Cognitive Enhancement

Neurofeedback (NFB) involves a brain-computer interface that allows users to learn to voluntarily control their cortical oscillations, reflected in the electroencephalogram (EEG). Although NFB is being pioneered as a noninvasive tool for treating brain disorders, there is insufficient evidence on the mechanism of its impact on brain function. Furthermore, the dominant rhythm of the human brain is the alpha oscillation (8-12 Hz), yet its behavioral significance remains multifaceted and largely correlative. In this study with 34 healthy participants, we examined whether during the performance of an attentional task, the functional connectivity of distinct fMRI networks would be plastically altered after a 30-min session of voluntary reduction of alpha rhythm (n=17) versus a sham-feedback condition (n=17). We reveal that compared to sham-feedback, NFB induced an increase of connectivity within regions of the salience network involved in intrinsic alertness (dorsal anterior cingulate), which was detectable 30 min after termination of training. The increase in salience network (default-mode network) connectivity was negatively (positively) correlated with changes in 'on task' mind-wandering as well as resting state alpha rhythm. Crucially, we observed a causal dependence between alpha rhythm synchronization during NFB and its subsequent change at resting state, not exhibited by the SHAM group. Our findings provide neurobehavioral evidence for the brain's exquisite functional plasticity, and for a temporally direct impact of NFB on a key cognitive control network, suggesting a promising basis for its use to treat cognitive disorders under physiological conditions.

One of the most noticeable trends in recent years has been the increasing reliance of public decision-making processes (bureaucratic, legislative and legal) on algorithms, i.e. computer programmed step-by-step instructions for taking a given set of inputs and producing an output. The question raised by this article is whether the rise of such algorithmic governance creates problems for the moral or political legitimacy of our public decision-making processes. Ignoring common concerns with data protection and privacy, it is argued that algorithm-driven decision-making does pose a significant threat to the legitimacy of such processes. Modeling my argument on Estlund’s threat of epistocracy, I call this the ‘threat of algocracy’. The article clarifies the nature of this threat, and addresses two possible solutions (named, respectively, “resistance” and “accommodation”). It is argued that neither solution is likely to be successful, at least not without risking many other things we value about social decision-making. The result is a somewhat pessimistic conclusion in which we confront the possibility that we are creating decision-making processes that constrain and limit opportunities for human participation.

In addition to causing distress and disability to the individual, neuropsychiatric disorders are also extremely expensive to society and governments. These disorders are both common and debilitating and impact on cognition, functionality and wellbeing. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used to treat cognitive dysfunction in Alzheimer's disease and attention deficit hyperactivity disorder, respectively. Other cognitive enhancers include specific computerized cognitive training and devices. An example of a novel form of cognitive enhancement using the technological advancement of a game on an iPad that also acts to increase motivation is presented. Cognitive enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects ‘cold’ cognition, but also improves ‘hot’ cognition, such as emotion recognition and task-related motivation. The lifestyle use of ‘smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups (e.g. military, doctors) under what conditions (e.g. war, shift work) and by what methods we would wish to improve and flourish.

Background: Neuroenhancement is the use of substances by healthy subjects to enhance mood or cognitive function. The
prevalence of neuroenhancement among Swiss university students is unknown. Investigating the prevalence of
neuroenhancement among students is important to monitor problematic use and evaluate the necessity of prevention
programs.
Study aim: To describe the prevalence of the use of prescription medications and drugs of abuse for neuroenhancement
among Swiss university students.
Method: In this cross-sectional study, students at the University of Zurich, University of Basel, and Swiss Federal Institute of
Technology Zurich were invited via e-mail to participate in an online survey.
Results: A total of 28,118 students were contacted, and 6,275 students completed the survey. Across all of the institutions,
13.8% of the respondents indicated that they had used prescription drugs (7.6%) or drugs of abuse including alcohol (7.8%)
at least once specifically for neuroenhancement. The most frequently used prescription drugs for neuroenhancement were
methylphenidate (4.1%), sedatives (2.7%), and beta-blockers (1.2%). Alcohol was used for this purpose by 5.6% of the
participants, followed by cannabis (2.5%), amphetamines (0.4%), and cocaine (0.2%). Arguments for neuroenhancement
included increased learning (66.2%), relaxation or sleep improvement (51.2%), reduced nervousness (39.1%), coping with
performance pressure (34.9%), increased performance (32.2%), and experimentation (20%). Neuroenhancement was
significantly more prevalent among more senior students, students who reported higher levels of stress, and students who
had previously used illicit drugs. Although ‘‘soft enhancers’’, including coffee, energy drinks, vitamins, and tonics, were used
daily in the month prior to an exam, prescription drugs or drugs of abuse were used much less frequently.
Conclusions: A significant proportion of Swiss university students across most academic disciplines reported
neuroenhancement with prescription drugs and drugs of abuse. However, these substances are rarely used on a daily
basis and more sporadically used prior to exams.

We review work on the effectiveness of different forms of cognitive enhancement, both pharmacological and non-pharmacological. We consider caffeine, methylphenidate, and modafinil for pharmacological cognitive enhancement (PCE) and computer training, physical exercise, and sleep for non-pharmacological cognitive enhancement (NPCE). We find that all of the techniques described can produce significant beneficial effects on cognitive performance. However, effect sizes are moderate, and consistently dependent on individual and situational factors as well as the cognitive domain in question. Although meta-analyses allowing a quantitative comparison of effectiveness across techniques are lacking to date, we can conclude that PCE is not more effective than NPCE. We discuss the physiological reasons for this limited effectiveness. We then propose that even though their actual effectiveness seems similar, in the general public PCE is perceived as fundamentally different from NPCE, in terms of effectiveness, but also in terms of acceptability. We illustrate the potential consequences such a misperception of PCE can have.

Use of ‘smart drugs’ among UK students is described in frequent media reports as a rapidly increasing phenomenon. This article reports findings from the first large-scale survey of pharmacological cognitive enhancement (PCE) among students in the UK and Ireland. Conducted from February to September 2012, a survey of a convenience sample of 877 students measured PCE prevalence, attitudes, sources, purposes and ethics. Descriptive and logistic regression statistical methods were used to analyse the data. Lifetime prevalence of PCE using modafinil, methylphenidate or Adderall was under 10%, while past regular and current PCE users of these substances made up between 0.3%–4% of the survey population. A substantial majority of students was unaware of and/or uninterested in PCE; however about one third of students were interested in PCE. PCE users were more likely to be male, British and older students; predictors of PCE use included awareness of other students using PCEs, ADHD symptomatology, ethical concerns, and alcohol and cannabis use. The survey addresses the need for better evidence about PCE prevalence and practices among university students in the UK. We recommend PCE-related strategies for universities based on the survey findings.

The debate about the desirability of using drugs to enhance human skills encompasses cognitive abilities such as memory and attention, and moral capacities such as emotional empathy and a sense of fairness. These two strands of literature in bioethics have grown relatively independent from each other, and an implicit framing assumption has emerged suggesting that apparently ‘value-free’ cognitive capacities and paradigmatically moral capacities are distinct and vary independently of each other. Here we identify key distinctions between competing accounts of cognitive enhancement and moral enhancement and argue that, despite the polarised nature of the bioethical debate, cognitive and moral capacities are intertwined. For example, moral behaviour can be improved by enhancing so-called ‘value-free’ abilities such as attention span; and cognitive skills can be honed by means of socio-moral interaction. Further, cognitive skill is frequently assigned the abstract status of virtue and treated in the same way as more paradigmatically ‘moral’ traits. We argue that the distinction between moral and cognitive enhancement is more apparent than real, since despite being nominally treated as distinct, cognitive and moral skills overlap significantly and are frequently interdependent. As such we present evidence to support the claim that the enhancement of these two kinds of capacities cannot be clearly disaggregated from each other in the way that the theoretical poles of the debate in the literature
suggest. We synthesise relevant scientific and bioethical literature and combine it with a line of analysis derived from Peter Hacker and others to show how a linguistically-informed approach can show us more clearly the terms of what can be said
intelligibly about cognitive and moral skills and their enhancement. As a result of this analysis we conclude that ethical questions in human bioenhancement should be considered in terms of flourishing at the level of the whole person imbued with feelings, thoughts, intentions and abilities and embedded within a particular social context, rather than the pharmacological modulation of particular cognitive or affective capacities which, though conceptually discrete, in the embodied context of moral agency are profoundly intertwined.

Evidence from cognitive neuroscience suggests that learning counterintuitive concepts in mathematics and science requires inhibitory control (IC). This prevents interference from misleading perceptual cues and naïve theories children have built from their experiences of the world. Here, we (1) investigate associations between IC, counterintuitive reasoning, and academic achievement and (2) evaluate a classroom-based computerised intervention, called Stop & Think, designed to embed IC training within the learning domain (i.e. mathematics and science content from the school curricula). Cross-sectional analyses of data from 627 children in Years 3 and 5 (7- to 10-year-olds) demonstrated that IC, measured on a Stroop-like task, was associated with counterintuitive reasoning and mathematics and science achievement. A subsample (n = 456) participated either in Stop & Think as a whole-class activity (teacher-led, STT) or using individual computers (pupil-led, STP), or had teaching as usual...

Psychostimulants are highly effective in the treatment of attention-deficit/hyperactivity disorder. The clinical efficacy of these drugs is strongly linked to their ability to improve cognition dependent on the prefrontal cortex (PFC) and extended frontostriatal circuit. The procognitive actions of psychostimulants are only associated with low doses. Surprisingly, despite nearly 80 years of clinical use, the neurobiology of the procognitive actions of psychostimulants has only recently been systematically investigated. Findings from this research unambiguously demonstrate that the cognition-enhancing effects of psychostimulants involve the preferential elevation of catecholamines in the PFC and the subsequent activation of norepinephrine α2 and dopamine D1 receptors. In contrast, while the striatum is a critical participant in PFC-dependent cognition, where examined, psychostimulant action within the striatum is not sufficient to enhance cognition. At doses that moderately exceed the clinical range, psychostimulants appear to improve PFC-dependent attentional processes at the expense of other PFC-dependent processes (e.g., working memory, response inhibition). This differential modulation of PFC-dependent processes across dose appears to be associated with the differential involvement of noradrenergic α2 versus α1 receptors. Collectively, this evidence indicates that at low, clinically relevant doses, psychostimulants are devoid of the behavioral and neurochemical actions that define this class of drugs and instead act largely as cognitive enhancers (improving PFC-dependent function). This information has potentially important clinical implications as well as relevance for public health policy regarding the widespread clinical use of psychostimulants and for the development of novel pharmacologic treatments for attention-deficit/hyperactivity disorder and other conditions associated with PFC dysregulation.

The prospect of improving or maintaining cognitive functioning has provoked a steadily increasing number of cognitive training interventions over the last years, especially for clinical and elderly populations. However, there are discrepancies between the findings of the studies. One of the reasons behind these heterogeneous findings is that there are vast inter-individual differences in how people benefit from the training and in the extent that training-related gains are transferred to other untrained tasks and domains. In this paper, we address the value of incorporating neural measures to cognitive training studies in order to fully understand the mechanisms leading to inter-individual differences in training gains and their generalizability to other tasks. Our perspective is that it is necessary to collect multimodal neural measures in the pre- and post-training phase, which can enable us to understand the factors contributing to successful training outcomes. More importantly, ...

A primary means for the augmentation of cognitive brain functions is “pharmacological cognitive enhancement” (PCE). The term usually refers to the off-label use of medical substances to improve mental performance in healthy individuals. With the final aim to advance the normative debate taking place on that topic, several empirical studies have been conducted to assess the attitudes toward PCE in the public, i.e., in groups outside of the academic debate. In this review, we provide an overview of the 40 empirical studies published so far, reporting both their methodology and results. Overall, we find that several concerns about the use of PCE are prevalent in the public. These concerns largely match those discussed in the normative academic debate. We present our findings structured around the three most common concerns: medical safety, coercion, and fairness. Fairness is divided into three subthemes: equality of opportunity, honesty, and authenticity. Attitudes regarding some concerns are coherent across studies (e.g., coercion), whereas for others we find mixed results (e.g., authenticity). Moreover, we find differences in how specific groups—such as users, nonusers, students, parents, and health care providers—perceive PCE: a coherent finding is that nonusers display more concerns regarding medical safety and fairness than users. We discuss potential psychological explanations for these differences.

This review examines longitudinal studies of changes in attentional control following mindfulness training. A total of 56 retreat studies, feasibility studies, and randomized controlled trials were identified. Outcome measures were broadly categorized based on whether they operated primarily via top-down mechanisms, involving goal-directed modulation of attention via endogenous information, or bottom-up mechanisms, involving attentional capture via exogenous cues. Although many feasibility and retreat studies provide promising evidence supporting gains in both top-down and bottom-up attention following mindfulness training, evidence from randomized controlled trials, especially those involving active control comparison groups, is more mixed. This review calls attention to the urgent need in our field of contemplative sciences for adopting the methodological rigor necessary for establishing the efficacy of mindfulness meditation as a cognitive rehabilitation tool. Although studies in...

This chapter takes the ‘wakefulness promoting’ drug modafinil as an exemplarity case in the sociology of pharmaceutical enhancement. The chapter draws on empirical data collected via 25 interviews with prospective users of modafinil, focusing on two of the ways in which prospective users of modafinil imagined how the drug might be used in their specific social domains: the use of modafinil as a safety tool in the workplace and its use as a study aid by university students. The data presented in this chapter suggests that although a therapy-enhancement dichotomy is a useful heuristic, it could also be limiting to uphold as it may direct attention away from other ways in which uses for new technologies can be positioned, negotiated, realised and resisted by (potential) users in the context of their daily lives.

Intellectual autonomy has long been identified as an epistemic virtue, one that has been championed influentially by (among others) Kant, Hume and Emerson. Manifesting intellectual autonomy, at least, in a virtuous way, does not require that we form our beliefs in cognitive isolation. Rather, as Roberts and Wood (2007, 259–60) note, intellectually virtuous autonomy involves reliance and outsourcing (e.g., on other individuals, technology, medicine, etc.) to an appropriate extent, while at the same time maintaining intellectual self-direction. In this essay, I want to investigate the ramifications for intellectual autonomy of a particular kind of epistemic dependence: cognitive enhancement. Cognitive enhancements (as opposed to therapeutic cogni-tive improvements) involve the use of technology and medicine to improve cognitive capacities in healthy individuals, through mechanisms ranging from smart drugs to brain-computer interfaces. With reference to case studies in bioethics, as well as the philosophy of mind and cognitive science, it is shown that epistemic dependence, in this extreme form, poses a prima facie threat to the retention of intellectual autonomy, specifically, by threatening to undermine our intellectual self-direction. My aim will be to show why certain kinds of cognitive enhancements are subject to this objection from self-direction, while others are not. Once this is established, we'll see that even some extreme kinds of cognitive enhancement might be not merely compatible with, but constitutive of, virtuous intellectual autonomy.

The article explores some of the issues that have arisen in the discourse on pharmaceutical cognitive enhancement (PCE), that is, the use of stimulant drugs such as methylphenidate, amphetamine and modafinil by healthy individuals of various populations with the aim of improving cognitive performance. Specifically, we explore the presumed sizes of existing PCE user populations and the policy actions that have been proposed regarding the trend of PCE. We begin with an introductory examination of the academic stances and philosophical issues involved in defining PCE. We then focus on an examination of the population sizes of presumed current PCE users that have been listed in the academic literature on PCE, on presuppositions, which have been problematized by some authors as based on anecdotal or misinterpreted survey data. We follow this with an empirical examination of a potential PCE user population in a national context (students at the University of Ljubljana in Slovenia). We then proceed to examine the regulatory options proposed in the academic literature to address PCE, finally comparing them with an empirical overview of the policy recommendations on PCE produced in the multinational context of several national ethics advisory bodies (EABs) in Europe. Our main conclusion is that there is still little debate among the national EABs on what type of public policy responses, if any, are needed to address PCE in European countries, and that the issues they do address are similar to those discussed and proposed in the academic articles on PCE.

There are a number of premises underlying much of the vigorous debate on pharmacological cognitive enhancement. Among these are claims in the enhancement literature that such drugs exist and are effective among the cognitively normal. These drugs are deemed to enhance cognition specifically, as opposed to other non-cognitive facets of our psychology, such as mood and motivation. The focus on these drugs as cognitive enhancers also suggests that they raise particular ethical questions, or perhaps more pressing ones, compared to those raised by other kinds of neuroenhancement. Finally, the use of these drugs is often claimed to be significant and increasing. Taken together, these premises are at the heart of the flurry of debate on pharmacological cognitive enhancement. In this article, it is argued that these are presumptions for which the evidence does not hold up. Respectively, the evidence for the efficacy of these drugs is inconsistent; neurologically it makes little sense to distinguish the cognitive from non-cognitive as separate targets of pharmacological intervention; ethically, the questions raised by cognitive enhancement are in fact no different from those raised by other kinds of neuroenhancement; and finally the prevalence rates of these drugs are far from clear, with the bulk of the claims resting on poor or misrepresented data. Greater conceptual clarity along with a more tempered appreciation of the evidence can serve to deflate some of the hype in the associated literature, leading to a more realistic and sober assessment of these prospective technologies.

Pharmacological neuroenhancement, defined as the misuse of prescription drugs, illicit drugs, or alcohol for the purpose of enhancing cognition, mood, or prosocial behavior, is not widespread in Europe – nevertheless, it does occur. Thus far,
no drug has been proven as safe and effective for cognitive enhancement in otherwise healthy individuals. European studies have investigated the misuse of prescription and illicit stimulants to increase cognitive performance as well as the use
of tranquilizers, alcohol, and cannabis to cope with stress related to work or
education. Young people in educational settings report pharmacological neuroenhancement more frequently than those in other settings. Although the regular use of drugs for neuroenhancement is not common in Europe, the irregular and low-dose
usage of neuroenhancers might cause adverse reactions. Previous studies have revealed that obtaining adequate amounts of sleep and using successful learning techniques effectively improve mental performance, whereas pharmacological neuroenhancement is associated with ambiguous effects. Therefore, nonsubstance-related alternatives should be promoted to cope with stressful situations. This paper reviews the recent research on pharmacological neuroenhancement in
Europe, develops a clear definition of the substances used, and formulates recommendations for practitioners regarding how to react to requests for neuroenhancement drug prescriptions. We conclude that monitoring the future development of pharmacological neuroenhancement in Europe is important to provide effective preventive measures when required. Furthermore, substance use to cope with stress related to work or education should be studied in depth because it is likely more prevalent and dangerous than direct neuroenhancement.

This article presents a model for regulating cognitive enhancement devices (CEDs). Recently, it has become very easy for individuals to purchase devices which directly modulate brain function. For example, transcranial direct current stimulators are increasingly being produced and marketed online as devices for cognitive enhancement. Despite posing risks in a similar way to medical devices, devices that do not make any therapeutic claims do not have to meet anything more than basic product safety standards. We present the case for extending existing medical device legislation to cover CEDs. Medical devices and CEDs operate by the same or similar mechanisms and pose the same or similar risks. This fact coupled with the arbitrariness of the line between treatment and enhancement count in favour of regulating these devices in the same way. In arguing for this regulatory model, the paper highlights potential challenges to its implementation, and suggests solutions.

This chapter reviews recent philosophical and neuroethical literature on the morality of moral neuroenhancements. It first briefly outlines the main moral arguments that have been made concerning moral status neuroenhancements. These are neurointerventions that would augment the moral status of human persons. It then surveys recent debate regarding moral desirability neuroenhancements: neurointerventions that augment that the moral desirability of human character traits,
motives or conduct. This debate has contested, among other claims (i) Ingmar Persson and Julian Savulescu’s contention that there is a moral imperative to pursue the development of moral desirability neuroenhancements, (ii) Thomas Douglas’ claim that
voluntarily undergoing moral desirability neuroenhancements would often be morally permissible, and (iii) David DeGrazia’s claim that moral desirability neuroenhancements would often be morally desirable. The chapter discusses a number of concerns that have been raised regarding moral desirability neuroenhancements, including concerns that they would restrict freedom, would produce only a superficial kind of moral
improvement, would rely on technologies that are liable to be misused, and would frequently misfire, resulting in moral deterioration rather than moral improvement.

The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements are permissible for individuals with no particular ‘medical’ disadvantage along any of the dimensions of interest. Rarely addressed in the literature, however, is the fact that sometimes the diminishment of a capacity or function, under the right set of circumstances, could plausibly contribute to an individual’s overall well-being: more is not always better, and sometimes less is more. Such cases may be especially likely, we suggest, when trade-offs in our modern environment have shifted since the environment of evolutionary adaptation. In this article, we introduce the notion of “diminishment as enhancement” and go on to defend a welfarist conception of enhancement. We show how this conception resolves a number of definitional ambiguities in the enhancement literature, and we suggest that it can provide a useful framework for thinking about the use of emerging neurotechnologies to promote human flourishing.

Internal working memory (WM) gating control policies have been suggested to constitute a critical component of task-sets that can be learned and transferred to very similar task contexts (Bhandari and Badre (Cognition, 172, 33–43, 2018). Here, we attempt to expand these findings, examining whether such control policies can be also trained and transferred to other untrained cognitive control tasks, namely to task switching and AX-CPT. To this end, a context-processing WM task was used for training, allowing to manipulate either input (i.e., top-down selective entry of information into WM) or output (i.e., bottom-up selective retrieval of WM) gating control policies by employing either a context-first (CF) or context-last (CL) task structure, respectively. In this task, two contextual cues were each associated with two different stimuli. In CF condition, each trial began with a contextual cue, determining which of the two subsequent stimuli is target relevant. In contrast, in the CL c...

This paper has two distinct but related goals: (1) to identify some of the potential consequences of the Internet for our cognitive abilities and (2) to suggest an approach to evaluate these consequences. I begin by outlining the Google effect, which (allegedly) shows that when we know information is available online, we put less effort into storing that information in the brain. Some argue that this strategy is adaptive because it frees up internal resources which can then be used for other cognitive tasks, whereas others argue that this is maladaptive because it makes us less knowledgeable. I argue that the currently available empirical evidence in cognitive psychology does not support strong conclusions about the negative effects of the Internet on memory. Before we can make value-judgements about the cognitive effects of the Internet, we need more robust and ecologically-valid evidence. Having sketched a more nuanced picture of the Google effect, I then argue that the value of our cognitive abilities is in part intrinsic and in part instrumental, that is, they are both valuable in themselves and determined by the socio-cultural context in which these cognitive abilities are utilised. Focussing on instrumental value, I argue that, in an information society such as ours, having the skills to efficiently navigate, evaluate, compare, and synthesize online information are (under most circumstances) more valuable than having a lot of facts stored in biological memory. This is so, partly because using the Internet as an external memory system has overall benefits for education, navigation, journalism, and academic scholarship.

The scope of this systematic review was to summarize the existing literature on the effects of heart rate variability biofeedback (HRV-BF) on executive functions (EFs) across the lifespan. Specifically, it aimed to investigate the factors that may affect the efficacy of HRV-BF interventions, such as the study population, duration and intensity of the intervention, or the technical equipment. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that measured and presented at least one EF were included. We included controlled and uncontrolled trials involving clinical and general populations. From the initial list of 137 papers, 16 final studies were reviewed, with 777 participants. Fifty-six percent of the studies included in this review reported significant positive effects of HRV-BF intervention on at least one EF. Attention was the domain that most often benefited from the intervention. The major...

There is mounting evidence that non-invasive brain stimulation devices - transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) could be used for cognitive enhancement. However, the regulatory environment surrounding such uses of stimulation devices is less clear than for stimulant drugs – a fact that has already been commercially exploited by several companies. 
In this paper, the mechanism of action, uses and adverse effects of non-invasive neurostimulation devices are reviewed, along with social and ethical challenges pertaining to their use as cognitive enhancements. Two regulatory approaches that could be used to facilitate responsible use of these devices as products and services are outlined. Apart from establishing the urgently needed comprehensive regulatory framework, they might provide a starting point for establishing long term physiological and social effects of enhancement uses of tDCS and TMS.