Hostname: page-component-669899f699-tpknm Total loading time: 0 Render date: 2025-04-27T13:52:35.034Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive enhancement for the ageing world: opportunities and challenges

Published online by Cambridge University Press:  16 July 2018

Marcello Ienca Open the ORCID record for Marcello Ienca [Opens in a new window] ,
David Martin Shaw  and
Bernice Elger
Marcello Ienca*
Affiliation:
Department of Health Sciences and Technology, ETH Zurich, Switzerland Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland
David Martin Shaw
Affiliation:
Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland Care and Public Health Research Institute, Maastricht University, The Netherlands
Bernice Elger
Affiliation:
Institute for Biomedical Ethics, Faculty of Medicine, University of Basel, Switzerland University Center for Legal Medicine, University of Geneva, Switzerland
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Population ageing and the global burden of dementia pose a major challenge for human societies and a priority for public health. Cognitive enhancement, i.e. the targeted amplification of core cognitive abilities, is raising increasing attention among researchers as an effective strategy to complement traditional therapeutic and assistive approaches, and reduce the impact of age-related cognitive disability. In this paper, we discuss the possible applicability of cognitive enhancement for public health purposes to mitigate the burden of population ageing and dementia. After discussing the promises and challenges associated with enhancing ageing citizens and people with cognitive disabilities, we argue that global societies have a moral obligation to consider the careful use of cognitive enhancement technologies as a possible strategy to improve individual and public health. In addition, we address a few primary normative issues and possible objections that could arise from the implementation of public health-oriented cognitive enhancement technologies.

Keywords

cognitive enhancementpublic healthethicstechnology governancepolicy
Type
Forum Article
Information
Ageing & Society , Volume 39 , Issue 10 , October 2019 , pp. 2308 - 2321
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Administration on Aging (2004) National Family Caregiver Support Program (FCSP) Complete Resource Guide. Washington, D.C.Google Scholar
Allen, J and Morelli, V (2011) Aging and exercise. Clinics in Geriatric Medicine 27, 661–671.Google Scholar
Alzheimer's Association (2017) Alzheimer's disease facts and figures. Alzheimer's & Dementia 13, 325–373.Google Scholar
Andersen, RA, Hwang, EJ and Mulliken, GH (2010) Cognitive neural prosthetics. Annual Review of Psychology 61, 169–190.Google Scholar
Barr, N, Pennycook, G, Stolz, JA and Fugelsang, JA (2015) The brain in your pocket: evidence that Smartphones are used to supplant thinking. Computers in Human Behavior 48, 473–480.Google Scholar
Bharucha, AJ, Anand, V, Forlizzi, J, Dew, MA, Reynolds, CF, Stevens, S and Wactlar, H (2009) Intelligent assistive technology applications to dementia care: current capabilities, limitations, and future challenges. American Journal of Geriatric Psychiatry 17, 88–104.Google Scholar
Bhimani, R (2014) Understanding the burden on caregivers of people with Parkinson’s: a scoping review of the literature. Rehabilitation Research and Practice. doi: 10.1155/2014/718527.Google Scholar
Bostrom, N and Sandberg, A (2009) Cognitive enhancement: methods, ethics, regulatory challenges. Science and Engineering Ethics 15, 311–341.Google Scholar
Buman, MP, Winter, SJ, Sheats, JL, Hekler, EB, Otten, JJ, Grieco, LA and King, AC (2013) The Stanford healthy neighborhood discovery tool: a computerized tool to assess active living environments. American Journal of Preventive Medicine 44, e41–e47.Google Scholar
Cabrera, LY (2015) Introduction to the enhancement debate. In Cabrera, LY (ed), Rethinking Human Enhancement. New York: Springer, pp. 1–30.Google Scholar
Carr, L and Harnad, S (2011) Offloading cognition onto the web. IEEE Intelligent Systems 26, 33–39.Google Scholar
Colleton, L (2008) The elusive line between enhancement and therapy and its effects on health care in the US. Journal of Evolution & Technology 18, 70–78.Google Scholar
Corbellini, G and Sirgiovanni, E (2015) Against paternalistic views on Neuroenhancement: a libertarian evolutionary account. Medicina nei Secoli 27, 1089–1110.Google Scholar
Daniels, N (2000) Normal functioning and the treatment–enhancement distinction. Cambridge Quarterly of Healthcare Ethics 9, 309–322.Google Scholar
Daniels, N, Kennedy, B and Kawachi, I (2000) Is social justice good for our health. Boston Review 25, 4–9.Google Scholar
Fateh-Moghadam, B and Gutmann, T (2014) Governing [through] autonomy. The moral and legal limits of ‘soft paternalism’. Ethical Theory and Moral Practice 17, 383–397.Google Scholar
Frankish, H and Horton, R (2017) Prevention and management of dementia: a priority for public health. The Lancet 390, 2614–2615.Google Scholar
Gottfredson, LS and Deary, IJ (2004) Intelligence predicts health and longevity, but why? Current Directions in Psychological Science 13, 1–4.Google Scholar
Greely, H, Sahakian, B, Harris, J, Kessler, RC, Gazzaniga, M, Campbell, P and Farah, MJ (2008) Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456, 702–705.Google Scholar
Guggenmos, DJ, Azin, M, Barbay, S, Mahnken, JD, Dunham, C, Mohseni, P and Nudo, RJ (2013) Restoration of function after brain damage using a neural prosthesis. Proceedings of the National Academy of Sciences of the United States of America 110, 21177–21182.Google Scholar
Guizzo, E (2015) A robot in the family. IEEE Spectrum 52, 28–58.Google Scholar
Halperin, JM and Healey, DM (2011) The influences of environmental enrichment, cognitive enhancement, and physical exercise on brain development: can we alter the developmental trajectory of ADHD? Neuroscience and Biobehavioral Reviews 35, 621–634.Google Scholar
Han, Y-S, Araki, T, Lee, P-Y, Choi, J-H, Kwon, I-S, Kwon, K-N and Kim, J-Y (2016) Development and effect of a cognitive enhancement gymnastics program for elderly people with dementia. Journal of Exercise Rehabilitation 12, 340–345.Google Scholar
Harris, J and Chan, S (2008) Enhancement is good for you!: understanding the ethics of genetic enhancement. Gene Therapy 15, 338–339.Google Scholar
Hart, CL, Taylor, MD, Smith, GD, Whalley, LJ, Starr, JM, Hole, DJ, Wilson, V and Deary, IJ (2004) Childhood IQ and cardiovascular disease in adulthood: prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies. Social Science & Medicine 59, 2131–2138.Google Scholar
Hashizume, O, Ohnishi, S, Mito, T, Shimizu, A, Iashikawa, K, Nakada, K, Soda, M, Mano, H, Togayachi, S and Miyoshi, H (2015) Epigenetic regulation of the nuclear-coded GCAT and SHMT2 genes confers human age-associated mitochondrial respiration defects. Scientific Reports 5, 10434.Google Scholar
Hellman, R (2014) Assistive Technologies for Coping at Home and Increased Quality of Life for Persons with Dementia; eChallenges e-2014 Conference Proceedings: eChallenges. International Information Management Corporation; October 29th–30th 2014; Belfast.Google Scholar
Hertogh, C (2013) Aging beyond frailty: the future of old age. In Schermer, M and Pinxten, W (eds), Ethics, Health Policy and (Anti-) Aging: Mixed Blessings. New York: Springer, pp. 91–104.Google Scholar
Ienca, M and Andorno, R (2017) Towards new human rights in the age of neuroscience and neurotechnology. Life Sciences, Society and Policy 13, 5.Google Scholar
Juengst, ET (1997) Can enhancement be distinguished from prevention in genetic medicine? Journal of Medicine and Philosophy 22, 125–142.Google Scholar
Kemoun, G, Thibaud, M, Roumagne, N, Carette, P, Albinet, C, Toussaint, L, Paccalin, M and Dugue, B (2010) Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dementia and Geriatric Cognitive Disorders 29, 109–14.Google Scholar
Leuner, K, Kurz, C, Guidetti, G, Orgogozo, J-M and Müller, WE (2010) Improved mitochondrial function in brain aging and Alzheimer disease – the new mechanism of action of the old metabolic enhancer Piracetam. Frontiers in Neuroscience 4, 1–11.Google Scholar
Montero-Odasso, M, Muir-Hunter, SW, Oteng-Amoako, A, Gopaul, K, Islam, A, Borrie, M, Wells, J and Speechley, M (2015) Donepezil improves gait performance in older adults with mild Alzheimer's disease: a phase II clinical trial. Journal of Alzheimer's Disease 43, 193–199.Google Scholar
Montero-Odasso, M, Verghese, J, Beauchet, O and Hausdorff, JM (2012) Gait and cognition: a complementary approach to understanding brain function and the risk of falling. Journal of the American Geriatrics Society 60, 2127–2136.Google Scholar
Morrow, D, Clark, D, Tu, W, Wu, J, Weiner, M, Steinley, D and Murray, MD (2006) Correlates of health literacy in patients with chronic heart failure. The Gerontologist 46, 669–676.Google Scholar
Park, DC and Bischof, GN (2013) The aging mind: neuroplasticity in response to cognitive training. Dialogues in Clinical Neuroscience 15, 109–119.Google Scholar
Parrot, M, Boots, E, McDermot, K, Kauwe, K and Edwards, J (2016) Brain training may protect against cognitive impairment and dementia: the ACTIVE Study. Paper presented at the Alzheimer's Association International Conference 2016. Toronto (Canada), July 22–28, 2016.Google Scholar
Pollack, ME (2007) Intelligent assistive technology: the present and the future. In Conati, C, McCoy, K and Paliouras, G (eds), User Modeling 2007. UM 2007. Lecture Notes in Computer Science, 4511. Berlin, Heidelberg: Springer.Google Scholar
Prince, M (2017) Progress on dementia – leaving no one behind. The Lancet 390, e51–e53.Google Scholar
Prince, M, Wimo, A, Guerchet, M, Ali, G, Wu, Y and Prina, M (2015) World Alzheimer Report 2015. The Global Impact of Dementia. An Analysis of Prevalence, Incidence, Cost and Trends. London: Alzheimer's Disease International.Google Scholar
Rechel, B, Grundy, E, Robine, J-M, Cylus, J, Mackenbach, JP, Knai, C and McKee, M (2013) Ageing in the European union. The Lancet 381, 1312–1322.Google Scholar
Sabanovic, S, Bennett, CC, Chang, W-L and Huber, L (2013) PARO robot affects diverse interaction modalities in group sensory therapy for older adults with dementia. In Rehabilitation Robotics (ICORR), 2013 IEEE International Conference. IEEE, 1–6.Google Scholar
Sabbah, W, Watt, RG, Sheiham, A and Tsakos, G (2009) The role of cognitive ability in socio-economic inequalities in oral health. Journal of Dental Research 88, 351–355.Google Scholar
Salthouse, TA (2009) When does age-related cognitive decline begin? Neurobiology of Aging 30, 507–514.Google Scholar
Sandberg, A and Bostrom, N (2006) Converging cognitive enhancements. Annals of the New York Academy of Sciences 1093, 201–227.Google Scholar
Saracchini, R, Catalina, C and Bordoni, L (2015) A mobile augmented reality assistive technology for the elderly. Comunicar 23, 65–73.Google Scholar
Schulz, R and Martire, LM (2004) Family caregiving of persons with dementia: prevalence, health effects, and support strategies. American Journal of Geriatric Psychiatry 12, 240–249.Google Scholar
Schutte, NS, Malouff, JM, Thorsteinsson, EB, Bhullar, N and Rooke, SE (2007) A meta-analytic investigation of the relationship between emotional intelligence and health. Personality and Individual Differences 42, 921–933.Google Scholar
Sententia, W (2004) Neuroethical considerations: cognitive liberty and converging technologies for improving human cognition. Annals of the New York Academy of Sciences 1013, 221–228.Google Scholar
Shaw, D (2014) Neuroenhancing public health. Journal of Medical Ethics 40, 389–391.Google Scholar
Singh, I and Kelleher, KJ (2010) Neuroenhancement in young people: proposal for research, policy, and clinical management. AJOB Neuroscience 1, 3–16.Google Scholar
Sörberg, A, Allebeck, P and Hemmingsson, T (2013) IQ and somatic health in early adulthood – a cross-sectional analysis of associations. Alma Sörberg 23, supplement 1, 273.Google Scholar
Sörensen, S and Conwell, Y (2011) Issues in dementia caregiving: effects on mental and physical health, intervention strategies, and research needs. American Journal of Geriatric Psychiatry 19, 491–496.Google Scholar
Starr, JM, Taylor, MD, Hart, CL, Davey Smith, G, Whalley, LJ, Hole, DJ, Wilson, V and Deary, IJ (2004) Childhood mental ability and blood pressure at midlife: linking the Scottish Mental Survey 1932 and the Midspan studies. Journal of Hypertension 22, 893–897.Google Scholar
The Guardian (2016) Aged care funding for nursing homes cut by $1.2bn in federal budget. The Guardian, 3 May. Available online at https://www.theguardian.com/australia-news/2016/may/03/aged-care-funding-nursing-homes-cut-federal-budget (Accessed 27 October 16).Google Scholar
To, WT, De Ridder, D, Hart, J Jr and Vanneste, S (2018) Changing brain networks through non-invasive neuromodulation. Frontiers in Human Neuroscience 12, 1–17.Google Scholar
United Nations (2015 a) World Population Ageing. New York: United Nations.Google Scholar
United Nations (2015 b) World Population Prospects: The 2015 Revision. New York: Department of Economic and Social Affairs, United Nations.Google Scholar
United States Department of Health and Human Services (2017) Available online at https://longtermcare.acl.gov/costs-how-to-pay/costs-of-care.html (Accessed 27 October 2017).Google Scholar
Vitaliano, PP, Strachan, E, Dansie, E, Goldberg, J and Buchwald, D (2014) Does caregiving cause psychological distress? The case for familial and genetic vulnerabilities in female twins. Annals of Behavioral Medicine 47, 198–207.Google Scholar
Walker, NP, McConville, PM, Hunter, D, Deary, IJ and Whalley, LJ (2002) Childhood mental ability and lifetime psychiatric contact: a 66-year follow-up study of the 1932 Scottish Mental Ability Survey. Intelligence 30, 233–245.Google Scholar
Whalley, LJ and Deary, IJ (2001) Longitudinal cohort study of childhood IQ and survival up to age 76. British Medical Journal 322, 819.Google Scholar
Zhang, MW and Ho, RC (2017) Personalized reminiscence therapy M-health application for patients living with dementia: innovating using open source code repository. Technology and Health Care 25, 153–156.Google Scholar