neurologist

(Edi­tor’s Note: giv­en the grow­ing media atten­tion to three appar­ent­ly sep­a­rate worlds ‑cog­ni­tive enhance­ment via drugs, brain fit­ness train­ing soft­ware, com­put­er­ized neu­rocog­ni­tive assessments‑, I found it refresh­ing to see our co-founder Elkhonon Gold­berg intro­duce the top­ic of cog­notrop­ic drugs with an inte­gra­tive per­spec­tive in the much updat­ed new edi­tion of his clas­sic book, now titled The New Exec­u­tive Brain: Frontal Lobes In A Com­plex World. Below goes an excerpt).

For many neu­ropsy­chol­o­gists, like myself, sci­ence is a labor of love, but see­ing patients is bread and but­ter. Tra­di­tion­al­ly, the clin­i­cal con­tri­bu­tion of neu­ropsy­chol­o­gy has been most­ly diag­nos­tic, with pre­cious lit­tle to offer patients by way of treat­ment. Neu­ropsy­chol­o­gy is not the only clin­i­cal dis­ci­pline for years con­signed to help­less voyeurism. Every dis­ci­pline con­cerned with cog­ni­tion shares this hum­bling predica­ment. A psy­chi­a­trist treat­ing a schiz­o­phrenic patient or a depressed patient finds him- or her­self in a sim­i­lar posi­tion. There are ample phar­ma­co­log­i­cal tools to treat the patient’s psy­chosis or mood, but very few to treat the patient’s cog­ni­tion. Even though psy­chi­a­trists increas­ing­ly rec­og­nize that cog­ni­tive impair­ment is often more debil­i­tat­ing in their patients than psy­chosis or mood dis­or­der, tra­di­tion­al­ly, very lit­tle direct effort has been aimed at improv­ing cognition.

A neu­rol­o­gist treat­ing a patient recov­er­ing from the effects of head injury does not fare much bet­ter. There are ade­quate means to con­trol the patient’s seizures but not his or her cog­ni­tive changes, despite the fact that cog­ni­tive impair­ment is usu­al­ly far more debil­i­tat­ing than an occa­sion­al seizure. Soci­ety has been so pre­oc­cu­pied with sav­ing lives, treat­ing hal­lu­ci­na­tions, con­trol­ling seizures, and lift­ing depres­sion that cog­ni­tion (mem­o­ry, atten­tion, plan­ning, prob­lem solv­ing) has been large­ly ignored. Grant­ed, var­i­ous neu­rolep­tics, anti­con­vul­sants, anti­de­pres­sants, seda­tives, and stim­u­lants do have an effect on cog­ni­tion, but it is an ancil­lary effect of a drug designed to treat some­thing else.

Alzheimer’s dis­ease and oth­er demen­tias have been society’s wake-up call. Here, in the most afflu­ent coun­try in the most afflu­ent of times, human minds were suc­cumb­ing to decay before human bod­ies, a sharp chal­lenge to the tac­it pop­u­lar belief that the “body is frail but soul is for­ev­er.” This pro­vid­ed an impe­tus for the devel­op­ment of an entire­ly new class of drugs, which can be termed famil­ial­ly as “cog­notrop­ic.” Their pri­ma­ry and explic­it pur­pose is to improve cognition.

Since med­ical and pub­lic pre­oc­cu­pa­tion with demen­tia focus­es on mem­o­ry, most of the phar­ma­co­log­i­cal efforts have been direct­ed at improv­ing mem­o­ry. At the time of this writ­ing, a hand­ful of drugs known as “Alzheimer’s drugs” or “mem­o­ry enhancers” have been approved by the U.S. Food and Drug Admin­is­tra­tion (FDA). In real­i­ty, both des­ig­na­tions are some­what mis­lead­ing. The drugs in ques­tion are [Read more…] about Cog­ni­tive Enhance­ment via Phar­ma­col­o­gy AND Neu­ropsy­chol­o­gy, in The New Exec­u­tive Brain