History of Cognitive Enhancement Treatments

Enhancing Metabolism. Metabolic enhancers theoretically work by promoting activity in relatively inactive areas of the brain. We can infer that these medications enhance brain activity by their ability to increase the brain s use of glucose and oxygen. The metabolic enhancers that have been tried to date include ergot alkaloids, nootropics, and vinca alkaloids. 

Ergot Alkaloids. The ergot alkaloid hydergine was introduced in the 1940s and was in fact the first medication approved by the FDA to enhance cognition in dementia patients. It continues to be used occasionally today, but numerous studies have not shown any clear benefit for hydergine or other ergot alkaloids. We therefore do not recommend its routine use. 

Nootropics. The nootropic medications (of which piracetam is the best known) are believed to enhance nerve cell activity by improving circulation in the tiniest of blood vessels (capillaries) that provide oxygen-rich blood to the nerve cells. In addition to enhancing nerve cell metabolism, these medications should theoretically protect nerve cells in the same manner as the anticoagulants. Although theoretically sound, the nootropics have not shown any significant benefit for demented patients. Therefore, we cannot recommend their use. 

Vinca Alkaloids. Finally, the vinca alkaloid vinpocetine has been shown to enhance learning and memory in laboratory animals. But again, it showed no benefit for patients with dementia. 

Why don t any of these medications work Clearly, they boost nerve cell activity. Some of them do enhance cognition in animals. But they do little for dementia patients. Why is this The explanation is probably that the small benefit of these medications pales in comparison to the widespread damage to nerve cells caused by dementia. The difference between a dementia s ability to compromise the way the brain works and a medication s ability to enhance brain function is so great that the medication produces no noticeable improvement. 

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