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莫达非尼对健康非睡眠剥夺受试者认知功能增强作用的系统评价。

Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: A systematic review.

作者信息

Battleday R M, Brem A-K

机构信息

Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.

Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom; Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

出版信息

Eur Neuropsychopharmacol. 2015 Nov;25(11):1865-81. doi: 10.1016/j.euroneuro.2015.07.028. Epub 2015 Aug 20.


DOI:10.1016/j.euroneuro.2015.07.028
PMID:26381811
Abstract

Modafinil is an FDA-approved eugeroic that directly increases cortical catecholamine levels, indirectly upregulates cerebral serotonin, glutamate, orexin, and histamine levels, and indirectly decreases cerebral gamma-amino-butrytic acid levels. In addition to its approved use treating excessive somnolence, modafinil is thought to be used widely off-prescription for cognitive enhancement. However, despite this popularity, there has been little consensus on the extent and nature of the cognitive effects of modafinil in healthy, non-sleep-deprived humans. This problem is compounded by methodological discrepancies within the literature, and reliance on psychometric tests designed to detect cognitive effects in ill rather than healthy populations. In order to provide an up-to-date systematic evaluation that addresses these concerns, we searched MEDLINE with the terms "modafinil" and "cognitive", and reviewed all resultant primary studies in English from January 1990 until December 2014 investigating the cognitive actions of modafinil in healthy non-sleep-deprived humans. We found that whilst most studies employing basic testing paradigms show that modafinil intake enhances executive function, only half show improvements in attention and learning and memory, and a few even report impairments in divergent creative thinking. In contrast, when more complex assessments are used, modafinil appears to consistently engender enhancement of attention, executive functions, and learning. Importantly, we did not observe any preponderances for side effects or mood changes. Finally, in light of the methodological discrepancies encountered within this literature, we conclude with a series of recommendations on how to optimally detect valid, robust, and consistent effects in healthy populations that should aid future assessment of neuroenhancement.

摘要

莫达非尼是一种经美国食品药品监督管理局(FDA)批准的促觉醒药物,它能直接提高皮质儿茶酚胺水平,间接上调大脑中血清素、谷氨酸、食欲素和组胺水平,并间接降低大脑中γ-氨基丁酸水平。除了已获批用于治疗过度嗜睡外,莫达非尼还被广泛用于非处方的认知增强。然而,尽管它很受欢迎,但对于莫达非尼在健康、未睡眠剥夺人群中的认知效果的程度和性质,人们几乎没有达成共识。文献中的方法差异以及依赖旨在检测患病而非健康人群认知效果的心理测量测试,使这个问题更加复杂。为了提供一个解决这些问题的最新系统评估,我们在MEDLINE数据库中用“莫达非尼”和“认知”进行检索,并回顾了1990年1月至2014年12月期间所有以英文发表的、研究莫达非尼在健康、未睡眠剥夺人群中认知作用的原始研究。我们发现,虽然大多数采用基本测试范式的研究表明服用莫达非尼可增强执行功能,但只有一半的研究显示注意力、学习和记忆有改善,甚至有少数研究报告发散性创造性思维受损。相比之下,当使用更复杂的评估方法时,莫达非尼似乎能持续增强注意力、执行功能和学习能力。重要的是,我们没有观察到任何副作用或情绪变化的优势。最后,鉴于该文献中遇到的方法差异,我们提出了一系列关于如何在健康人群中最佳检测有效、稳健和一致效果的建议,这些建议应有助于未来对神经增强的评估。

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