoiding the problem of radically enhancing effects? This paper aims to show that transhumanism can overcome the worries of radically enhancing effects by instead pursuing radical human enhancement via incremental moderate human enhancements (Weak Transhumanism). In this sense, weak transhumanism is much like traditional transhumanism in its aims, but starkly different in its execution. This version of transhumanism is weaker given the limitations brought about by having to avoid radically enhancing effects. I consider numerous objections to weak transhumanism and conclude that the account survives each one. This paper's proposal of 'weak transhumanism' has the upshot of providing a way out of the 'problem of radically enhancing effects' for the transhumanist, but this comes at a cost-the restrictive process involved in applying multiple moderate enhancements in order to achieve radical enhancement will most likely be dissatisfying for the transhumanist, however, it is, I contend, the best option available.

Who Wants to Enhance Their Cognitive Abilities? Potential Predictors of the Acceptance of Cognitive Enhancement

With advances in new technologies, the topic of cognitive enhancement has been at the center of public debate in recent years. Various enhancement methods (e.g., brain stimulation, smart drugs, or working memory training) promise improvements in one's cognitive abilities such as intelligence and memory. Although these methods have been rather ineffective so far, they are largely available to the general public and can be applied individually. As applying enhancement might be accompanied by certain risks, it is important to understand which individuals seek to enhance themselves. For instance, individuals' intelligence, personality, and interests might predict their willingness to get enhanced. Thus, in a preregistered study, we asked 257 participants about their acceptance of various enhancement methods and tested predictors thereof, such as participants' psychometrically measured and self-estimated intelligence. While both measured and self-estimated intelligence as well as participants' implicit beliefs about intelligence, did not predict participants' acceptance of enhancement; a younger age, higher interest in science-fiction, and (partially) higher openness as well as lower conscientiousness did. Thus, certain interests and personality traits might contribute to the willingness to enhance one's cognition. Finally, we discuss the need for replication and argue for testing other potential predictors of the acceptance of cognitive enhancement.

Electroencephalogram based brain-computer interface: Applications, challenges, and opportunities

Brain-Computer Interfaces (BCI) is an exciting and emerging research area for researchers and scientists. It is a suitable combination of software and hardware to operate any device mentally. This review emphasizes the significant stages in the BCI domain, current problems, and state-of-the-art findings. This article also covers how current results can contribute to new knowledge about BCI, an overview of BCI from its early developments to recent advancements, BCI applications, challenges, and future directions. The authors pointed to unresolved issues and expressed how BCI is valuable for analyzing the human brain. Humans' dependence on machines has led humankind into a new future where BCI can play an essential role in improving this modern world.

Modulation effects of low-intensity transcranial ultrasound stimulation on the neuronal firing activity and synaptic plasticity of mice

Low-intensity transcranial ultrasound stimulation (TUS) has been effective in modulating several neurological and psychiatric disorders. However, how TUS modulates neuronal firing activity and synaptic plasticity remains unclear. Thus, we behaviorally tested the whisker-dependent novel object discrimination ability in mice after ultrasound stimulation and examined the cortical neuronal firing activity and synaptic plasticity in awake mice after ultrasound stimulation by two-photon fluorescence imaging. The current study presented the following results: (1) TUS could significantly improve the whisker-dependent new object discrimination ability of mice, suggesting that their learning and memory abilities were significantly enhanced; (2) TUS significantly enhanced neuronal firing activity; and (3) TUS increased the growth rate of dendritic spines in the barrel cortex, but did not promote the extinction of dendritic spines, resulting in enhanced synaptic plasticity. The above results indicate that TUS can improve the learning and memory ability of mice and enhance the neuronal firing activity and synaptic plasticity that are closely related to it. This study provides a research basis for the application of ultrasound stimulation in the treatment of learning- and memory-related diseases.

Grand Theft Auto-Based Cycling Simulator for Cognitive Enhancement Technologies in Dangerous Traffic Situations

While developing traffic-based cognitive enhancement technology (CET), such as bike accident prevention systems, it can be challenging to test and evaluate them properly. After all, the real-world scenario could endanger the subjects' health and safety. Therefore, a simulator is needed, preferably one that is realistic yet low cost. This paper introduces a way to use the video game Grand Theft Auto V (GTA V) and its sophisticated traffic system as a base to create such a simulator, allowing for the safe and realistic testing of dangerous traffic situations involving cyclists, cars, and trucks. The open world of GTA V, which can be explored on foot and via various vehicles, serves as an immersive stand-in for the real world. Custom modification scripts of the game give the researchers control over the experiment scenario and the output data to be evaluated. An off-the-shelf bicycle equipped with three sensors serves as a realistic input device for the subject's movement direction and speed. The simulator was used to test two early-stage CET concepts enabling cyclists to sense dangerous traffic situations, such as trucks approaching from behind the cyclist. Thus, this paper also presents the user evaluation of the cycling simulator and the CET used by the subjects to sense dangerous traffic situations. With the knowledge of the first iteration of the user-centered design (UCD) process, this paper concludes by naming improvements for the cycling simulator and discussing further research directions for CET that enable users to sense dangerous situations better.

The ubiquity of the fallacy of composition in cognitive enhancement and in education

Research into cognitive enhancement is highly controversial, and arguments for and against it have failed to identify the logical fallacy underlying this debate: the fallacy of composition. The fallacy of composition is a lesser-known fallacy of ambiguity, but it has been explored and applied extensively to other fields, including economics. The fallacy of composition, which occurs when the characteristics of the parts of the whole are incorrectly extended to apply to the whole itself, and the conclusion is false, should be addressed in the debate on cognitive enhancement and within education. Within cognitive enhancement, the premise that individual distinct cognitive processes can be enhanced by cognitive enhancers leads to the conclusion that they must enhance cognition overall, and this idea is pervasive in the literature. If the goal of cognitive enhancement is to enhance cognition or learning, and not merely individual cognitive processes, then this is a clear example of the fallacy of composition. The ambiguity of "cognitive," "cognition," and "enhancement" only perpetuates this fallacy and creates more confusion surrounding the purposes and goals of enhancement. Identifying this fallacy does not threaten the existing body of research; however, it provides a novel framework to explore new avenues for research, education, and enhancement, particularly through education reform initiatives. Education enhances and facilitates learning, and improvements to education could be considered cognitive enhancements. Furthermore, the same fallacy is ubiquitous in education; educators commit it by "teaching to the test" and prioritizing memorization over generalizable skills such as critical thinking and problem solving. We will explore these new avenues for research and highlight principles of learning success from other disciplines to create a clearer understanding of the means and ends of cognitive enhancement. Recognizing the pervasiveness of composition fallacy in cognitive enhancement and education will lead to greater clarity of normative positions and insights into student learning that steer away from fallacious reasoning.

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.

On the psycho-emotional deficitisation of workers in the age of cognitive enhancement

Despite being the subject of public and scholarly debates for some time, the topic of cognitive enhancement remains theoretically under-developed in organisation studies. This is because the ‘dots’ still have to be ‘connected’ between macro-level phenomena (here, the therapeutic ethos and cognitive capitalism), and micro-level phenomena (in this case, cognitive abilities). In this essay, we use Fromm’s notion of social character to theorise dialectally about the interaction between these macro and micro-level phenomena. Doing so enables us to examine how the macro/micro interaction fosters to adoption of cognitive enhancement in the context of work, and what kinds of consequences might emerge from this. We propose the psycho-emotional deficitisation of workers as a central consequence of the aforementioned interaction, and define it as an internalised version of external ideals of what it means to be a productive worker under cognitive capitalism, which over time generates and reinforces the affective experience of being deficient. Our theorising around socially patterned defects of a cognitive kind has crucial ramification for our understanding of technology-mediated affective control at work and how human–technology interactions shape the subjectivities of workers towards greater self-inferiorisation vis-à-vis the perceived superiority of technology. We close by foreshadowing avenues for future research.

Neurobiological reduction: From cellular explanations of behavior to interventions

Scientific reductionism, the view that higher level functions can be explained by properties at some lower-level or levels, has been an assumption of nervous system analyses since the acceptance of the neuron doctrine in the late 19th century, and became a dominant experimental approach with the development of intracellular recording techniques in the mid-20th century. Subsequent refinements of electrophysiological approaches and the continual development of molecular and genetic techniques have promoted a focus on molecular and cellular mechanisms in experimental analyses and explanations of sensory, motor, and cognitive functions. Reductionist assumptions have also influenced our views of the etiology and treatment of psychopathologies, and have more recently led to claims that we can, or even should, pharmacologically enhance the normal brain. Reductionism remains an area of active debate in the philosophy of science. In neuroscience and psychology, the debate typically focuses on the mind-brain question and the mechanisms of cognition, and how or if they can be explained in neurobiological terms. However, these debates are affected by the complexity of the phenomena being considered and the difficulty of obtaining the necessary neurobiological detail. We can instead ask whether features identified in neurobiological analyses of simpler aspects in simpler nervous systems support current molecular and cellular approaches to explaining systems or behaviors. While my view is that they do not, this does not invite the opposing view prevalent in dichotomous thinking that molecular and cellular detail is irrelevant and we should focus on computations or representations. We instead need to consider how to address the long-standing dilemma of how a nervous system that ostensibly functions through discrete cell to cell communication can generate population effects across multiple spatial and temporal scales to generate behavior.

Assessment of knowledge, perception, attitude, and use of performance-enhancing substances among students of Faculty of Medicine, Alexandria University, Egypt: a pilot study

Background

The market for performance enhancement substances (PESs) is currently one of the fastest expanding sectors. Most studies have always concentrated on athletes in terms of PESs’ misuse, ignoring a critical segment of the community: the future health-care workers. Thus, the aim of the study was to probe the knowledge, perception, and attitude of medical students regarding the misuse of PESs in sports and medical academic study. A cross-sectional study was conducted among students of Alexandria Faculty of Medicine, Egypt. Data were collected via self-administered electronic survey from 208 students of both sexes (aged from 18 to 26 years old). Analysis of factors affecting the consumption of PESs like gender differences, and their prior knowledge and perception was performed using logistic regression models.

Results

More than half of the participants have no idea about law concerning the use of doping substances. There were no significant disparities in knowledge and perception between males and females. Female students, on the other hand, consistently reported having a better understanding of the negative impacts of PESs’ misuse. Surprisingly, females are more prone to consume PESs for cognitive enhancement rather than the physical performance.

Conclusions

The study is the first to explore the awareness of the medical students, their attitude, and perception towards different ethical scenarios confronted in the daily practice. This finding pinpoints that the common trend of striving for fitness and an ideal body shape and weight has produced a shift in the prevalence of the PESs use according to gender in Egypt. Moreover, females in medicine academics are more prone to use PESs to improve the cognitive functions albeit it is nonsignificant statistically. Therefore, efforts should be directed to raise the awareness of medical practitioners of diverse categories of these substances, health hazards, laws, and penalties. More importantly, policy measures for their production, marketing, and misuse among university students should be reconsidered by the government.

Autonomy, procedural and substantive: a discussion of the ethics of cognitive enhancement

As cognitive enhancement research advances, important ethical questions regarding individual autonomy and freedom are raised. Advocates of cognitive enhancement frequently adopt a procedural approach to autonomy, arguing that enhancers improve an individual's reasoning capabilities, which are quintessential to being an autonomous agent. On the other hand, critics adopt a more nuanced approach by considering matters of authenticity and self-identity, which go beyond the mere assessment of one's reasoning capacities. Both positions, nevertheless, require further philosophical scrutiny. In this paper, we investigate the ethics of cognitive enhancement through the lenses of political and philosophical arguments about autonomy and freedom. In so doing, we contend that a substantive, relational account of individual autonomy offers a more holistic understanding of the ethical concerns of cognitive enhancement.

The Ethics of Supernumerary Robotic Limbs. An Enactivist Approach

Supernumerary robotic limbs are innovative devices in the field of wearable robotics which can provide humans with unprecedented sensorimotor abilities. However, scholars have raised awareness of the ethical issues that would arise from the large adoption of technologies for human augmentation in society. Most negative attitudes towards such technologies seem to rely on an allegedly clear distinction between therapy and enhancement in the use of technological devices. Based on such distinction, people tend to accept technologies when used for therapeutic purposes (e.g., prostheses), but tend to raise issues when similar devices are used for upgrading a physical or cognitive ability (e.g., supernumerary robotics limbs). However, as many scholars have pointed out, the distinction between therapy and enhancement might be theoretically flawed. In this paper, we present an alternative approach to the ethics of supernumerary limbs which is based on two related claims. First, we propose to conceive supernumerary limbs as tools that necessarily modify our psychological and bodily identity. At the same time, we stress that such a modification is not ethically bad in itself; on the contrary, it drives human interaction with the environment. Second, by comparing our view with the extended mind thesis, we claim that the mediation through tools is crucial for the formation of novel meanings and skills that constitute human interaction with the world. We will relate the latter claim to enactivism as a helpful theoretical perspective to frame issues related to artificial limbs and, more in general, to technologies for augmentation. Based on this approach, we finally sketch some suggestions for future directions in the ethics of supernumerary limbs.

On the (Non-)Rationality of Human Enhancement and Transhumanism

The human enhancement debate has over the last few decades been concerned with ethical issues in methods for improving the physical, cognitive, or emotive states of individual people, and of the human species as a whole. Arguments in favour of enhancement defend it as a paradigm of rationality, presenting it as a clear-eyed, logical defence of what we stand to gain from transcending the typical limits of our species. If these arguments are correct, it appears that adults should in principle be able to make rational and informed decisions about enhancing themselves. In this paper, however, we suggest that a rational and informed choice to enhance oneself may in some cases be impossible. Drawing on L. A. Paul's work on 'transformative experience', we argue that some enhancements-such as certain moral or cognitive modifications-may give rise to unbridgeable epistemic gaps in key domains. Importantly, such gaps could prove to be not merely contingently unbridgeable due to a lack of information at a given moment, but radically unbridgeable, making someone in a non-enhanced state inherently unable to conceive of what it would be like to be enhanced in a particular way. Where this experience is key to understanding what values are being pursued by the enhancement itself, it may prove impossible for a person to be sufficiently informed, and to make a rational decision about whether or not to enhance herself. This poses a challenge for human enhancement proponents in general, and for transhumanists in particular.

Mental and Spiritual Health Needs of Cognitively Enhanced People: A Therapeutic and Spiritual Care Model for Responding

Cognitively enhanced people will have mental and possibly spiritual health needs that merit therapeutic and spiritual care response. This article addresses people who, although significantly enhanced, overlap with ordinary or “normal” (i.e., non-enhanced) people such that their status as humans is not questioned. Effective therapeutic and spiritual care approaches for these cognitively enhanced individuals will have a strong cognitive component. Cognitive therapy, originated by Aaron Beck, is an example of a therapeutic model that could prove useful with people cognitively enhanced. Four relevant elements of the cognitive therapy modality are explored: a developed cognitive structure, little consideration to unconscious factors, minimum attention to family of origin, and collaboration. Two psychological challenges with religious dimensions and import, which could be faced by individuals as a consequence of their cognitive enhancements, are concerns about physicality and fitting into community with ordinary humans and other enhanced humans.

Supporting Cognition With Modern Technology: Distributed Cognition Today and in an AI-Enhanced Future

In the present article, we explore prospects for using artificial intelligence (AI) to distribute cognition via cognitive offloading (i.e., to delegate thinking tasks to AI-technologies). Modern technologies for cognitive support are rapidly developing and increasingly popular. Today, many individuals heavily rely on their smartphones or other technical gadgets to support their daily life but also their learning and work. For instance, smartphones are used to track and analyze changes in the environment, and to store and continually update relevant information. Thus, individuals can offload (i.e., externalize) information to their smartphones and refresh their knowledge by accessing it. This implies that using modern technologies such as AI empowers users via offloading and enables them to function as always-updated knowledge professionals, so that they can deploy their insights strategically instead of relying on outdated and memorized facts. This AI-supported offloading of cognitive processes also saves individuals' internal cognitive resources by distributing the task demands into their environment. In this article, we provide (1) an overview of empirical findings on cognitive offloading and (2) an outlook on how individuals' offloading behavior might change in an AI-enhanced future. More specifically, we first discuss determinants of offloading such as the design of technical tools and links to metacognition. Furthermore, we discuss benefits and risks of cognitive offloading. While offloading improves immediate task performance, it might also be a threat for users' cognitive abilities. Following this, we provide a perspective on whether individuals will make heavier use of AI-technologies for offloading in the future and how this might affect their cognition. On one hand, individuals might heavily rely on easily accessible AI-technologies which in return might diminish their internal cognition/learning. On the other hand, individuals might aim at enhancing their cognition so that they can keep up with AI-technologies and will not be replaced by them. Finally, we present own data and findings from the literature on the assumption that individuals' personality is a predictor of trust in AI. Trust in modern AI-technologies might be a strong determinant for wider appropriation and dependence on these technologies to distribute cognition and should thus be considered in an AI-enhanced future.

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.

The Benefits of Video Games on Brain Cognitive Function: A Systematic Review of Functional Magnetic Resonance Imaging Studies

Benefits of video games on cognitive function have been proved by increasing evidence. However, reasons for game-induced changes in cognitive function are still elusive. Therefore, this study conducted a systematic review of brain function activation changes in association with video games. We retrieved publications from three electronic databases (PubMed, Web of Science, and PsycInfo), with publication dates before 8 February 2021. After screening the study with fMRI data, 13 studies were included in this work, including 9 cross-sectional studies and 4 types of research. In this review, we summarized the potential benefits of video games on cognitive function and discussed the effects of different types of video games on cognitive function. In particular, we highlighted the effect of video games on attention ability and visuospatial ability and addressed the functional brain activation changes in frontal and parietal lobes and other related brain regions induced by games. Finally, we pointed out that when discussing the effect of video games on brain function, types of video games should be carefully categorized.

Trust and Psychedelic Moral Enhancement

Moral enhancement proposals struggle to be both plausible and ethically defensible while nevertheless interestingly distinct from both cognitive enhancement as well as (mere) moral education. Brian Earp (Royal Institute of Philosophy Supplement 83:415–439, 12) suggests that a promising middle ground lies in focusing on the (suitably qualified) use of psychedelics as adjuncts to moral development. But what would such an adjunctive use of psychedelics look like in practice? In this paper, I draw on literature from three areas where techniques for moral development have been discussed: psychotherapy (e.g., Overholser 2010; Burns 1980) education (e.g., Uhl and Lütge, 2018), and AI-assisted enhancement (e.g., Lara and Deckers, Neuroethics 13(3):275–287, 17) in order to propose more concrete ways in which to use psychedelics as adjuncts to moral development. It is shown that in each of these areas, we can see that trusting relationships (e.g., Baier 1986; Hawley 2019) between the facilitator and the agent will very plausibly maximize the success of this type of moral enhancement. Finally, I appeal to literature on informed consent for use of psychedelics (e.g., Smith and Sisti, Journal of Medical Ethics, 22; Johnson et al., The Journal of Psychopharmacology 22(6):603–20, 23) and on the therapeutic relationship in psychotherapy (e.g., Dryden and Reeves 2013; Horvath et al. 2011) to outline concrete suggestions for facilitating dimensions of trust most likely to maximize the benefits of (adjunctive) psychedelic moral enhancement. The result is a newly detailed practical proposal for how we might best facilitate moral enhancement by using drugs as adjuncts to moral development

Super-Men and Wonder-Women: the Relationship Between the Acceptance of Self-enhancement, Personality, and Values

Due to ongoing technological innovations, self-enhancement methods are publicly discussed, researched from different perspectives, and part of ethical debates. However, only few studies investigated the acceptance of these methods and its relationship with personality traits and values. The present study investigated to what extent people accept different enhancement methods and whether acceptance can be predicted by Big Five and Dark Triad traits, vulnerable narcissism, and values. In an online survey (N = 450), we measured personality traits and values. Additionally, participants read scenarios about enhancement methods and answered questions about their acceptance of these scenarios. Factor analysis indicated a general factor of acceptance across scenarios. Correlation analyses showed that high agreeableness, agreeableness-compassion, conscientiousness, conscientiousness-industriousness, and conservation- and self-transcendence values are related to less acceptance of self-enhancement. Moreover, individuals high on Dark Triad traits, vulnerable narcissism, and self-enhancement values exhibit more acceptance. Hierarchical regression analysis revealed that said values and Big Five traits explained unique variance in the acceptance of self-enhancement. These findings highlight the importance of considering personality and values when investigating self-enhancement—a topic that is receiving increasing attention by the public, politicians, and scientists.

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.

CRISPR immunity: a case study for justified somatic genetic modification?

The current SARS-CoV-2 pandemic has killed thousands across the world. SARS-CoV-2 is the latest but surely not the last such global pandemic we will face. The biomedical response to such pandemics includes treatment, vaccination, and so on. In this paper, though, we argue that it is time to consider an additional strategy: the somatic (non-heritable) enhancement of human immunity. We argue for this approach and consider bioethics objections we believe can be overcome.

Assessing prevalence, knowledge and use of cognitive enhancers among university students in the United Arab Emirates: A quantitative study

BACKGROUND

Cognitive enhancers (CE) are often used to improve memory, alertness and cognitive capacity. These products are commercially and pharmaceutically available. Due to high academic pressure, university students are at risk of CE misuse. However, data regarding this issue are limited, especially in the United Arab Emirates (UAE).

AIMS

To assess the prevalence of CE intake; evaluate students' knowledge of these substances; and identify student characteristics associated with CE usage.

METHOD

A cross sectional study based on a validated online survey that was distributed using university-licensed software (Qualtrics) as a direct web link via email and social media to all Medical, Pharmacy, Dentistry, Nursing and Engineering students enrolled in six UAE universities. Associations between student characteristics and CE use were investigated using the chi-squared test and multiple logistic regression. Reasons for CE use, temporal patterns of use, details regarding purchase and types of CE used were compared by gender.

RESULTS

One quarter of students had used CEs. There was a clear difference between users and non-users in terms of gender (p<0.001). CE users were disproportionately represented by students from either UAE or other Arab countries (p<0.001), and by students of Medicine, followed by Pharmacy, Dentistry, and Engineering (p<0.001). CE use increased with year of study, reaching the highest level in the fourth year (p<0.001), which for most programmes is the final year. Modafinil was self-administered, especially in males, for concentration and alertness; B12 was typically taken by female students for academic performance and concentration; and high-dosage caffeine compounds were ingested to improve alertness levels. Use of the internet for both obtaining information and purchasing CEs was frequently reported. Multiple logistic regression analysis showed that gender, nationality, and year of study were associated with CE use among UAE university students.

CONCLUSIONS

Universities need to address the prevalence of CE use amongst their students by providing effective support programs.

The case for biotechnological exceptionalism

Do biomedical interventions raise special moral concerns? A rising number of prominent authors claim that at least in the case of biomedical enhancement they do not. Treating biomedical enhancements different from non-biomedical ones, they claim, amounts to unjustified biomedical exceptionalism. This article vindicates the familiar thesis that biomedical enhancement raises specific concerns. Taking a close look at the argumentative strategy against biomedical exceptionalism and provides counterexamples showing that the biomedical mode of interventions raises concerns not relevant otherwise. In particular, biomedical interventions throughout raise concerns of informed consent, which only rarely turn up in comparable non-biomedical interventions.

What do people think about technological enhancements of human beings? An introductory study using the Technological Enhancements Questionnaire in the context of values, the scientistic worldview, and the accepted versions of humanism

BACKGROUND

Rapid development of technologies increases the possibility of technological enhancements of human beings, e.g., in their cognitive skills or physical fitness. Attitudes towards such enhancements may result in their social acceptance or rejection.

PARTICIPANTS AND PROCEDURE

One hundred and thirty-nine young Polish adults participated in the study. Participants completed the designed Technological Enhancements Questionnaire (TEQ) and questionnaires to measure values, the scientistic worldview, and the accepted versions of humanism.

RESULTS

The study showed a one-dimensional TEQ structure and its satisfactory reliability. Attitudes towards technological enhancements correlated positively with achievement, self-direction in thought, power over resources, the scientistic worldview, and the evolutionary version of humanism. They also correlated negatively with tradition and the liberal version of humanism.

CONCLUSIONS

The TEQ questionnaire is a short, reliable tool to measure attitudes towards technological enhancements. This preliminary study provided some significant results, but future work to validate the questionnaire is needed.

Pharmacological Cognitive Enhancement and Cheapened Achievement: A New Dilemma

Recent discussions of cognitive enhancement often note that drugs and technologies that improve cognitive performance may do so at the risk of “cheapening” our resulting cognitive achievements (e.g., Kass, Life, liberty and the defense of dignity: the challenge for bioethics, Encounter Books, San Francisco, 2004; Agar, Humanity’s end: why we should reject radical enhancement, MIT Press, Cambridge, 2010; Sandel, The case against perfection. Harvard University Press, Cambridge, 2007; Sandel, The case against perfection: what’s wrong with designer children, bionic athletes, and genetic engineering?”. In: Holland (ed) Arguing about bioethics, Routledge, London, 2012; Harris in Bioethics 25:102–111, 2011). While there are several possible responses to this worry, we will highlight what we take to be one of the most promising—one which draws on a recent strand of thinking in social and virtue epistemology to construct an integrationist defence of cognitive enhancement. (e.g., Pritchard in Synthese 175:133–151, 2010; Palermos in Synthese 192:2955–2286, 2015; Clark in Synthese 192:3757–3375, 2015). According to such a line, there is—despite initial appearances to the contrary—no genuine tension between using enhancements to attain our goals and achieving these goals in a valuable way provided the relevant enhancement is appropriately integrated into the agent’s cognitive architecture (in some suitably specified way). In this paper, however, we show that the kind of integration recommended by such views will likely come at a high cost. More specifically, we highlight a dilemma for users of pharmacological cognitive enhancement: they can (1) meet the conditions for cognitive integration (and on this basis attain valuable achievements) at the significant risk of dangerous dependency, or (2) remain free of such dependency while foregoing integration and the valuable achievements that such integration enables. After motivating and clarifying the import of this dilemma, we offer recommendations for how future cognitive enhancement research may offer potential routes for navigating past it.

Reprint of: Pharmacosex: Reimagining sex, drugs and enhancement

BACKGROUND

The use of drugs in sexual contexts is receiving closer attention in the media, public health bodies and communities than ever before. However, research to date is most often concerned with the sex-related drug use of lesbian, gay, bisexual, transgender and queer (LGBTQ) populations, and particularly men who have sex with men (MSM) engaging in 'chemsex'. Against a backdrop dominated by public health and medical science perspectives, this article seeks to move beyond prevailing sex on drug discourses characterised by risk and harm, or pleasure. Drawing on an expansive notion of enhancement, we explore intersections between drug consumption and sex via the concept of 'pharmacosex': the ways in which wider populations experiment with a range of illicit drugs that modify and enhance their sex lives in the context of broader processes of the pharmaceuticalisation of sexuality.

METHODS

Drawing on two empirical studies comprising a virtual ethnography and 45 interviews with participants across a range of gender and sexual identities who regularly combine sex and drugs, this article contributes to the growing body of research that attends to the materiality of drug consumption practices in relation to the historical and social contexts from which they emerge.

RESULTS

Our participants reported variegated and complex modes of enhancement in relation to a wide range of psychoactive substances. Participants described enhanced emotional connectedness, bodily sensations, disinhibition and desire, but they also discussed how sex enhances drug experiences. As important but currently neglected in research literature were the therapeutic dimensions of drug-taking reported, which cannot be neatly distinguished from purely hedonic motivations. While enhancement was also experienced by participants in more challenging ways in relation to shame, regret, risk and/or harm, these experiences simultaneously afforded space for the emergence of innovative practices of risk-management, safety and care.

CONCLUSION

This study exposes the diversity of practices and meanings sex-related drug use hold for participants, but also demonstrates the paucity of biomedical conceptions of sexual enhancement limited to stamina, function and libido, and the need for a more expansive approach. The study also raises questions about the extent to which contemporary discourses of self-improvement have come to 'inhabit' sexuality in the twenty-first century, and the role drugs might play in this context. By shifting the gaze from pathology to enhancement and exploring the plurality of practice, we can better understand the motivations for engaging in sex-related drug use, thereby circumventing knee-jerk counterproductive enforcement and policy responses.

‘Beyond’ Human Enhancement — Taking the Developing Country’s Perspective Seriously

Bioethicists and philosophers dominate the on-going debate on human enhancement. They have debated the definition of human enhancement as well as the potential impacts of human enhancement technologies (such as pharmaceutical enhancements or pre-natal selection). These discussions have percolated, through bioethics bodies and bioethics recommendations, policy makers and have eventually been translated into policy. While some suggestions have been based largely in Western liberal democracies, others have deliberated the geopolitical consequences of human enhancement technologies. This paper argues that the present debate currently lacks perspectives from developing countries. It begins by introducing the current debate on human enhancement and recognizes Allen Buchanan’s well-raised concerns on how these technologies may potentially cause new injustices for low- and middle-income countries (‘developing countries’). It then provides two arguments calling for further research into human enhancement from the perspective of developing countries. First, this paper will argue that the current frames with which enhancement technologies are viewed are inherently neoliberal and require change. The second argument shows how the potential impacts of human enhancement technologies in developing countries have not been fully realized by analyzing how human enhancement technologies will impact Thailand, a developing country.

Attitudes of medicine, pharmacy, and dentistry students about psychostimulant use to enhance cognition

INTRODUCTION

The use of psychostimulant drugs to increase academic success is common among young people. There is no study examining this issue in Turkish population. In this study, the prevalence, attitudes, knowledge, and ethical evaluations of Pharmacological Cognitive Enhancement (PCE) in university students were investigated.

METHOD

A structured online survey was carried out with 1148 undergraduate and postgraduate (master, PhD and residency) students in different faculties of Medicine, Dentistry and Pharmacy in Turkey. Comparisons between groups, correlation and regression analysis about associated variables were made.

RESULTS

The general prevalence of PCE in our study was found to be 7.4%. The highest prevalence was seen in the faculty of medicine (8.4%), among the residency students (15.5%). There was no significant difference prevalence of PCE between the faculties. Education level, smoking, study performance satisfaction, and knowledge level were found to be factors associated with PCE. Around 40% of PCE users stated that they used it with the recommendation of their friends. PCE users had a lower perception of harm and risk, and rated the use of it as more acceptable and normal behaviour.

CONCLUSION

PCE is a method used by young with high knowledge, low study performance satisfaction, to increase their academic success, especially during exam periods. Peer effect is an important factor in increasing prevalence.

Toward Predicting Human Performance Outcomes From Wearable Technologies: A Computational Modeling Approach

Wearable technologies for measuring digital and chemical physiology are pervading the consumer market and hold potential to reliably classify states of relevance to human performance including stress, sleep deprivation, and physical exertion. The ability to efficiently and accurately classify physiological states based on wearable devices is improving. However, the inherent variability of human behavior within and across individuals makes it challenging to predict how identified states influence human performance outcomes of relevance to military operations and other high-stakes domains. We describe a computational modeling approach to address this challenge, seeking to translate user states obtained from a variety of sources including wearable devices into relevant and actionable insights across the cognitive and physical domains. Three status predictors were considered: stress level, sleep status, and extent of physical exertion; these independent variables were used to predict three human performance outcomes: reaction time, executive function, and perceptuo-motor control. The approach provides a complete, conditional probabilistic model of the performance variables given the status predictors. Construction of the model leverages diverse raw data sources to estimate marginal probability density functions for each of six independent and dependent variables of interest using parametric modeling and maximum likelihood estimation. The joint distributions among variables were optimized using an adaptive LASSO approach based on the strength and directionality of conditional relationships (effect sizes) derived from meta-analyses of extant research. The model optimization process converged on solutions that maintain the integrity of the original marginal distributions and the directionality and robustness of conditional relationships. The modeling framework described provides a flexible and extensible solution for human performance prediction, affording efficient expansion with additional independent and dependent variables of interest, ingestion of new raw data, and extension to two- and three-way interactions among independent variables. Continuing work includes model expansion to multiple independent and dependent variables, real-time model stimulation by wearable devices, individualized and small-group prediction, and laboratory and field validation.

Doctor, please make me freer: Capabilities enhancement as a goal of medicine

Biomedical innovations are making possible the enhancement of human capabilities. There are two philosophical stances on the role that medicine should play in this respect. On the one hand, naturalism rejects every medical intervention that goes beyond preventing and treating disease. On the other hand, welfarism advocates enhancements that foster subjective well-being. We will show that both positions have considerable shortcomings. Consequently, we will introduce a third characterization in which therapies and enhancements can be reconciled with the legitimate objectives of medicine inasmuch as they improve the capabilities that enable the freedom to pursue personal well-being.

Biases for Evil and Moral Perfection

I argue that deeply ingrained dispositions to do evil do not render moral perfection impossible. I discuss various accounts of moral perfection and the evidence from cognitive (neuro)science that points towards a strong disposition for evil. Afterwards, I discuss three strategies that can allow humans to overcome their evil dispositions. These are: cognitive enhancement, avoiding triggering situations and structural solutions.

Cognitive interventions in children and adolescents from low socioeconomic status backgrounds: a systematic review protocol of randomized controlled trials

BACKGROUND

Many studies have evaluated the effects that a lack of resources has in children's physical and cognitive development. Although there are reviews that have focused on applied interventions from different perspectives, there is still a need for a comprehensive review of what has been attempted with these children from the cognitive intervention field. The aim of this paper is to present a protocol for a systematic review collecting randomized controlled trials (RCTs) studies whose purpose was to enhance cognitive development through the implementation of cognitive interventions in children and adolescents (< 18 years old) from low socioeconomic Status (SES) settings.

METHODS

The following databases will be searched: Web of Science (WoS core collection), PsycINFO, Cochrane Central Register of Controlled Trial, ERIC, PubMed, ICTRP and Opengrey Register (System for Information of Grey Literature in Europe). Searches will be adapted for each database. Additionally, the reference list of articles included in the review will also be searched. As part of this process, two reviewers will determine, independently, the suitability of each article taking into account predefined inclusion/exclusion criteria. Pertinent data will then be extracted, including sample characteristics, specifics of the intervention, and outcomes, as well as follow-up measures. Internal validity will be assessed using the Cochrane Risk of Bias Tool. A quantitative synthesis of results will be conducted using a meta-analysis. However, if a meta-analysis is difficult to implement due to the diversity of the studies (for example, in terms of measures used to estimate the effect size, intervention types, outcomes, etc.), the technique synthesis without meta-analysis (SWiM) will be used. A description of outcome measures will be provided, as measured by validated neuropsychological instruments of any cognitive function.

DISCUSSION

The systematic review will offer a framework based on evidence to organisations, institutions, and experts who want to implement or promote interventions aimed at enhancing cognitive domains in children and adolescents who live in disadvantaged contexts.

SYSTEMATIC REVIEW REGISTRATION

This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 16 March 2020 (registration number: CDR42020150238).

Social Justice Theories as the Basis for Public Policy on Psychopharmacological Cognitive Enhancement

Psychopharmacological cognitive enhancements could lead to a higher quality of life of healthy individuals with lower cognitive capacities, but the current regulatory framework does not seem to enable access to this group. This article discusses why Sen’s Capability Approach could open up such access, while two other modern social justice theories – utilitarianism and Rawls’ Justice as Fairness – could not. In short, the utilitarian approach is proven to be inadequate, due to practical reasons and having a low chance of real-world success. Rawls’ Justice as Fairness seems to be problematic because of conflicting stances that follow from his First Principle of Justice. The Capability Approach has the greatest chance of success in the context of these substances, because of arguments that can be identified under the banners of agency/self-respect and the way the public views those who take the capability path out of their poor situation. The article also discusses general and practical problems with psychopharmacological cognitive enhancement that should be addressed when writing new policy on this topic.

Recommendations for Responsible Development and Application of Neurotechnologies

Advancements in novel neurotechnologies, such as brain computer interfaces (BCI) and neuromodulatory devices such as deep brain stimulators (DBS), will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these challenges and make recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies. We explore potential ethical challenges in four key areas: identity and agency, privacy, bias, and enhancement. To address them, we propose (1) democratic and inclusive summits to establish globally-coordinated ethical and societal guidelines for neurotechnology development and application, (2) new measures, including “Neurorights,” for data privacy, security, and consent to empower neurotechnology users’ control over their data, (3) new methods of identifying and preventing bias, and (4) the adoption of public guidelines for safe and equitable distribution of neurotechnological devices.

Viability of tDCS in Military Environments for Performance Enhancement: A Systematic Review

INTRODUCTION

Transcranial electrical stimulation (tES) as a method of cognitive enhancement in both diseased and healthy individuals has gained popularity. Its potential for enhancing cognition in healthy individuals has gained the interest of the military. However, before it being implemented into military training or operational settings, further work is needed to determine its efficacy and safety. Although a considerable amount of literature exists, few studies have specifically evaluated its use in enhancing cognition relative to operational, military tasks. Therefore, in a first step to evaluate its efficacy, we completed a systematic literature review of studies using transcranial direct current stimulation (tDCS), a type of tES, to enhance cognitive processes in healthy individuals.

METHODS

A systematic literature review was conducted to identify literature published between 2008 and 2018 that used a method of tES for cognitive enhancement. As part of a larger literature review effort, 282 articles were initially retrieved. These were then screened to identify articles meeting predetermined criteria, to include those using various methods of tES, resulting in 44 articles. Next, the articles were screened for those using tDCS or high-definition tDCS, resulting in 34 articles for review and information extraction.

RESULTS

Of the 34 articles reviewed, 28 reported some degree of enhancement (eg, improved accuracy on tasks and reduced reaction times). Areas of cognitive enhancements included executive functioning, creativity/cognitive flexibility, attention/perception, decision-making, memory, and working memory. However, the precise outcomes of enhancement varied given the range in tasks that were used to assess the constructs. Additionally, the stimulation parameters in terms of intensity applied, duration of stimulation, and brain region targeted for stimulation varied.

CONCLUSIONS

The conclusions to be drawn from this systematic literature review include the identification of a brain region for targeting with stimulation to enhance a broad range of cognitive constructs applicable to military tasks, as well as stimulation parameters for duration and intensity. The dorsolateral prefrontal cortex was most frequently targeted in the studies that found enhanced performance across several cognitive constructs. Stimulation intensities of 2 mA and durations of 20 minutes or longer appeared frequently as well. Although several parameters were identified, further work is required before this type of technology can be recommended for operational use.

Ethics of Early Intervention in Alzheimer's Disease

Alzheimer's disease (AD) research, treatment, and prevention focus increasingly on developing personalized interventions based on personal genetic, biological, phenotypic data, for early intervention (EI) to limit harm. This approach has much to recommend it, but important ethical and philosophical challenges follow that should be considered, which we analyze here. We argue that advancing understanding of the causes of AD undermines the clarity of the distinction between primary and secondary prevention. This makes it increasingly unclear how primary and secondary categories can be appealed to as the basis for making judgements about what interventions are permissible, and for distinguishing between acceptably vs unacceptably early points in life to intervene. Timely efforts at prevention are vital for limiting harm from AD and given the logic of EI is that, in presence of risk, earlier is better, one might assume that earliest is best. This may or may not be the case; however, the permissibility of intervening in different ways at different stages of life is complex and turns on numerous contextual factors. We consider the particular ethical implications of intervening at different points in the life course, presenting a valuable resource for negotiating clinical and policy implications of EI in AD.

Cognitive Enhancement: Unanswered Questions About Human Psychology and Social Behavior

Stimulant drugs, transcranial magnetic stimulation, brain-computer interfaces, and even genetic modifications are all discussed as forms of potential cognitive enhancement. Cognitive enhancement can be conceived as a benefit-seeking strategy used by healthy individuals to enhance cognitive abilities such as learning, memory, attention, or vigilance. This phenomenon is hotly debated in the public, professional, and scientific literature. Many of the statements favoring cognitive enhancement (e.g., related to greater productivity and autonomy) or opposing it (e.g., related to health-risks and social expectations) rely on claims about human welfare and human flourishing. But with real-world evidence from the social and psychological sciences often missing to support (or invalidate) these claims, the debate about cognitive enhancement is stalled. In this paper, we describe a set of crucial debated questions about psychological and social aspects of cognitive enhancement (e.g., intrinsic motivation, well-being) and explain why they are of fundamental importance to address in the cognitive enhancement debate and in future research. We propose studies targeting social and psychological outcomes associated with cognitive enhancers (e.g., stigmatization, burnout, mental well-being, work motivation). We also voice a call for scientific evidence, inclusive of but not limited to biological health outcomes, to thoroughly assess the impact of enhancement. This evidence is needed to engage in empirically informed policymaking, as well as to promote the mental and physical health of users and non-users of enhancement.

The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

INTRODUCTION

Cognitive enhancers (CEs), also known as "smart drugs", "study aids" or "nootropics" are a cause of concern. Recent research studies investigated the use of CEs being taken as study aids by university students. This manuscript provides an overview of popular CEs, focusing on a range of drugs/substances (e.g., prescription CEs including amphetamine salt mixtures, methylphenidate, modafinil and piracetam; and non-prescription CEs including caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine) that have emerged as being misused. The diverted non-prescription use of these molecules and the related potential for dependence and/or addiction is being reported. It has been demonstrated that healthy students (i.e., those without any diagnosed mental disorders) are increasingly using drugs such as methylphenidate, a mixture of dextroamphetamine/amphetamine, and modafinil, for the purpose of increasing their alertness, concentration or memory.

AIM

To investigate the level of knowledge, perception and impact of the use of a range of CEs within Higher Education Institutions.

METHODOLOGY

A systematic review was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Whilst 1400 studies were identified within this study through a variety of electronic databases (e.g., 520 through PubMed, 490 through Science Direct and 390 through Scopus), 48 papers were deemed relevant and were included in this review.

RESULTS

The most popular molecules identified here included the stimulant CEs, e.g., methylphenidate, modafinil, amphetamine salt mixtures and caffeine-related compounds; stimulant CEs' intake was more prevalent among males than females; drugs were largely obtained from friends and family, as well as via the Internet. It is therefore suggested that CEs are increasingly being used among healthy individuals, mainly students without any diagnosed cognitive disorders, to increase their alertness, concentration, or memory, in the belief that these CEs will improve their performance during examinations or when studying. The impact of stimulant CEs may include tolerance, dependence and/or somatic (e.g., cardiovascular; neurological) complications.

DISCUSSION

The availability of CEs for non-medical indications in different countries is influenced by a range of factors including legal, social and ethical factors. Considering the risk factors and motivations that encourage university students to use CE drugs, it is essential to raise awareness about CE-related harms, counteract myths regarding "safe" CE use and address cognitive enhancement in an early stage during education as a preventative public health measure.