Cognitive impairment, including dementia, is growing to be a public health problem worldwide. It is estimated by 2050, there will be 135 million people with dementia. While researchers are still studying how the brain ages and what impacts risk for cognitive decline, many are looking for ways to protect against age-related cognitive decline. 

Nootropics are considered over-the-counter "smart drugs or brain supplements that are designed to improve certain aspects of mental function such as memory, creativity, motivation, and attention. Many adults may be looking to these smart drugs to help in these areas, but do they actually help boost brain function?

Navigating different types of smart drugs can be difficult, and this smart guide has everything one should know!

What Are Nootropics?

Studies have shown structural and functional changes observed in the aging brain can be attributed to increased brain oxidative stress. Nootropics are thought to protect brain cells from inflammation and damage caused by oxidative stress. This protection is key for brain health, as neurons cannot be reproduced like other cells in the brain. 

Once damage to neurons happens, there is no reversing it. Therefore, preventative measures are important for maintaining neuron health throughout aging. Nootropics can also impact neurotransmitter levels in the brain which can lead to cognitive enhancement.

Observational studies have shown certain nutrients in foods may help delay age-associated cognitive decline. Nootropics can be one or a combination of these nutrients isolated in supplement form designed to positively impact brain health. They can also be herbs, like ginkgo biloba, that are thought to be beneficial for brain function.

Benefits of Smart Drugs

Do nootropics actually help protect against age-associated cognitive decline? Will taking these smart drugs help boost memory, attention, or focus? So far, research studies have not found nootropics to show a significant effect on brain health.

A 2015 review on supplements and brain health concluded supplements such as omega 3 fatty acids, vitamin E and B vitamins did not affect brain function in adults without dementia. Even though observational studies have found an association of higher intake of omega 3's with brain health, random controlled trials have not shown this positive effect. This suggests there may be something in addition to omega 3's alone that benefits brain function. 

A 2019 review on brain aging, cognition, and diet also suggests more research is needed before certain food-derived nootropics can be prescribed for brain health benefits. Other nootropic ingredients may have some in vitro or animal research studies suggesting they can promote cognitive function, but clinical trials are needed to confirm if the same benefit and long-term safety are seen in humans. 

MIND Diet Benefit

What has shown to have a beneficial role in protecting against cognitive decline with aging is the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diet. The MIND diet has been shown from research to help protect against cognitive decline. This diet is high in antioxidants, as it emphasizes whole plant foods like green leafy vegetables, berries, nuts/seeds, legumes, and whole grains. 

Nootropics try to isolate compounds from these foods that make up the MIND diet, but research has not supported these to have the same brain benefit effects. Why? It is likely there is a synergistic effect from ALL the components of a mind, healthy diet cannot be put into one supplement. 

Another consideration is how long supplementation may take in order to reap any benefits. Cognitive decline can vary when it starts in adulthood but may start as early as in the twenties to thirties. Taking a nootropic later in adulthood may not have the same benefit as eating like the MIND diet throughout early to late adulthood.

Types of Smart Drugs

There are a variety of types and combinations of nootropics available on the market, and they propose to boost brain function in various ways. 

Natural nootropics are compounds derived from foods or herbs that either are meant to protect neurons from oxidative stress or target pathways in the brain to raise levels of neurotransmitters like dopamine. Synthetic-based nootropics are drugs that also target neurotransmitter levels in the brain. 

Both types of nootropics may be bought online or from a health store without a prescription.

Natural Nootropics

Some common natural nootropic ingredients can include the following:

• B vitamins are not always considered a nootropic alone, but they can be a common ingredient in many nootropic supplements. Observational studies have shown B vitamins may help play a role in lowering the risk for dementia. 

• Vitamin E is an antioxidant. Like B vitamins it is not always considered a nootropic but may be a part of nootropic supplements.

• Omega-3's have many potential health claims due to their anti-inflammatory effects on the body. Omega 3's can be a common part of nootropic supplements.

• Ginkgo biloba has been used for centuries for many ailments and is one of the more common nootropics. It is thought to work by increasing cerebral blood flow and reducing amyloid neurotoxicity.

• Ginseng is the most commonly sold medicinal herb worldwide. Some research has shown ginseng may improve memory and cognitive function.

• Caffeine can be listed by other names such as 1, 3, 7-trimethylxanthine and be a common additive for nootropic supplements. Caffeine is a stimulant and may be helpful for increasing alertness and other cognitive functions.

• Rhodiola rosea (golden root) grows in higher elevations in Europe and Asia. It is promoted to increase energy, improve mental capacity and improve athletic performance. 

• Bacopa monnieri is from a plant native to India and may act as an antioxidant, have cognition-enhancing properties sedative, and have neuroprotective effects. 

Synthetic Nootropics

Synthetic nootropics target the same neurotransmitter pathways in the brain as natural nootropics but are derived synthetically instead of from food or herbs. They can also be prescribed by doctors for various medical conditions. 

• Armodafinil is a drug to help increase wakefulness by increasing glutamate in the hypothalamus. This drug can be prescribed to people suffering from sleep disorders like narcolepsy.

• Citicolineis a drug that modulates acetylcholine, dopamine, and glutamate. It can help improve memory in those with dementia and those recovering from traumatic brain injury.

• Piracetam is a drug used in the early development of Alzheimer's disease. It can be purchased online and is touted as beneficial for memory improvement.

• Ampakines are a drug class that bind to certain neurotransmitter receptors in the brain and can potentially impact the improvement of learning, cognition, and alertness.

• Cerebrolysin is derived from pig brain tissue and is used to treat stroke patients in China and Russia.

Risks of Smart Drugs

While there are not current strong research studies to suggest nootropic supplements do provide significant mental health benefits, can taking nootropics be harmful? 

The 2019 review mentioned above concluded there are issues that need to be addressed for smart drug supplements such as:

• Safety 
• Standardisation of active constituents 
• Clarification for which combinations of ingredients work best for improved cognition. 

The interactions that may occur between nootropics and medications are not clearly known. As with any other supplement, it is always recommended to consult your healthcare team before taking a nootropic supplement, especially if on any medication.

Some side effects from synthetic nootropics can include:

• Headache
• Insomnia
• Gastrointestinal discomfort
• Tremors
• Dizziness
• Restlessness
• Fatigue
• Vertigo
• Agitation

While side effects can vary, it is important to note certain individuals with a history of mental or substance use disorders might be particularly vulnerable to adverse effects of nootropics.

Nootropics Summary

Nootropics are often referred to as smart drugs available over the counter. They are touted as offering brain function benefits like increasing memory, focus or attention and may advertise they can help lower risk for age-related cognitive decline. 

Some observational studies have shown associations with nootropic ingredients and improved brain function, but random controlled trials have failed to show any significant benefit. Long-term safety and a combination of ingredients for optimal brain health need further research.

There may be side effects with taking nootropics, and it is recommended to consult a healthcare team before taking these supplements.

What is shown by research to positively affect brain health is eating a healthy, plant-based diet, like the MIND diet. Eating a variety of foods throughout the life cycle, along with exercise, can offer cognitive and overall health benefits.

References:

Forbes SC, Holroyd-Leduc JM, Poulin MJ, Hogan DB. Effect of Nutrients, Dietary Supplements and Vitamins on Cognition: a Systematic Review and Meta-Analysis of Randomized Controlled Trials. Can Geriatr J. 2015;18(4):231-245. Published 2015 Dec 23. doi:10.5770/cgj.18.189.

Suliman NA, Mat Taib CN, Mohd Moklas MA, Adenan MI, Hidayat Baharuldin MT, Basir R. Establishing Natural Nootropics: Recent Molecular Enhancement Influenced by Natural Nootropic. Evid Based Complement Alternat Med. 2016;2016:4391375. doi:10.1155/2016/4391375. 

Talih F, Ajaltouni J. Probable Nootropicinduced Psychiatric Adverse Effects: A Series of Four Cases. Innov Clin Neurosci. 2015;12(11-12):21-25.

Heid M. Nootropics, or 'Smart Drugs,' Are Gaining Popularity. Should You Take Them? Time. Published January 23, 2019. https://time.com/5509993/nootropics-smart-drugs-brain/.