Is Methylphenidate Beneficial and Safe in Pharmacological Cognitive Enhancement?
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REVIEW ARTICLE
Is Methylphenidate Beneficial and Safe in Pharmacological Cognitive Enhancement? Ajay Kapur1
© Springer Nature Switzerland AG 2020
Abstract Nootropics are drugs used to either treat or benefit cognition deficits. Among this class, methylphenidate is a popular agent, which acts through indirect dopaminergic and noradrenergic agonism and, therefore, is proposed to enhance performance in catecholamine-dependent cognitive domains such as attention, memory and prefrontal cortex-dependent executive functions. However, investigation into the efficacy of methylphenidate as a cognitive enhancer has yielded variable results across all domains, leading to debate within the scientific community surrounding its off-label use in healthy individuals seeking scholaristic benefit or increased productivity. Through analysis of experimental data and methodological evaluation, it is apparent that there are dose-, task- and domain-dependent considerations surrounding the use of methylphenidate in healthy individuals, whereby tailored dose administration is likely to provide benefit on an individual basis dependent on the domain of cognition in which benefit is required. Additionally, it is apparent that there are subjective effects of methylphenidate, which may increase user productivity irrespective of cognitive benefit. Whilst there is not extensive study in healthy older adults, it is plausible that there are dose-dependent benefits to methylphenidate in older adults in selective cognitive domains that might improve quality of life and reduce fall risk. Methylphenidate appears to produce dose-dependent benefits to individuals with attention-deficit/hyperactivity disorder, but the evidence for benefit in Parkinson’s disease and schizophrenia is inconclusive. As with any off-label use of pharmacological agents, and especially regarding drugs with neuromodulatory effects, there are inherent safety concerns; epidemiological and experimental evidence suggests there are sympathomimetic, cardiovascular and addictive considerations, which might further restrict their use within certain demographics.
1 Introduction Efforts to improve the cognitive capacity of patients with brain disorders have accelerated research efforts concerning nootropics—drugs used to treat or benefit cognition deficits [1]. Reports suggest increasing off-label use of nootropics in healthy individuals seeking neuro-enhancement [2, 3]. Use has been reported in military personnel who are required to remain awake and focused for long periods of time [4], academics wanting to maintain focus [2] or students seeking improved grades [5]. The estimated use of prescription stimulants in students is between 5 and 15% in the USA
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40263-020-00758-w) contains supplementary material, which is available to authorized users.
Key Points Single-dose methylphenidate administration has a variable measurable effect on cognition in investigations, but likely exerts a dose
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