The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

Abstract: 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 CE drugs such as methylphenidate, amphetamine salt mixtures, modafinil and over-the-counter substances such as caffeine, vitamin B6 & B12 and guarana, that have emerged as misused. The diverted non-prescription use of these molecules and the related potential for de-pendence 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; Method-ology: A systematic review was here performed, in adherence with the PRISMA (Preferred Re-porting Items for Systematic Reviews and Meta-Analyses) guidelines. Whilst 1,400 studies were identified within this through a variety of electronic databases (e.g. 520 through PubMed, 490 through Science Direct and 390 through Scopus), 48 papers were deemed as relevant and were included in this review; Results: The most popular molecules identified here included the stimulant CEs, e.g. methylphenidate, modafinil, amphetamine 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 here 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.