Do Nootropics Actually Help Alzheimer's and Other Ills?

Many are sold, but which if any are worth it?

Source: David Roonlid, creative commons

This is a guest column by David Rönnlid, CEO of Nootralize, a Swedish company dedicated to evidence-based cognitive enhancement.

Imagine being able to focus on exactly what you want to, falling asleep as soon as you as soon as hit the pillow, or not being anxious in situations because self-confidence tells you that actually you can handle them.

These outcomes may elude you for many reasons, but preliminary findings suggest that in some people certain compounds can improve memory, mood, social performance, and other aspects of cognition.

Treatment for cognitive deficits

They are called nootropics, substances that safely enhance a user’s cognition when used properly. Unfortunately, quality research is lacking for many compounds being promoted by biohackers today. Of 78 compounds reviewed by Nootralize.com, only 25 were subjected to placebo-controlled trials in healthy humans [1]. Bacopa Monnieri, a creeping wetland herb used in Ayurvedic medicine for centuries, is one of the most evidence-backed botanicals studied to date. Also called brahmi, Bacopa has proven useful in Alzheimer’s disease, attention-deficit/hyperactivity disorder (ADHD), and in treating anxiety.

Studies published in Nature Neuropsychopharmacology and other quality journals show a meaningful effect on the retention of new information and a slowed rate of forgetting newly acquired facts. Attention, verbal, and visual short-term memory are unaffected.

Bacopa inhibits inflammatory pathways in the brain, and its primary constituents are saponins, soapy turpentine-like molecules that are more familiar from their use in detergents and foam fire extinguishers. Beyond that, much remains to be learned about how the herb affects memory, mood, and difficult behavior [2-4].

Some nootropics act quickly, others after 12 weeks or more of daily use, while some companies selling herbal compounds make frankly absurd claims. Unscrupulous actors unfortunately impede efforts to gather reliable data that can be evaluated dispassionately.

Critics disparage nootropics as pseudoscience, apparently unaware of the irony that the sentence, “nootropics are a pseudoscience” is itself unscientific. Naysayers seem to harbor a reflexive bias against the possibility that any kind of cognitive enhancer might exist, especially one derived from plants.

But historically, all medicines were plant-based, including a majority of modern ones that we now synthesize chemically. One also wonders what critics would say about the many drugs in the pipeline for Alzheimer’s and the even greater number that have been tried and failed in clinical trials.

Evidently, faultfinders don’t understand what the term “pseudoscience” means. The dictionary defines it as “a collection of beliefs or practices mistakenly claimed to be both scientific and factual but incompatible with the scientific method.” Those who dismiss cognitive enhancers often back their arguments by saying there isn’t yet enough scientific research on them. But lacking evidence of effiicacy does not make a substance pseudoscientific; claiming effectiveness when it has proven ineffective or received insufficient research would be.

Science-based medicine is built on evidence. As of 2020, there is still a dearth of research on the safety and efficacy of almost all promising cognitive boosters. Some will fail like many that have already been tested. Others may prove useful for specific populations in well-defined settings.

A number of agents have been tried in other neurodegenerative conditions such as Parkinson’s Disease, and in helping healthy people cope with the normal forgetfulness of aging (“Now what did I come in this room for?”). To date, nootropics seem most promising in individuals suffering from cognitive deficits, where they may repair or at least slow the cognitive decline.