‘Cognitive enhancers’: A qualitative exploration of university students’ experiences with prescription medicines for academic purposes

Qualitative work with students who use prescription medicines for academic purposes is limited. Thus, a more nuanced understanding of tertiary students’ experiences is urgently needed. Our study – which draws on five semi-structured interviews with New Zealand university students, complemented with information from local newspapers, blog entries and discussion forums – reveals students’ motivations and perceived effects, their risk perceptions and provides insights into the circumstances enabling the engagement with prescription medicines for academic purposes. Students were influenced by peers and social norms; and ideas about identity, morality and fairness also played a role for engaging with cognitive enhancers. Students used high levels of stress and workload to justify their use but took individual responsibility for their practices. By taking responsibility in this way, rather than considering it as a product of their environment, they buy into the neoliberal university discourse. Unexpectedly, some participants were already receiving medically justified psychopharmacological treatment but extended and supplemented this with nonmedical use. Others considered their use as being for academic emergencies, and that their low level of use helped manage risks. Overall, students viewed pharmacological cognitive enhancement for improving academic performance as cautious, safe, and morally acceptable. We argue in this paper that a local understanding of students’ motivations, justifications and perceptions of pharmacological cognitive enhancement is required, to tailor policies and support systems better to their needs and behaviours.

Behavioral and Psychosocial Context of Pharmaceutical Cognitive Enhancers` Misuse

Background In an effort for better memory, greater motivation and concentration, otherwise healthy individuals use Pharmaceutical Cognitive Enhancers (PCE), medicines for the treatment of cognitive deficits of patients with various disorders and health problems, to achieve greater productivity, efficiency, and performance. Methods In our study, we examined the use of PCE use among 289 students at the Slovenian Faculty of Electrical Engineering and Computer Science in the behavioral and psychosocial context (students’ attitudes towards study, parents, health, leisure time and work). Furthermore, we addressed also the immediate reasons, or the hypothesized connections of behavioral and psychosocial aspects, related to PCE misuse. The study consisted of a structured questionnaire, and the chi-square tests were used. Results An analysis of student statements revealed differences in students` and parents` attitudes toward good academic grades. In addition, students chose among 17 values relating to relationships with parents, friends, partners, careers, study obligations, leisure, hobbies, material goods, appearance and the future, and assessed their importance. Regardless of the group they belonged to, young people cited the same values among the most important. Good grades and parental opinions have proven to be key factors in the context of PCE abuse. Conclusions This research was the first study to examine the relation between PCE misuse and the role of different behavioral and psychosocial factors. However, the further research is needed, both on the actual effects of PCE on healthy people, as well as on continuing research towards behavioral and psychosocial factors.

The HDAC inhibitor CI-994 acts as a molecular memory aid by facilitating synaptic and intra-cellular communication after learning

Long-term memory formation relies on synaptic plasticity, activity-dependent transcription and epigenetic modifications. Multiple studies have shown that HDAC inhibitor (HDACi) treatments can enhance individual aspects of these processes, and thereby act as putative cognitive enhancers. However, their mode of action is not fully understood. In particular, it is unclear how systemic application of HDACis, which are devoid of substrate specificity, can target pathways that promote memory formation. In this study, we explore the electrophysiological, transcriptional and epigenetic responses that are induced by CI-994, a class I HDAC inhibitor, combined with contextual fear conditioning (CFC) in mice. We show that CI-994-mediated improvement of memory formation is accompanied by enhanced long-term potentiation in the hippocampus, a brain region recruited by CFC, but not in the striatum, a brain region not primarily implicated in contextual memory formation. Furthermore, using a combination of bulk and single cell RNA sequencing, we find that synaptic plasticity-promoting gene expression cascades are more strongly engaged in the hippocampus than in the striatum, but only when HDACi treatment co-occurred with CFC, and not by either treatment alone. Lastly, using ChIP-sequencing, we show that the combined action of HDACi application and conditioning is required to elicit enhancer histone acetylation in pathways that may underlie improved memory performance. Together, our results indicate that systemic HDACi administration amplifies brain-region specific processes that are naturally induced by learning. These findings shed light onto the mode of action of HDACis as cognitive enhancers.Significance StatementMemory formation relies on a plethora of functions, including epigenetic modifications. Over the past years, multiple studies have indicated the potential of HDAC inhibitors (HDACi) to act as cognitive enhancers, but their mode of action is not fully understood. Here, we tested whether HDACi treatment improves memory formation via “cognitive epigenetic priming”, stipulating that HDACis – without inherent target specificity – specifically enhance plasticity-related processes. We found that combining HDACi with fear learning, but not either treatment alone, enhances synaptic plasticity as well as memory-promoting transcriptional signaling in the hippocampus, a brain area known to be recruited by fear learning, but not in others. These results lend experimental support to the theory of “cognitive epigenetic priming”.

Nutraceuticals for Smart Aging and Potential Drug Interactions

The use of nutraceuticals as cognitive enhancers is on the rise and may be especially problematic in polymedicated older patients. The potential of interaction of these products with drugs commonly prescribed to this age group is evaluated in this work, by identification of mutual targets (enzymes, transporters and receptors).

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.

Use of Cognitive Enhancers by Portuguese Medical Students: Do Academic Challenges Matter?

Introduction: Nonmedical use of prescription drugs and other substances for cognitive enhancement in the academic environment has been documented in several studies. However, the prevalence among Portuguese university students is unknown. We aimed to assess the prevalence and academic contexts of the use of cognitive enhancers of a sample of Portuguese medical students.Material and Methods: An online questionnaire about the use of cognitive enhancers was completed by 1156 participants, who were either medical students (group 1) or newly qualified physicians applying for the Portuguese medical licensing exam (group 2).Results: Coffee was the most frequently used substance for cognitive enhancement purposes in both groups, whereas nonmedical use of prescription drugs for cognitive enhancement was lower in undergraduate students (5%) and higher in licensing exam applicants (14%). Methylphenidate (35%) and modafinil (10%) were the most consumed prescription substances and they were mainly used to enhance attention (83%) and memory (44%). Use of prescription drugs for cognitive enhancement was mainly associated with studying for medical school exams and the medical licensing exam. Most prescription drugs for cognitive enhancement were obtained through medical prescription (54%).Discussion: These results show a low consumption of prescription drugs for cognitive enhancement by Portuguese medical students. Licensing exam applicants show a higher consumption of almost every substance included in this study, which might be explained by the crucial role of the exam in defining their future career path and desire by students to improve the cognitive skills that determine exam success.Conclusion: Studying drugtaking behaviors in medical students and young doctors is relevant for public health and medical education, since they will soon be in charge of drugs prescription. Therefore, ethical and medical concerns raised by off label consumption of prescription drugs for cognitive enhancement purposes must be openly addressed.

Understanding the relationship between safety beliefs and knowledge for cognitive enhancers in UK university students

Background Cognitive enhancers (CE) are prescription drugs taken, either without a prescription or at a dose exceeding that which is prescribed, to improve cognitive functions such as concentration, vigilance or memory. Previous research suggests that users believe the drugs to be safer than non-users and that they have sufficient knowledge to judge safety. However, to date no research has compared the information sources used and safety knowledge of users and non-users. Objectives This study compared users and non-users of CE in terms of i) their sources of knowledge about the safety of CE and ii) the accuracy of their knowledge of possible adverse effects of a typical cognitive enhancer (modafinil); and iii) how the accuracy of knowledge relates to their safety beliefs. Methods Students (N = 148) from King’s College London (UK) completed an anonymous online survey assessing safety beliefs, sources of knowledge and knowledge of the safety of modafinil; and indicated whether they used CE, and, if so, which drug(s). Results The belief that the drugs are safe was greater in users than non-users. However, both groups used comparable information sources and have similar, relatively poor drug safety knowledge. Furthermore, despite users more strongly believing in the safety of CE there was no relationship between their beliefs and knowledge, in contrast to non-users who did show correlations between beliefs and knowledge. Conclusion These data suggest that the differences in safety beliefs about CE between users and non-users do not stem from use of different information sources or more accurate safety knowledge.