神經增強

神经增强（英語：Neuroenhancement）或认知增强（英語：cognitive enhancement），是指對已知無任何精神疾病的健康人身上，通過應用神經生物學研究成果，有針對性地增強或擴展其認知與情感能力，算是個概括性的術語。通過藥物或非藥物方法來改善神經功能，或是超出了维持或恢复健康所必需的范围，而旨在改善人类形态或機能的干预措施，以及伴随这些目标和做法的神經倫理學（英语：Neuroethics）討論。 尽管广义上的認知增強剂，還包括使用被认为不健康或有严重副作用的精神活性物质，但神经增強剂仍能几乎不会产生副作用的可靠地为健康人带来超出正常功能的大量认知、社交、心理、情绪或运动方面的益处。促智藥包括莫达非尼、假馬齒莧、磷脂酰丝氨酸和咖啡因等已被证实有健脑功效的药物，與用于治疗神经系统疾病的其他药物。 通过非药物措施来改善认知能力的方法，包括行为方法（活动、技巧和改变）、非侵入性脑刺激技术（已被用于改善各种认知和情感功能）和脑机接口（在扩展运动和认知能力方面具有很大潜力）。 有许多包括智能药物与膳食补充剂在内的促智药，与神经或认知增强有关，但许多营养剂在健康人身上起效小，副作用大。最常见、最流行或最起效最显著的神经增强剂包括莫达菲尼和哌醋甲酯（利他林），此类药或可能产生显著的促智效果（或至少与咖啡因效果相同或相似）。 一般的兴奋剂和各种抗失智药（英语：Dementia#Medications）、抗焦虑药、神入感激發劑（英语：Empathogen–entactogen）、各种微量用剂（英语：microdosing）（主要用微剂量迷幻剂（英语：Psychedelic microdosing））、及抗抑郁药，尽管或不被认为是属促智药之范围，但或从属于神经增强的范畴。 尽管神经增强剂通常是在临床或技术领域取得成功后才被考虑投入使用，但其也常被用于帮助缺乏如社交技能与共情能力在内的，正常认知、运动和情感能力的个体。此种情况下，神经增强药物试图增加催产素，降低皮质醇水平，以帮助个体提高沟通与社交能力。 神经增强不仅涉及强化短期和长期的智力（通常由各种类型的评估确定）、学习能力（如记忆强化）、专注或沉浸能力，及通过各类心理测量所体现的指标，而且还涉及： 情绪（“增强情绪”） 动机（“增强动机”） 任务乐趣 交际能力（与交谈或移情有关） 作为不健康行为或物质的替代品（如物质使用障碍或冲动消费） 意志力和自控力 创造力 认知耐力（如认知工作耐力、抗疲劳能力） 特定能力与技能（如语言流畅性、解决问题与推理的反应时间等） 心理复原力 增强剂有生化、物理和行为层面上不同的增强策略。乙醯半胱氨酸，一种低副作用的认知增强剂，与改善不健康的物质使用或稳定情绪都有关系。 莫达非尼是觉醒促进剂（英语：Wakefulness-promoting agent）之一，能减轻疲劳、提高警惕、减少白天过度嗜睡（英语：Excessive daytime sleepiness）症状与改善情绪。莫达非尼目前获准用于治疗嗜睡症、睡眠呼吸暂停和轮班工作睡眠紊乱等疾病，目前也正被美国空军采用，以用于减轻机组人员执行长时间任务所带来的疲劳。莫达非尼在普通大众中也越来越受欢迎，在《自然》杂志进行的一次在线调查中，1400名读者中就有8.8%承认出于非医疗原因使用莫达非尼。他们使用莫达非尼的理由是为了提高注意力和对特定任务的专注度，或者是为了抵御睡眠不足和倒时差。若将莫达非尼销售量与患者人数进行比较发现，两者的比例失调，表明对莫达非尼的滥用现象严重。 莫达非尼被报告出，可以改善非有失眠症状的健康个体的执行能力，或改善注意力、学习能力与记忆力。而莫达非尼对睡眠不足者的作用更为显著：单一剂量就已能提高清醒度、执行能力与记忆力。在持续睡眠不足的情况下，重复服用莫达非尼有助于保持比安慰剂更高的清醒水平，但对改善注意力和执行能力没有帮助。由于此类试验大多针对军人进行，因而还需进一步研究莫达非尼对普通人群的影响。莫达非尼或会损害人的自我监控能力，研究发现的常见趋势之一是：参与者对自己在认知测试中的表现评价高于实际水平，这表明存在「自负」效应。 莫达非尼在普通人群中也越来越受欢迎，除了希望借此改善自身神经系统性能，给药厂带来的经济利益也是原因之一。每年，莫达非尼的市场份额就超过7亿美元，表明除医用外的份额很高。莫达非尼也是目前市场上，比较容易买到的神经增强药物之一。莫达非尼可以从许多网站（大多产自亚洲国家）或暗网市场上买到。莫达非尼首次引起公众注意是在2003年田径世锦赛上，世界冠军长跑运动员凯莉·怀特因非法服用莫达非尼，被检测出阳性反应，因此也失去了两枚金牌。 哌醋甲酯（MPH）又名利他林，是兴奋剂，用于治疗注意力缺陷多动障碍（ADHD）。但众所周知，哌醋甲酯在普通人群——尤其是在大学生中被大量滥用。在《自然》杂志开展的一次在线调查中，1400名读者中有12.4%承认出于非医疗原因使用哌醋甲酯，使用MPH的理由是为了提高注意力、改善睡眠不足和倒时差。 将MPH销售量与患者人数进行比较后发现，两者的比例失调，表明滥用现象严重。MPH被认为对巩固记忆有积极作用，尽管研究未能最终证实此说法。流行观点认为MPH能增强注意力，但这一观点同样未能得到证实。MPH的研究报告指出，MPH能提高解题能力。然而，当重复研究以期复现结果时，安慰剂组的得分更高，这表明MPH甚至会损害成绩。这些不确定的、普遍负面的记忆力改善研究结果，不足以解释出于非医疗用途使用MPH的原因。除了用于改善神经机能外，用药者还可能有其他动机，如主观和娱乐效果等，而这推动了其在无处方的情况下用药。 美金剛胺，一种NMDA受体拮抗剂，用于治疗中至重度阿尔茨海默病患者，但也被用作神经增强药物。由于此类研究，大多是对美金刚的单剂量测试，而因此类药物，只有在持续摄入后才会显示出某些无论积极或消极的效果。因而，在此之前，单剂量美金刚研究不足以揭示该药物的实际潜力。 多奈哌齐，一种乙酰胆碱酯酶抑制剂（AChEI），用于治疗轻至中度阿尔茨海默病患者。虽然，许多乙酰胆碱酯酶抑制剂都可能是潜在的神经增强物质，但因多奈哌齐被广泛用于治疗阿尔茨海默病，因而在普通人群中是属最常用的乙酰胆碱酯酶抑制剂。 关于多奈哌齐的大多数研究都无法最终验证该药物具有神经增强的能力，尽管这些研究中，服用多奈哌齐的参与者组得分高于服用安慰剂的参与者组。多奈哌齐能帮助患者保持训练任务、言语记忆和外显记忆。在睡眠剥夺研究中，虽然多奈哌齐对休息良好的个体没有影响，但对被睡眠剥夺24小时的个体有积极影响，记忆力和注意力都得到了提高；若非如此，在如此睡眠不足的境地下，其记忆力和注意力就会出现缺陷。不过，值得注意的是，此种效果仅出现在因睡眠不足，而成绩明显下降的人身上。 有相关研究探索了现有认知增强剂的衍生物，这些衍生物具有或可能具有更高的生物利用度，如乙醯半胱胺酸的衍生物N-乙酰-L-胱氨酸（英语：Acetylcysteinamide），和其他生物利用度增强策略。另一种增强药效、效力或选择性（selectivity）的方法是改进给药方式，开辟更多给药途径，如通过奈米乳液（英语：nanoemulsion）鼻内给药（英语：Drug delivery to the brain）（"nose-to-brain" drug deliver），或假设通过脑部植入给药。 半衰期或也是研发课题之一。如，尽管莫达非尼能显著提高人的警觉性，但其半衰期长达约13小时，会延迟或影响入睡时间与睡眠，而目前市面上，也还没有短效的莫达非尼。根据2009年的两项研究，阿莫达非尼的消除速度，比外消旋莫达非尼的S-异构体慢约三倍。 研究还可能围绕以下问题进行（英语：Research question）： 无论长短期——特别是对健康人群——使用药物的一般安全性和有效性。（借助神經成像技术、脑图谱分析（英语：Brain mapping）、神經影像智力測試（英语：Neuroimaging intelligence testing）。） 研究還可以測量經常使用莫達非尼等化學物質對動物模型的死亡率与壽命的影響。 不同方案（如剂量、时间和安排）。 组合（如并行、周期或顺序及前体、消耗和辅因子） 目前正研究的常见组合之一，是将茶氨酸与咖啡因同时结合使用。 又一项研究调查了，高剂量莫达非尼与低剂量咖啡因（各200mg）的组合。 还有一些研究，将不同类型的认知增强剂（如莫达非尼等生化与行为增强剂）与冥想组合。 尿苷与胆碱（胞磷膽鹼（英语：Citicoline）或鸡蛋中的胆碱）和Omega-3（如鱼中所含之Omega-3）组合的多营养素干预具有协同作用，能更好地改善认知与情绪的某些指标。 影响因素（如情境、任务难度、个人因素（英语：personalized medicine）（如基因或基础技能水平）、与方案有关的因素等） 相互作用（如多重用药（英语：polypharmacy）和联合用药） 利弊权衡类问题。 根据不同因素，莫达非尼可在用药前后使： 因其半衰期长而影响睡眠。 （輕微）增加靜息心率和血壓。 損害某些领域上的創造力，但却可能有益于某些創造力領域或創造性任務（例如文學小說寫作）。 減少或增加焦慮。 或会导致自负。 有頭痛等副作用的風險，但濫用或成癮的可能性較低。 有些药理制剂或存有些许问题，使有些人认为此类药剂不适于增强神经功能，或不认为是属神经增强剂。例如「尼古丁和苯丙胺类药物（如阿德拉）」可能会丧失「胆碱能与多巴胺受体反应性，并最终导致表观遗传下调」。人们使用各类娱乐药物常因之一，是其对社交能力、情绪或创造力等方面，所产生的认知增强效果。以酒精为例，这可能对健康产生重大影响，包括对认知功能的长期负面影响，还可能诱发对药效耐受，长期药物工具化也可能会导致药物成瘾。 些许明显需要调节的认知领域，如情绪，尽管不是先决条件，但或对其他认知功能有益。如，情绪低落或处于抑郁情绪，往往与创造力增强有关。 短期内，无法用于人类的高级认知增强技术，可以建立在设计受体的研究基础上，並通过蛋白质激活或抑制神经元，如使用药物遗传学技术（英语：Receptor activated solely by a synthetic ligand）。 经过基因改造的神经元可将外部元件与神经连接。2020年，研究人員報告稱，通过生物工程對秀麗隱桿線蟲進行了改造，使其能够在脑细胞中合成、制造和组装生物電子材料（英语：Bioelectronics），实现了对特定神经元群膜特性的调控，以及操纵活体动物的行为。 如果有机神经形态设备达到一定程度，并具有生物相容性，就有可能實現新型大腦植入物。还有有關潜在的可植入式物理人工神经元的研究。基因工程或干细胞培育的神经组织的生物移植也有可能实现，另种方法是透過濕件計算機（英语：Wetware computer）達成。 健腦食品所含各種化合物，以草藥或分離物形式攝入，如：桂皮、可可粉、 花色素苷（如於 山桑子和西洋接骨木之中）、硝酸盐（如於紅菜頭之中）、蜂蜜、多酚（存在於許多水果和蔬菜之中）、儿茶素、 L-多巴苯丙氨酸和酪氨酸,苯乙胺、類胡蘿蔔素如番茄紅素（於番茄醬中）茶氨酸、芹菜素（和洋甘菊）、薑、草本茶（尤為香蜂花、迷迭香、辣薄荷和含咖啡因的飲料（英语：Caffeinated drink））、红景天、肌酸、Ω-3脂肪酸（如，藻類提取物（英语：Algaculture））以及纠正普遍存有的微量营养素缺乏症研究其對健康年輕人認知能力，可能产生的微小，但显著的影响或叠加影响。 膳食中的葡萄糖（及其糖原形態）是大脑的主要能量来源，尽管直接摄入葡萄糖会影响健康，但一些研究人员认为葡萄糖是種「生化增强剂」，需要持續補充，但以單醣補充，会使血糖飙升，且其提供的葡萄糖供应，也不会持续太久。与快速吸收或高GI食物相比，吸收缓慢的含碳水化合物食物或低GI食物释放葡萄糖的速度较慢。尽管脑葡萄糖代谢与神经退行性疾病有关，但有关脑葡萄糖代谢与认知能力之间联系的研究却很少。乳酸（尤其是在特定类型的运动中释放）也可能与认知能力的提高有关。 正在进行早期研究的、具有显著潜在可行性的藥劑——作为最终藥劑或類似藥劑的原型——有可能在特定情况下（如学习阶段）对健康青年人特殊層面產生影響。但至少在大多情況下、此類藥劑、对人体的影响和安全性基本未知、因此未被广泛應用或沒被應用、如： 食慾素-A、FGL、PTEN-PDZ和磷酸肌醇3-激酶PTD4-PI3KAc、 益智二肽（英语：dihexa）、环丝氨酸、多巴胺再攝取抑制劑CE-123（英语：CE-123）和CE-158、安帕金（英语：ampakine），如IDRA-21和CX717（英语：CX717）、雷帕替奈（英语：rapastinel）、ISRIB、citicoline（英语：citicoline）、選擇性（英语：selective receptor modulator）受体调节剂、如MRK-016（英语：MRK-016）（作用於GABAA亞型受體）、類似莫達非尼的CRL-40,940（英语：CRL-40,940）和modafiendz、受莫达菲尼启发或混合型SNDRIJZ-IV-10（英语：JZ-IV-10）和JZAD-IV-22、TAK-925（英语：Danavorexton）（食慾素受體拮抗劑（英语：Orexin receptor）與莫達非尼有類似的覺醒作用）、唤醒性或促认知性嗜睡症候选药物，如samelisant（英语：samelisant）、紫檀芪、伊布莫侖（英语：ibutamoren）、H3受體拮抗劑（英语：H3 receptor antagonist）替洛利生。 一些药物、如广泛使用的、与社交能力相关的 GABA受体激动剂（英语：GABA receptor agonist）苯妥英钠、至少在某些剂量下——尽管不一定——会对某些人产生持久的重大副作用和成瘾可能性。其他值得注意的再利用（英语：drug repurposing）化学品已经被广泛用于其他目的、并具有潜在的神经增强功能、但在大多数情况下、没有或很少有針對青年人的研究。側面研究顯示有有限效應和或大小未知的藥劑包括： 大麻二酚、神經肽腦活素（英语：cerebrolysin）、尼麥角林（英语：nicergoline）、石杉鹼甲（英语：huperzine-A）、二甲基乙醇胺和甲氯芬酯（英语：meclofenoxate）、vinpocetine（英语：vinpocetine）、 十六酰胺乙醇（PEA）、和砒硫醇（英语：pyritinol）。 神經刺激（英语：Neurostimulation）方法目前正被研究與開發，研究结果表明，刺激程序的细节至关重要，否則會損害而非增強認知能力。人们对这种方法，能否在认知领域产生有意义的结果提出了质疑。刺激方法包括电刺激、磁刺激、激光光刺激、几种形式的声刺激以及神经反馈（英语：neurofeedback）等物理刺激方法。也有一種想法是，將可神經刺激的穿戴物集成至頭盔之中。 如果說，神经增強药，是提高认知能力的方法之一，那麼对运动皮层的跨顱直流電刺激（tDCS），則被視作另種方法。tDCS最初是用於帮助脑损伤（如中风）患者。但在過去幾年，人们对其在健康人身上的应用也产生了浓厚的兴趣。最近研究已表明，tDCS能改善神经可塑性，促进年轻人运动学习，因而，也有可能将这种方法应用到老年人群中。 在一项研究中，用tDCS刺激大脑的高级认知功能區，如语言功能區，结果改善了受試者的单词检索能力。tDCS通过增强特定受刺激网络的连通性发挥作用，在对任务执行至关重要的高度特定脑区提供神经效率。在此期间，fMRI圖还显示语义检索过程活动减少，表明大脑任务关键区域的处理效率更高。限定任务相关区域活动的减少，被认为有助于巩固运动学习與提高记忆能力。tDCS最新研究正试图定位刺激，以影响所需的高度特定的任务相关神经元子集。2022 年，科学家们证实，跨顱直流電刺激可根据频率的不同，在一个月内改善65-88岁人群的短或长期记忆。 腦深層刺激術（DBS）是另一种神经强化疗法。与tDCS不同之處在於，DBS需要植入医疗设备，而且只限于帕金森病和肌张力障碍等少数严重疾病。一项研究显示，在3个月的治疗过程中，DBS使肌张力障碍患者的运动能力提高39%，残疾程度降低38%，生活质量提高30%。患者的肌张力障碍症状减轻50%。DBS手術后的数小时至数天内，病情明显改善。目前，DBS的疗效远远超过大剂量三苯氧胺（一种用于治疗肌张力障碍的强效药物）。 腦波夾帶（英语：Brainwave entrainment），也称脑波同步或神经夹带，是指观察到脑波（大脑中的大规模电振荡）会自然地与周期性外部刺激的节奏同步，如闪烁的灯光、语言、音乐或触觉刺激。由于不同的意识状态，可能与不同的主导脑电波频率有关，因此假设脑电波夹带可以诱导出一种理想的状态。如，研究人员发现，对慢波睡眠中的delta波，进行声波夹带具有改善健康受试者记忆力的功能效果。一项研究表明，采用「视觉闪烁范式」，以个体自身的大脑节奏（即alpha波）对其进行诱导，可大大加快感知视觉学习速度，并在誘導後第二天依舊保持。特别是，在检测背景杂波中的目标，或识别噪声中的径向玻璃图案与同心玻璃图案的辨别任务中，与不進行alpha波誘導一組相比，诱导組大大加快了学习速度（该组「进步速度至少是对照组的三倍」）。 发展教育也可是神经强化一部分。神经科学和软件（如人工智能和自适应在线学习环境）方面的成果或与这一发展相关，终身学习可被视为认知能力提升的方式之一。 如何分配時間，可能会对认知产生重大影响，反之亦然。而這可通过各种非药物方式調節，如决策、优先顺序、例行活动、反思实践、推理相关技术、游戏化、激励措施等。一篇综述指出，採用「动机访谈、使用奖励或激励措施」等增强动机的措施，可使干预措施在改善健康行为方面，取得更大成功。典型的活动包括睡眠、有偿劳动、学校、社交媒体、电视、志愿服务、锻炼、社交活动和业余爱好等。 有有關時間分配的研究，也有關於各类媒体使用对认知影响的研究。屏幕时间和游戏行为对认知的影响，可能在很大程度上取决于活动、情境、替代活动和内容。而使用认知增强剂藥物的动机就包括「优化时间」和「增加清醒时间」。 在課堂引入和整合多媒體等工具設備，可以提高认知能力和灵活性，降低认知负荷，也可培養數位素養。批判性思维、技术支持的探究学习、科学推理能力和解决问题的技能，可能与认知领域有关，或為「元认知技能」。教育改进或可視為提高認知能力，「教育者」常犯一種谬误，即当他们采用「应试教育」和优先考虑「记忆，而非批判性思维與解决问题等可推广的技能」时，他们会假定如果「个别独特的认知过程可以得到提高[......][这]就一定会提高整体认知能力」此種谬误。 基因工程是未来潜在的认知增强生化策略之一，目前仅在动物模型中进行了初步但成功的测试，还不是研究人员可选取的增强方法。 喬治·丘奇根据科学研究汇编了一份基因改造清单，进行改造会带来有利成效，如减少睡眠需求、与认知相关的变化（如预防阿尔茨海默病）、抗病能力、更高的瘦肌肉质量与更强的学习能力，及相关的研究与潜在的负面影响。一项神经遗传学（英语：Neurogenetics）全基因組關聯分析元分析调查有关语言技能的遗传相关性，报告了迄今为止人类独有的语言相关能力的遗传因素，特别是五个测试特征技能水平差异的因素，也还使用了神经解剖学、神经影像学的数据。但，相关性不等同因果性，因果性既不一定独立于社会因素，也不一定完全有用。 神经强化的主要着重点，如优化儿童发育因素及延缓、逆转或减轻大脑老化。而增强人类记忆与学习能力的尝试，在科学领域也有着悠久历史。 支持提升认知能力的人认为，认知能力提升对劳动力，尤为老年劳动力有巨大的潜在益处。因为上世纪医疗技术的大幅提高，人类平均预期寿命随之大幅增加。发达国家的人口统计数据显示，老年劳动力迅速增长。但，年龄增长通常打击学习新技能之能力，而现今，行业整合比以往任何时候，都更需要员工能够获取和保留新技能的能力。随着老龄人口增加，与年龄有关的失调和疾病，所造成的经济、社会和健康负担也随之增加。最近，「由于全球老龄比例不断增加，而且预计与年龄相关的大脑认知功能衰退也会加剧」，增强认知功能的问题也愈发受到人们关注。 一篇评论指出，「即使是身体正常的年轻人，因睡眠不足、时差或其他压力因素，也并不总是正常发挥身体机能，有些人，可能需要认知增强剂才能在某些情况下发挥最佳水平」。因此，神经增强涉及的是提高各认知领域的能力，使其在更多和更具体的时间内接近并提高最佳水平，及改善神经心理之弱点或并非疾病的轻度缺陷。 常见的神经增强药物，通常对健康人有着很好的耐受。而此类药物已成为治疗各类精神疾病患者的主流药物。由于有关神经增强剂及其功能的大部分信息都源于研究实验，因此，确定不良反应的最佳方法，是脱落率指标与用药者的主观评价。多奈哌齐、美金剛胺、派醋甲酯和莫达非尼的脱落率极低或根本没有。在药物试验中，参与者报告了服用多奈哌齐、美金刚、派醋甲酯或莫达非尼后，出现有以下不良反应：胃肠道不适（恶心）、头痛、头晕、做噩梦、焦虑、嗜睡、紧张、不安、睡眠障碍和失眠，但副作用通常会在治疗过程中消去。虽然没有关于腦深層刺激手術副作用的报告，但有18%的患者报告了与设备相关的并发症，如导线脱落或断裂导致的感染。各种因素，如剂量、时间和行为之因素，都可能形成，或决定副作用出现。但，认知增强剂被广泛使用，但其对健康的长或短期影响，几乎完全未知，或已知对健康不利。 家长与医疗保健师对使用各类神经增强剂的人之安全与健康状况感到担忧。2011年，在杰恩·卢克（Jayne Lucke）发表的一篇文章中，将神经增强的概念与西地那非作比较，指出「西地那非的娱乐性使用者对自己勃起能力的信心低于非使用者，尽管他们的勃起功能明显更好。他们对这些药物产生了心理依赖」。作者认为，神经增强剂使用者也会出现类似的问题。此外，会有高估预期干预措施，或认为其超过实际效果之情况，而过度自信。 若越多人参与进促智队伍一员，那或会导致人们「最终会感到，自己受到了微妙的胁迫，不得不参与进来，以便在学校或职场中保持竞争力」，又或是在军队中，或是受到同伴的各种压力而参与其中。Dubljević指出，「确保纳税人充分知情、跟踪任何不利影响，并由筹集资金（如通过税收或收费）以解决相关社会问题至关重要」，表明政府也可以在应对神经增强挑战方面发挥更积极的作用。在医疗系统中，若没采取调整生产措施，如提高产量、降低生产成本，那样调整，神经增强可能会诱发「处方药转移」现象，分散治疗用处方药之比例。一篇评论假设，近期针对健康个体的随机对照试验样本量有限，部分原因或是研究受到媒体与生物伦理文献影响，这些文献围绕着在健康受试者中使用药物增强认知能力的伦理等主题展开论述。 对于包括膳食补充剂與治疗药品在内的认知增强剂，似乎缺乏各种要求、质量标准、验证和鉴定流程、抽样调查与实验室检测等措施，或为治理失败（英语：Governance failure）之果。意味着，尽管用药者可能是完全了解当前关于化学品利弊与个人用药因素的有关知识，药品仍可能存有，与标签不同或质量较差的风险，这在某些情况下，会造成危险。一项研究，提出了一份建议：「创立知识库——作为学校和成人教育中，有关营养与健康教育的一部分，使人们能够抵制与食品补充剂有关的营销与广告，权衡利弊，知悉潜在健康风险」。 神经强化常被与体育运动中的兴奋剂问题类比，因此有时也被称其为脑兴奋剂。人们普遍关注问题之一是，服用提高成绩药物的人，比不服用的人，享有不公平的优势。但许多运动员认为，要想战胜使用能提高成绩的药物的运动员，唯一方法是，自己也用；看待服用神经增强药物的人时，普通人想法类似。在一项针对18至34岁青少年的调查研究中，50%的青少年对使用兴奋剂的概念几乎没有异议。尤其是学生群体，往往认为认知神经增强剂，可被接受。 通常讲，以神经增强为目的的此类药物，道德可接受性（包括公平观念）是决定使用或不使用这类药物重要因素之一。研究表明，对此类药物的道德反对，大幅降低了使用此类药物的意愿。许多人认为，监管神经增强剂的唯一出路是允许所有人使用，从而最大限度地減少以此帶來的不公平優勢。另一方面，禁止使用这些药物可能会对社会造成有害影响，因为这不仅会形成黑市，扩大非法使用造成的问题，还会增加社会执法成本。因此，需要对神经增强药物利弊进一步评估，使决策者更容易对此类药物的监管做出决定。 总的来说，认知多样性——或某种「最佳多样性范围」——或许有价值。科技进步带来的新能力，自然会引发相关的伦理问题。还有人推测，认知增强技术（CET），也可能会增加认知多样性，如，不同的人会选择增强其认知的不同方面。此外，认知能力的提高，也可能会减少不平等现象，如通过「公平竞争」以及缩小「基因抽签」带来的不平等。 另一问题是分配正义，涉及「谁能获得，新的认知增强技术」与「谁能体验到其益处」之问。影响认知增强剂成本，主要因素之一，便是其专利性，不利于降低成本推广。网上药店可以大幅降低成本，提高可负担性，使消费者得以支付得起某些药品。天然制剂（少量存于食物）可以「为社会经济背景较差，或居住在较贫穷国家的患者提供更多选择」。艾倫·布坎南（英语：Allen Buchanan）在其著作中建议，「我们应该抓住这一新兴药物技术提供的机遇，投入资源，确保这些药物得到适当的开发与测试、确保获得这些药物的机会平等且开放，以避免不公正和黑市的发展」。 Sententia将认知自由之实际应用表示为两个原则： 只要行为不危及他人，就不应违背个人意愿，强迫他们使用与大脑直接交互的技术，也不应强迫他们服用某些精神药物。 只要个人随后不从事伤害他人的行为，就不应禁止他们使用新的增强思维的药物和技术，也不应将其定罪。 第一原则旨在保护个人免受国家、公司或其他个人干扰认知过程，第二原则旨在确保个人拥有改变与增强自身意识之自由。享有认知自由之个体，可以自由地，以任何方式改变自己的心理过程，无论通过冥想、瑜伽或祈祷等间接方式，或，通过精神药物与神经技术进行直接的认知干预来达到。由于精神药物是强有力改变认知功能方法之一，许多主张认知自由的人，同时也倡导药物相关立法改革；他们声称，「对毒品的战争」实际上是「对精神状态的战争」。认知自由与伦理中心（Center for Cognitive Liberty and Ethics，CCLE）及其他倡导认知自由的组织，一直在游说重新审查与改革违禁药物法；CCLE的主要指导原则之一是：「政府不应在刑事上禁止认知增强或体验任何精神状态」。还有人以认知自由为由，呼吁改革对使用百忧解、利他林和阿德拉等增强认知能力的处方药之限制。 认知自由对超人类主义运动支持者而言，也同样重要，超人类主义运动关键信条之一，便是增强人类的精神功能。Wrye Sententia强调了认知自由，在确保追求人类精神增强的自由，及选择反对增强的自由方面的有着相当重要性。Sentia认为，承认「指导、修改或强化个人思维过程的权利（以及不如此做的权利）」对于自由应用新兴神经技术，以增强人类认知能力至关重要；而且需要超越当前的思想自由概念。Sentia称，「认知自由的优势在于，它既能保护那些确实想改变大脑的人，也能保护那些不想改变大脑的人」。 许多人权倡议者业已提出许多相关神经增强的人权倡议。 2023年，在妮塔·A·法拉尼（英语：Nita A. Farahany）出版一本书中，提出了一项新的有关认知自由的人权倡议，作为「对现有的隐私权、思想自由权和自决权等其他人权的更新」，部分原因是一些神经增强技术也可能被用于「非自愿神经监控」等方式（包括商业目的），而容易受到黑客攻击或被用于操纵。还有人提出「认知自由权、精神隐私权、精神完整权和心理连续性权」等权利。2021年，智利成为第一个批准神经法的国家，规定了有关个人身份、自由意志和精神隐私的权利。 神经增强药在一些小说和电影中扮演着重要角色，如2011年的《藥命效應》，该片在一定程度上，以富有想象力的方式，探究与探讨了使用神经增强药的机遇与威胁。 公众对神经增强问题的看法不一。通常说，25岁以下的年轻人，认为神经增强剂可被接受，或说决定权于个人手中。医疗保健官员和家长则担忧，如安全因素、缺乏有关这些药物完整信息，及可能出现的不可逆之不良影响。事实证明，这些担忧，会降低使用此类药物的意愿。 2016年，德国对6454名受访者进行的一项研究发现，认知增强药物的终身使用率相当低（2.96%），而每十名受访者中，就有一人愿意服用此类药物（10.45%）。据研究估计，美国有7-9%的大学生服用神经增强药物。有些研究估计这一数字高达12%，甚至20%。一项对5000多名德国大学生进行随机抽样大规模调查发现，30天内使用此类药物的比例相对较低，分别为1.2%、2.3%、3.2%和4.6%。在过去6个月内，使用过此类药物的学生中，39.4%表示在此期间使用过一次，24.2%使用过两次，12.1%使用过三次，24.2%使用过三次以上。研究表明，神经增强药物的消费者更愿意在未来使用这些药物，例如，由于药物带来的积极体验或成瘾倾向。学生们认为使用这些药物，主要是为了提高注意力、提高警觉性或「嗨」起来。 神经增强药物使用者对神经增强药物积极潜力的评价高于非使用者，而对这些药物不良反应的评价低于非使用者，这表明他们对这些药物的效果更有信心。在一项针对1324名德国学生的调查中，32%不服用神经增强药物的受访者，认为这些药物具有积极促认知效果，12%参与者认为这些药物具有放松效果。相比之下，54%的服用神经增强药物的参与者认为这些药物具有积极的认知效果，25%的人认为这些药物具有放松效果。 对保持「警觉」与「专注」的需求，也可以从咖啡因消费的趋势中看出。在美国，学生和普通人的咖啡因消耗量都在90%左右。服用神经增强剂的学生服用大麻等精神活性药物的频率也更高。一项针对德国大学教师（包括教授）的研究发现，其使用神经增强药物的比例非常低。只有0.9%的受访者报告使用过这类药物。不过，10%的受访者愿意在未来服用此类药物，这或表明此类药物的流行率或会上升。与工作有关的压力是使用这类药物的原因之一。 医生在确定神经增强药物的潜在滥用方面发挥重要作用。有些神经增强药物无需处方，容易买到，而其他需要处方的药物，则由医生自行决定。在对瑞士精神科医生和全科医生进行的一项调查中，大多数受访医生一致认为，他们判断功能障碍是否应被视为疾病的标准是，患者是否表示出主观痛苦或对日常工作能力造成负面影响。不过，大多数接受调查的医生都认为，如果没有明确的功能障碍迹象，他们不会开药。 Battleday, Ruairidh; Brem, Anna-Katharine. 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