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Appendix 3 – Existing drugs for cognitive
enhancement
Drugs to treat ADHD
ADHD is commonly treated using the stimulants methylphenidate (Ritalin, Equasym, Concerta,
Medikinet) and dexamphetamine (Dexedrine), both of which are related to amphetamine. These
drugs work by increasing the levels of the neurotransmitters dopamine and noradrenaline. When
the drugs are used at prescribed doses, the increase in dopamine seems to improve levels of
concentration. However, taken at high dose, the drugs can give users a high. This, combined with
dopamine’s involvement in pleasure and reward pathways, means the drugs also have potential for
abuse and addiction.
Drugs to treat Narcolepsy
Narcolepsy is a rare neurological disorder of the control of sleep. Symptoms include excessive
daytime sleepiness and strong urges to sleep at inappropriate times - when driving for example. It
isn’t clear what causes narcolepsy, but it seems to be related to the levels of a protein called orexin
that controls sleep patterns and appetite. The daytime sleepiness can be reduced using many of the
stimulants used to treat ADHD. Of other drugs used to treat the condition, modafinil is particularly
significant in cognitive enhancement. The drug increases noradrenaline and dopamine levels in a
similar way to amphetamines, but unlike amphetamines, which affect the whole brain, its action
seems to be more localised to regions involved in wakefulness. However, it isn’t clear exactly how
modafinil works. The drug was controversially trialled by the MoD to see if it could help keep soldiers
alert with little sleep. The drug improves concentration, memory and wakefulness with relatively few
side-effects and is increasingly being used illicitly by university students to help them study better on
dramatically reduced amounts of sleep. The drug is banned in sport.
Drugs to treat Alzheimer’s disease
In Alzheimer’s disease there is visible degeneration in the brain. Accompanying this is a drop in levels
of a number of neurotransmitters including acetylcholine which is particularly important in learning
and working memory. Three of the licenced drugs to treat Alzheimer’s disease increase levels of the
acetylcholine by blocking the enzyme acetylcholine esterase which is responsible for breaking down
acetylcholine. Trials of the acetylcholine esterase inhibitor donepezil on pilots in flight simulators
found that the drug helped pilots to remember complex flight tasks.
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