Will a pill boost your brain power?

The 49-year-old software developer who came to my office had dark circles under his eyes and was clearly stressed. His company was downsizing, and his mother's Alzheimer's disease was getting worse. With the exception of possible sleep apnea, he appeared healthy but complained that over the years his productivity had slowed and he had trouble keeping up with younger colleagues. If only he could improve his concentration, he explained, he'd be less likely to be laid off. He wanted a prescription for Ritalin (methylphenidate and generic), the stimulant often used to treat children with Attention Deficit Hyperactivity Disorder (ADHD).

The demand for neuroenhancements—drugs to improve memory, attention, and focus—has risen steadily over the past decade. Prescriptions for so-called brain boosters for adults 18 and older numbered about 3.2 million as of October 2007.

Stimulants such as Ritalin and Adderall (an amphetamine/dextroamphetamine combination), both approved for treating ADHD, have been used to improve academic performance and to help users learn new skills. The Alzheimer's drug Aricept (donepezil) is being prescribed to treat usual age-related memory changes, while Provigil (modafinil), approved to treat narcolepsy and help combat sleep apnea, is also used to keep pilots alert.

The appeal of those drugs can be understandable: Who doesn't want to be more alert? Healthy adults may begin to notice slower reasoning skills and memory function in their 30s, and the decline continues with age. They may forget names, where they put their keys, or where they parked the car. Although that is a part of normal aging, some people are more greatly affected than others. While it's not necessarily an indicator of dementia, it can be distressing. And more people are asking their doctors for help.

Because of the unknown risks associated with long-term use in normal patients, Dan Larriviere, M.D., J.D., the lead author of an October 2009 guidance statement for physicians through the American Academy of Neurology, advises against the use of neuroenhancers as a first-line therapy. Instead of a prescription, he suggests patients step up efforts to get adequate sleep and exercise, and eat nutritiously.

As I spoke with my patient, it became clear that anxiety about his job and his mother's condition interfered with his concentration and performance. He was later diagnosed and treated for sleep apnea, a condition that can reduce attention span. He also began seeing a therapist and resumed exercising. When I saw him a few months later for tennis elbow, he still had his job, looked more relaxed, and no longer requested a neuroenhancer.

Get a checkup. Cognitive problems can stem from medical conditions, such as high blood pressure.

Review your meds. Prescription and over-the-counter drugs, including some antibiotics, antihistamines, pain relievers, and incontinence and ulcer drugs, can cloud thinking.

Stop multitasking. Doing several tasks at once can cause confusion and it can take longer to complete them than tackling them sequentially.

Address your stress. Studies show that people under stress perform worse than their calmer counterparts.

Get enough sleep. Fatigue impedes the ability to learn and do complex tasks.