Although these findings have not conclusively demonstrated synergistic effects, we still believe that such approaches are compelling options to maintain both cognitive and physical health in aging 65 and provide a time- and resource-efficient means of targeting multiple risk factors in OA Our perspective is that, to achieve synergistic effects, a combined cognitive and physical challenge should be delivered in an integrated manner without trade-offs across domains, and that this can be obtained by simultaneously engaging multiple closed-loop systems across areas to achieve a common outcome from a single intervention.

This approach is currently being tested in clinical trials. There is growing interest in using various forms of meditation as therapeutic interventions to enhance attention 67 and combat cognitive decline in OA In addition to leading to improvements in cognition 69 , meditation and mindfulness practices have been studied as potential therapies for loneliness 70 , depression 71 , impulse control 72 , and chronic pain management 73 in OA.

Long-term meditation has been found to mitigate signs of brain aging 74 , 75 and improve well-being in OA Moreover, these practices do not offer quantifiable metrics of success or performance feedback during the learning phases — factors that are important for maintaining engagement with an intervention Further, traditional meditation is difficult to personalize because it is not adaptive or tailored to individuals, making it overly challenging for some novices.

Although recent studies have tested the delivery of website-accessible 79 and mobile 80 meditation programs, these online practices tend to duplicate the procedures of traditional meditation and consequently have faced similar hurdles to implementation.

In addition, while meditation apps on mobile devices have become increasingly ubiquitous 81 , studies to date have either failed to characterize their effects on cognition or have shown equivocal results An example of an approach to achieving a closed-loop digital meditation is MediTrain 83 , which was designed with the goal of improving focused, sustained attention.

This digital approach to meditation personalizes the experience to the real-time abilities of individuals, provides both punctuated and continuous feedback, and includes adaptivity that increases the challenge level as the user improves. Following several studies demonstrating a positive impact of MediTrain on attention in younger populations 83 , 84 , 85 , a large-scale, fully remote trial of this digital intervention is being conducted in OA using a mobile RCT platform Fig.

Interestingly, another modern, technology-enabled approach to meditation relies on neurofeedback from EEG signals recorded from a consumer device and has led to similar improvements in cognitive control These new technologically enabled types of meditation may open the door for personalization of treatments, with some forms for example, neurofeedback versus performance-based feedback working better for specific individuals.

First, recruitment is conducted entirely remotely through social-media outreach, online advertisements, agreements with senior living centers, and direct mail campaigns.

Next, OA are sent a link to visit a mobile RCT portal where they complete informed consent and eligibility forms on their computers or mobile devices. They then complete baseline cognitive assessments, demographic questionnaires, and surveys of real-life behaviors and conditions, and those data are input into machine-learning algorithms that predict which digital intervention is most appropriate for each person, and randomization is done in a stratified manner.

Once assigned to an arm, OA complete the digital intervention at home while data are collected remotely. Finally, advanced device or cloud-based analytics allow for rapid analysis of results in real time, accelerating the pace of research and discovery. These results can then be interpreted by researchers or visualized and presented to the participants as a performance dashboard, enabling them to monitor their own progress.

The OA population is extremely heterogeneous Increasing age is associated with the risk of detrimental physiological or sensory changes, as well as increased risk of chronic diseases for example, diabetes, cancer, heart disease, and cognitive impairment.

At the same time, chronological age is not always a good predictor of functional capacity, with some individuals over the age of 80 continuing to work and travel, while other younger individuals are unable to. This variability in older populations is often overlooked when developing cognitive therapeutics, thus limiting the potential efficacy of interventions in some populations.

Further, within trials of cognitive interventions, there is often pronounced variability in treatment responses that is ignored when reporting group averages, suggesting the need for additional personalization tactics.

We propose that these differences represent meaningful heterogeneity, such that there is likely not a one-size-fits-all solution for cognitive enhancement in OA.

A critical step to developing personalized interventions is identification of biomarkers that predict intervention success for a particular individual 88 , Some of the most promising personalization results come from studies that have used advanced neuroimaging methods to uncover neural factors that predict treatment success in an individual.

Much of this work in OA has focused on metrics related to magnetic resonance imaging MRI , spanning individual brain regions to large-scale brain-network properties 89 , Although much of the work using structural brain region predictors for example, volume 91 , 92 , 93 and thickness 94 has been largely inconclusive, more recently one common organizing principle of functional brain networks — modularity — has emerged as a potential unifying predictor of outcomes across a variety of interventions Modularity may be a biomarker of cognitive plasticity that predicts treatment outcomes across interventions Although much of this work in OA has focused on MRI-related metrics, parallel findings in younger adults have identified electroencephalogram EEG -based markers that predict treatment outcomes Extending such EEG findings to OA will be an important next step as affordable, consumer-grade home EEG devices continue to increase in quality and ease of use, paving the way for at-home neural diagnostics that can be used to tailor intervention strategies or parameters to individuals.

Although it is clear that individual differences play an important role in intervention responsiveness 88 , 99 , there are several lines of future work that will translate our understanding of these differences to developing personalized interventions. First, there is a need to better understand biomarkers of treatment outcomes.

Second, it is likely that multiple biomarkers that span demographics, cognition, and neural profiles have interacting, and potentially additive, effects on predicting outcomes.

Large-sample RCTs that incorporate machine learning will be critical in developing multimodal models that elucidate these predictive effects. Indeed, ongoing work is using an online citizen science approach to recruit tens of thousands of volunteers to validate and personalize cognitive enhancement technologies , and machine learning is now being used to optimize non-invasive brain-stimulation protocols for different individuals We anticipate a future of personalized digital therapeutics in which individuals are pre-assigned optimal training parameters, thus maximizing treatment outcomes for everyone.

An example of a technology-based, non-pharmacological strategy for enhancing cognition in aging that has benefited from a precision-medicine approach is non-invasive brain stimulation NIBS. Of particular interest is the coupling of NIBS with cognitive challenges; the hypothesis is that targeted neural networks are selectively activated by task engagement and then further modulated by brain stimulation, resulting in synergistic neuro-enhancing effects that drive greater cognitive improvement This raises the possibility that NIBS could be used to augment any closed-loop, cognitive therapeutic approaches by enhancing the underlying neuroplasticity, thus leading to even greater cognitive enhancement.

Two forms of NIBS methodologies are transcranial direct current stimulation tDCS and transcranial alternating current stimulation tACS. These techniques modulate neuronal transmembrane potentials by delivering weak electrical currents tDCS and tACS , , , thereby altering plasticity in the stimulated brain regions , Although the application of NIBS is generally thought to be a safe, non-pharmacological approach that has shown potential to counteract age-associated cognitive decline , crucial questions surrounding the heterogeneity of effects remain unaddressed.

First, optimal stimulation protocols and regimes need to be established. The direction and magnitude of effects of NIBS are strongly influenced by the prevailing brain states in targeted regions at the time of stimulation , Thus, the timing of the stimulation while a cognitive task is administered during the stimulation is critical.

Second, inter-individual variability exists in response to NIBS, with efficacy of NIBS being related to degree of education , genotype , pre-intervention performance , and the magnitude of the electric fields that reach the targeted brain area , which underscores the importance of individualizing stimulation parameters.

In summary, an effective use of NIBS to induce cognitive enhancement in aging brains likely requires an integration of optimal stimulation protocols and individually tailored stimulation parameters to more precisely target the specific functional networks that underlie cognitive functions most in need of improvement.

Testing hypotheses about the factors that predict or moderate treatment responses in the remarkably heterogenous OA population requires large and diverse cohort samples.

Such large-scale studies are also needed to move the field beyond findings from relatively small studies towards the real-world validation of cognitive therapeutic technologies.

An emerging solution is to leverage modern, mobile technology for example, the Internet, wireless mobile devices, and cloud-based analytical and storage servers to facilitate the recruitment of larger, more diverse, representative cohorts into clinical trials while minimizing costs.

The need for such a solution has been augmented by the COVID pandemic, which has led to an even greater necessity for new, creative tools for improving public mental health in the setting of such unpredictable conditions. New digital health technologies also hold promise for altering the landscape of how RCTs are conducted Fig.

Indeed, it is now clear that mobile technology can be especially powerful in improving research-participant access, especially to those living in rural areas or members of minority ethnic groups, while simultaneously reducing the expense and time course of such trials Most of these research platforms have been designed to assist with enrolling participants, collecting data, and applying human resources for data interrogation, rather than complex study coordination.

However, we believe that the next phase of this field will use technology for more than data collection, but also to make easily interpretable data more actionable for both researchers and participants.

Indeed, there is an important value in developing technology not only to collect data, but also to accelerate the pace of research and enhance the security of data collected remotely for example, through cloud-based analytics and storage.

Relevant to this discussion, more OA are embracing new technology every year. The clear trend is toward increased adoption of mobile technologies, making it important to study and refine digital interventions for enhancing cognition now, so they can reach as many OA as possible.

Critically, the percentage of the population that owns a mobile device is equally distributed among white, Black, and Hispanic people , , Thus, fully remote trials of digital therapeutics have the potential to greatly increase the ability to disseminate these interventions at scale and to reach drastically more diverse study populations than would be expected from a trial that requires participants to come into a medical or research center.

One step toward addressing this goal is making such tools easily accessible. Research has demonstrated that telemedicine and mobile approaches show comparable efficacy to in-person treatment , resulting in substantial interest in using mobile apps as an alternative care-delivery platform.

Such digital approaches to cognitive enhancement have the potential for breaking down barriers to access, especially in underserved or hard-to-reach populations of OA We have reviewed several approaches in which technology can aid in the personalization of cognitive enhancement in aging, but other emerging technologies also offer exciting new avenues for innovation.

Elements such as art, music, story, challenge, and competition could be dynamically manipulated to maximize engagement and compliance to further personalize experiences. Key to such an approach will be collection of large amounts of data and the application of machine-learning and artificial-intelligence techniques to create robust and dynamic predictive models of the factors that moderate treatment responses at the individual level.

There are a host of new accessible mobile technologies that can be leveraged to collect ecologically valid data as individualized baseline signatures and ongoing diagnostic monitoring of OA in the real-world and in real-time In addition to cognitive enhancement, technology is transforming the broader landscape of mental health and high-quality, personalized care for healthy OA who are living longer with each generation.

Technologies that attempt to modify and support real-life behaviors have advanced at a tremendous pace in recent years. For example, several methods have been developed to combat loneliness, anxiety, and depression, which are common in OA Examples include online and mobile delivery of established clinical treatments, such as cognitive behavioral therapy ; VR paradigms for fostering greater feelings of connectedness and boosting mood ; artificial-intelligence-driven voice-activated technologies for example, Alexa that not only help with organization and access to news and media, but also increase connectedness through human—machine conversations ; and therapeutic robots in the form of appealing animals that help OA cope with anxiety and memory loss These technologies are exciting and add to the emerging ecosystem of methods that can be tailored to the specific needs of an individual.

The impact of these therapeutic technologies could be augmented through combinatorial approaches as discussed above and by the incorporation of closed-loop systems for example, a robotic companion that receives passive physiological signals from a wearable device and uses those data to guide its real-time engagement with its OA companion.

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Neurostimulation methods are being researched and developed. Applications of augmented reality technologies see below are investigated for general memory enhancement, extending perception and learning-assistance. The Internet may be considered as a " powerful cognitive enhancement technology " [24] or as enabling "Internet-extended cognition" or "Web-extended minds" or "human-extended machine cognition".

Substantial neuroenhancement potential therefore may lie in measures such as individual empowerment possibly via existing education systems , software development and better collaborative systems for sorting and categorizing information.

Quality standards, validation and authentication , sampling and lab testing are commonly substandard or absent for products thought to be cognitive enhancers, including dietary supplements. Neuroenhancement products are mentioned in entertainment productions, such as Limitless , which may to some degree probe and explore opportunities and threats of using such products.

In general, the younger population under the age of 25 feel that neuroenhancements are acceptable or that the decision lies in the hand of that individual. Healthcare officials and parents feel concerned due to safety factors, lack of complete information on these drugs, and possible irreversible adverse effects.

Such concerns have been shown to reduce the willingness to take such drugs. A German study among 6. A large-scale survey using a random sample of more than 5.

It has been shown that consumers of neuroenhancement drugs are much more willing to also use them in the future, e. due to positive experiences or a tendency towards addiction.

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Extension of cognition in the healthy. Main article: Modafinil. Main article: Methylphenidate. See also: Food safety and Health policy.

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As population aging advances at an increasing rate, efforts to help people maintain or improve cognitive function late in life are critical. Although some studies have shown promise, the question of whether cognitive training is an effective tool for improving general cognitive ability remains incompletely explored, and study results to date have been inconsistent.

In this Perspective, we argue that modern technology has the potential to enable large-scale trials of public health interventions to enhance cognition in older adults in a personalized manner. Technology-based cognitive interventions that rely on closed-loop systems can be tailored to individuals in real time and have the potential for global testing, extending their reach to large and diverse populations of older adults.

We propose that the future of cognitive enhancement in older adults will rely on harnessing new technologies in scientifically informed ways.

Federico Cavanna, Stephanie Muller, … Enzo Tagliazucchi. Hamilton Se-Hwee Oh, Jarod Rutledge, … Tony Wyss-Coray. Roey Schurr, Daniel Reznik, … Samuel J. Population aging — the increasing percentage of older adults OA in a community — is poised to become one of the most significant social transformations of the twenty-first century, with implications for nearly all sectors of society 1.

Importantly, population aging will be accompanied by a proportionate increase in OA who will experience normal age-related cognitive impairments, as well as more severe cognitive decline 2 , 3. Preventing or remediating cognitive decline in OA by as little as 1 year may delay the onset of nearly 10 million new cases of dementia 2.

Despite widespread enthusiasm for the development of cognitive enhancement approaches in this age group, numerous trials of cognitive training, dietary, and lifestyle interventions 4 have either failed to prevent cognitive decline or have had relatively modest effects.

Further, several meta-analyses of cognitive training in younger populations 5 , 6 , 7 have failed to demonstrate far transfer of training gains Box 1 ; however, other meta-analyses 8 , 9 , 10 and large-scale studies 11 , 12 , 13 that focused on OA suggest there is more potential in that group for broader gains from cognitive training.

A common element in most of these studies is a one-size-fits-all approach that treats all participants in the same manner and ignores the vast degree of heterogeneity in older populations 14 , This is in contrast to other fields, such as geroscience, that have moved toward a precision-medicine model for combating age-related decline.

A treatment plan can thus be tailored to the person, avoiding reliance on a typical trial-and-error approach. Although some researchers have explored multimodal interventions to remediating cognitive decline 17 , the precision-medicine model has not yet deeply penetrated the field of cognitive enhancement in aging For example, approaches to cognitive enhancement through the delivery of interactive experiences often fail to sufficiently engage OA with challenges, rewards, and stimuli that are appropriate for them — factors that are thought to be critical for maximizing neuroplasticity Modern technology, however, has the potential to transform this field by enabling cognitive interventions to be targeted to individuals who are most in need, as well as to those who will benefit most from a specific intervention.

Further, OA report being open to using new technologies for improving cognitive function, with a personalized approach seen as most desirable 19 , An important goal, therefore, is to bridge the gap between neuroscience and technology to develop and validate scientifically informed, technology-based interventions to explore the benefits of a precision-medicine model of cognitive enhancement for OA.

In this article, we will review progress in several technological domains that, from our perspective, hold great potential to transform the field of cognitive enhancement in OA: 1 developing new interventions that implement closed-loop systems to personalize delivery of plasticity-harnessing software, 2 advancing a precision-medicine model of cognitive enhancement through the identification of predictive biomarkers to deliver the most effective intervention to each person, 3 enabling remote, large-scale, real-world studies to validate promising results of laboratory-based studies of cognitive enhancement with smaller cohorts, and 4 expanding delivery of validated interventions to larger and more diverse populations.

We will begin by reviewing the methodology of non-invasive, technology-based, closed-loop interventions and several examples of cognitive enhancement approaches that incorporate different instantiations of closed-loop systems in OA Box 1.

A less effective illusion of depth perspective 2. Participants do not experience an immersive environment with computer or tablet screens. Closed-loop system : A system also called a feedback system that adapts its output on the basis of real-time, quantitative measurements from the input arm.

Cognitive enhancement : Cognition refers to the mental processes required to gain knowledge and achieve goals, including attention, memory, perception, decision making, language, and emotional regulation.

Enhancement is a lasting increase in one or more of these abilities above a personal baseline, whether that is considered normal or impaired.

Cognitive intervention : A non-pharmacological approach to enhancing cognition that is based on scientifically informed principles of neuroplasticity that is, the ability of the brain to change. High-fidelity long-term memory LTM : Recalling distinct and specific information for episodic, spatial, associative or temporal order details about a prior experience.

High-fidelity LTM depends on the hippocampus. Network modularity : A graph theoretical approach to model functional networks in the brain. Modularity quantifies the extent to which a network is partitioned into sub-networks also referred to as modules or communities.

A network with high modularity has many connections within sub-networks and fewer connections between sub-networks. Non-invasive brain stimulation NIBS : A set of technologies in which various patterns of electrical or magnetic stimulation are used to alter brain activity from the surface of the scalp without breaking the skin.

Precision medicine: An approach that tailors medical treatments to the individual, rather than taking a one-size-fits-all approach. The most appropriate and optimal treatment parameters are selected based on genetic, environmental, and lifestyle factors that may predict treatment success for an individual.

SMART design: The sequential multiple assignment randomized trial SMART is a type of research study designed to allow the testing of multiple potential adaptive interventions while tailoring key variables.

Transfer is sometimes referred to as generalization. This approach does not capitalize on the fact that, as a result of neuroplasticity, cognitive abilities are fluid over time. Thus, many cognitive interventions are either too easy or too difficult for an individual, particularly as their abilities improve over time.

In this section, we provide brief examples of emerging approaches to cognitive enhancement that rely on closed-loop designs and new technologies that show promise for transforming the field see Fig.

Note that this selection does not include all approaches being pursued, but rather reflects specific domains in which the authors have the greatest level of experience and knowledge. a , Combining fitness and cognitive challenges in a meaningful way can lead to synergistic effects of an intervention.

b , Digital forms of meditation make the practice more accessible to large, diverse populations. c , Head-mounted VR displays enable highly immersive environments that provide the context and engagement needed to bolster long-term memory functions.

d , Neurostimulation applied in conjunction with a cognitive intervention can help accelerate learning and enhance gains in cognitive abilities. The enhancement of declining cognitive control abilities for example, attention, working memory, and cognitive flexibility 18 , 22 are of notable interest for OA because these abilities are particularly vulnerable to the effects of healthy aging and have a large impact on quality of life One of the first cognitive enhancement interventions to rely on a closed-loop system was the NeuroRacer intervention These effects significantly exceeded those in both active- and no-contact-control groups 24 , with observed improvements in multitasking performance on the game itself persisting 6 years later, without any booster training It has further been shown that other closed-loop neurotherapeutic approaches can lead to significant gains in cognitive control in both older humans 26 , 27 , 28 and aged rodents Validating closed-loop cognitive enhancement tools for older adults in randomized controlled trials to show meaningful cognitive gains and then advancing them as a regulated medical device will be especially important, given the number of products marketed as cognitive-aging and dementia treatments without scientific support.

In addition to cognitive control, declining long-term memory LTM affects diverse aspects of cognitive performance and results in an overall diminished quality of life for many healthy OA Chronic memory loss is typically first apparent as impairments in high-fidelity memory that is, recalling distinct and specific information 30 , which is the most precise form of LTM.

The progression of memory loss in aging is a cardinal sign of mild cognitive impairment MCI 31 and may foreshadow the onset of dementia High-fidelity memory depends on the flexible association of information that is remembered in distinct and detailed terms, and it depends on the hippocampal memory system 32 , Although practice and other mnemonic strategies have been shown to improve the ability to remember studied information 34 , the goal of strengthening high-fidelity LTM mechanisms in OA with behavioral or pharmaceutical interventions has proven elusive.

The animal literature has provided evidence that an exposure regimen of environmental enrichment can upregulate hippocampal functions 35 , 36 , which in turn promotes better memory A similar approach to environmental enrichment in humans may generalize to improvements in high-fidelity LTM capabilities 38 , Yet applying these principles to humans, who have rich, detailed memories from a lifetime of experience, presents a unique challenge.

Because upregulating hippocampal function is thought to result from encoding complex information into LTM 35 , 37 , a principal challenge is presenting OA with information that is both novel and captivating enough to hold their deep engagement for an extended intervention; for example, an adaptive environment that is customized to each individual.

Modern technology now enables more elaborate and immersive sensory presentations and manipulation of a wider range of stimuli in cognitive interventions, thus leading to more engaging and personalized learning experiences. Studies have found that head-mounted-display virtual reality HMD VR drives greater engagement and increased performance relative to the same task presented on a flat-screen-monitor 40 , In terms of customizing the intervention environment, the use of HMD VR tools enables: 1 flexible control of the novelty of rich visual stimuli and game-play mechanics, which underpins development of the most intriguing learning experiences, and 2 increasing the engagement of participants in order to sustain their attentiveness and motivation for long, repeated training sessions that are necessary to achieve broader improvements in high-fidelity LTM.

As such, OA can encounter a dynamic and personalized learning challenge that is, environmental enrichment with interventions using HMD VR. Further, several studies have shown that OA are often enthusiastic about using VR platforms, and research has shown that it is possible to design VR experiences that are accessible to OA 43 ; therefore, getting OA to use VR at home is highly feasible To capitalize on these technological advantages, the Labyrinth intervention advances beyond flat-screen video games to stimulate learning in new spatial environments 45 by incorporating HMD VR and motion-capture sensors in a spatial wayfinding game Specifically, task performance in 3D VR uses binocular vision, which arises from a complex network of dorsal occipital areas and feeds a more intricate representation of the environment forward to enhance spatial-memory encoding The results from an intervention trial of Labyrinth showed that healthy OA increased their spatial wayfinding abilities in the game, but more importantly, these gains generalized to improved high-fidelity LTM performance on an unpracticed memory test Notably, post-training memory performance in OA who engaged with Labyrinth reached levels comparable to baseline high-fidelity LTM in younger adults.

Unlike the ambiguity surrounding the potential benefits of cognitive training for OA, the benefits of physical-fitness interventions have been well established in both healthy and cognitively impaired individuals 47 , 48 , Mechanistically, physical-fitness interventions have been shown to increase production of proteins such as BDNF, IGF-1, and VEGF 50 , 51 , which modulate neurogenesis 52 , 53 and subsequently facilitate enhanced brain functions 54 , 55 through heightened brain network connectivity discussed more below.

Similarly, cognitive training has been shown to lead to increased neuronal plasticity at the cellular for example, BDNF expression 56 , 57 and network for example, functional connectivity 24 , 58 levels.

New technologies, such as motion-capture sensors and VR, hold great promise for increasing engagement and enjoyment of physical-fitness training in OA Interestingly, results from animal studies have shown that linking physical and cognitive challenges can lead to synergistic enhancement of cognitive processes Although several studies 61 , 62 have sought to evaluate combined cognitive- and physical-training programs to enhance cognition in OA, the conclusions from these studies have been largely inconclusive, possibly owing to intervention delivery limitations.

In some studies, participants alternated days devoted to each training modality and thus were not exposed to an integrated experience 61 , Other studies that attempted simultaneous physical and cognitive training inadvertently created an imbalanced training environment by failing to incorporate common goals that united the components 63 , Although these findings have not conclusively demonstrated synergistic effects, we still believe that such approaches are compelling options to maintain both cognitive and physical health in aging 65 and provide a time- and resource-efficient means of targeting multiple risk factors in OA Our perspective is that, to achieve synergistic effects, a combined cognitive and physical challenge should be delivered in an integrated manner without trade-offs across domains, and that this can be obtained by simultaneously engaging multiple closed-loop systems across areas to achieve a common outcome from a single intervention.

This approach is currently being tested in clinical trials. There is growing interest in using various forms of meditation as therapeutic interventions to enhance attention 67 and combat cognitive decline in OA In addition to leading to improvements in cognition 69 , meditation and mindfulness practices have been studied as potential therapies for loneliness 70 , depression 71 , impulse control 72 , and chronic pain management 73 in OA.

Long-term meditation has been found to mitigate signs of brain aging 74 , 75 and improve well-being in OA Moreover, these practices do not offer quantifiable metrics of success or performance feedback during the learning phases — factors that are important for maintaining engagement with an intervention Further, traditional meditation is difficult to personalize because it is not adaptive or tailored to individuals, making it overly challenging for some novices.

Although recent studies have tested the delivery of website-accessible 79 and mobile 80 meditation programs, these online practices tend to duplicate the procedures of traditional meditation and consequently have faced similar hurdles to implementation.

In addition, while meditation apps on mobile devices have become increasingly ubiquitous 81 , studies to date have either failed to characterize their effects on cognition or have shown equivocal results An example of an approach to achieving a closed-loop digital meditation is MediTrain 83 , which was designed with the goal of improving focused, sustained attention.

This digital approach to meditation personalizes the experience to the real-time abilities of individuals, provides both punctuated and continuous feedback, and includes adaptivity that increases the challenge level as the user improves.

Following several studies demonstrating a positive impact of MediTrain on attention in younger populations 83 , 84 , 85 , a large-scale, fully remote trial of this digital intervention is being conducted in OA using a mobile RCT platform Fig.

Interestingly, another modern, technology-enabled approach to meditation relies on neurofeedback from EEG signals recorded from a consumer device and has led to similar improvements in cognitive control These new technologically enabled types of meditation may open the door for personalization of treatments, with some forms for example, neurofeedback versus performance-based feedback working better for specific individuals.

First, recruitment is conducted entirely remotely through social-media outreach, online advertisements, agreements with senior living centers, and direct mail campaigns.

Next, OA are sent a link to visit a mobile RCT portal where they complete informed consent and eligibility forms on their computers or mobile devices. They then complete baseline cognitive assessments, demographic questionnaires, and surveys of real-life behaviors and conditions, and those data are input into machine-learning algorithms that predict which digital intervention is most appropriate for each person, and randomization is done in a stratified manner.

Once assigned to an arm, OA complete the digital intervention at home while data are collected remotely. Finally, advanced device or cloud-based analytics allow for rapid analysis of results in real time, accelerating the pace of research and discovery.

These results can then be interpreted by researchers or visualized and presented to the participants as a performance dashboard, enabling them to monitor their own progress. The OA population is extremely heterogeneous Increasing age is associated with the risk of detrimental physiological or sensory changes, as well as increased risk of chronic diseases for example, diabetes, cancer, heart disease, and cognitive impairment.

At the same time, chronological age is not always a good predictor of functional capacity, with some individuals over the age of 80 continuing to work and travel, while other younger individuals are unable to. This variability in older populations is often overlooked when developing cognitive therapeutics, thus limiting the potential efficacy of interventions in some populations.

Further, within trials of cognitive interventions, there is often pronounced variability in treatment responses that is ignored when reporting group averages, suggesting the need for additional personalization tactics. We propose that these differences represent meaningful heterogeneity, such that there is likely not a one-size-fits-all solution for cognitive enhancement in OA.

A critical step to developing personalized interventions is identification of biomarkers that predict intervention success for a particular individual 88 , Some of the most promising personalization results come from studies that have used advanced neuroimaging methods to uncover neural factors that predict treatment success in an individual.

Much of this work in OA has focused on metrics related to magnetic resonance imaging MRI , spanning individual brain regions to large-scale brain-network properties 89 , Although much of the work using structural brain region predictors for example, volume 91 , 92 , 93 and thickness 94 has been largely inconclusive, more recently one common organizing principle of functional brain networks — modularity — has emerged as a potential unifying predictor of outcomes across a variety of interventions Modularity may be a biomarker of cognitive plasticity that predicts treatment outcomes across interventions Although much of this work in OA has focused on MRI-related metrics, parallel findings in younger adults have identified electroencephalogram EEG -based markers that predict treatment outcomes Extending such EEG findings to OA will be an important next step as affordable, consumer-grade home EEG devices continue to increase in quality and ease of use, paving the way for at-home neural diagnostics that can be used to tailor intervention strategies or parameters to individuals.

Although it is clear that individual differences play an important role in intervention responsiveness 88 , 99 , there are several lines of future work that will translate our understanding of these differences to developing personalized interventions.

First, there is a need to better understand biomarkers of treatment outcomes. Second, it is likely that multiple biomarkers that span demographics, cognition, and neural profiles have interacting, and potentially additive, effects on predicting outcomes.

Large-sample RCTs that incorporate machine learning will be critical in developing multimodal models that elucidate these predictive effects. Indeed, ongoing work is using an online citizen science approach to recruit tens of thousands of volunteers to validate and personalize cognitive enhancement technologies , and machine learning is now being used to optimize non-invasive brain-stimulation protocols for different individuals We anticipate a future of personalized digital therapeutics in which individuals are pre-assigned optimal training parameters, thus maximizing treatment outcomes for everyone.

An example of a technology-based, non-pharmacological strategy for enhancing cognition in aging that has benefited from a precision-medicine approach is non-invasive brain stimulation NIBS. Of particular interest is the coupling of NIBS with cognitive challenges; the hypothesis is that targeted neural networks are selectively activated by task engagement and then further modulated by brain stimulation, resulting in synergistic neuro-enhancing effects that drive greater cognitive improvement This raises the possibility that NIBS could be used to augment any closed-loop, cognitive therapeutic approaches by enhancing the underlying neuroplasticity, thus leading to even greater cognitive enhancement.

Two forms of NIBS methodologies are transcranial direct current stimulation tDCS and transcranial alternating current stimulation tACS. These techniques modulate neuronal transmembrane potentials by delivering weak electrical currents tDCS and tACS , , , thereby altering plasticity in the stimulated brain regions , Although the application of NIBS is generally thought to be a safe, non-pharmacological approach that has shown potential to counteract age-associated cognitive decline , crucial questions surrounding the heterogeneity of effects remain unaddressed.

First, optimal stimulation protocols and regimes need to be established. The direction and magnitude of effects of NIBS are strongly influenced by the prevailing brain states in targeted regions at the time of stimulation , Thus, the timing of the stimulation while a cognitive task is administered during the stimulation is critical.

Second, inter-individual variability exists in response to NIBS, with efficacy of NIBS being related to degree of education , genotype , pre-intervention performance , and the magnitude of the electric fields that reach the targeted brain area , which underscores the importance of individualizing stimulation parameters.

In summary, an effective use of NIBS to induce cognitive enhancement in aging brains likely requires an integration of optimal stimulation protocols and individually tailored stimulation parameters to more precisely target the specific functional networks that underlie cognitive functions most in need of improvement.

Testing hypotheses about the factors that predict or moderate treatment responses in the remarkably heterogenous OA population requires large and diverse cohort samples. Such large-scale studies are also needed to move the field beyond findings from relatively small studies towards the real-world validation of cognitive therapeutic technologies.

An emerging solution is to leverage modern, mobile technology for example, the Internet, wireless mobile devices, and cloud-based analytical and storage servers to facilitate the recruitment of larger, more diverse, representative cohorts into clinical trials while minimizing costs.

The need for such a solution has been augmented by the COVID pandemic, which has led to an even greater necessity for new, creative tools for improving public mental health in the setting of such unpredictable conditions.

New digital health technologies also hold promise for altering the landscape of how RCTs are conducted Fig. Indeed, it is now clear that mobile technology can be especially powerful in improving research-participant access, especially to those living in rural areas or members of minority ethnic groups, while simultaneously reducing the expense and time course of such trials Most of these research platforms have been designed to assist with enrolling participants, collecting data, and applying human resources for data interrogation, rather than complex study coordination.

However, we believe that the next phase of this field will use technology for more than data collection, but also to make easily interpretable data more actionable for both researchers and participants. Indeed, there is an important value in developing technology not only to collect data, but also to accelerate the pace of research and enhance the security of data collected remotely for example, through cloud-based analytics and storage.

Relevant to this discussion, more OA are embracing new technology every year. The clear trend is toward increased adoption of mobile technologies, making it important to study and refine digital interventions for enhancing cognition now, so they can reach as many OA as possible.

Critically, the percentage of the population that owns a mobile device is equally distributed among white, Black, and Hispanic people , , Thus, fully remote trials of digital therapeutics have the potential to greatly increase the ability to disseminate these interventions at scale and to reach drastically more diverse study populations than would be expected from a trial that requires participants to come into a medical or research center.

One step toward addressing this goal is making such tools easily accessible. Research has demonstrated that telemedicine and mobile approaches show comparable efficacy to in-person treatment , resulting in substantial interest in using mobile apps as an alternative care-delivery platform.

Such digital approaches to cognitive enhancement have the potential for breaking down barriers to access, especially in underserved or hard-to-reach populations of OA We have reviewed several approaches in which technology can aid in the personalization of cognitive enhancement in aging, but other emerging technologies also offer exciting new avenues for innovation.

Elements such as art, music, story, challenge, and competition could be dynamically manipulated to maximize engagement and compliance to further personalize experiences. Key to such an approach will be collection of large amounts of data and the application of machine-learning and artificial-intelligence techniques to create robust and dynamic predictive models of the factors that moderate treatment responses at the individual level.

There are a host of new accessible mobile technologies that can be leveraged to collect ecologically valid data as individualized baseline signatures and ongoing diagnostic monitoring of OA in the real-world and in real-time In addition to cognitive enhancement, technology is transforming the broader landscape of mental health and high-quality, personalized care for healthy OA who are living longer with each generation.

Technologies that attempt to modify and support real-life behaviors have advanced at a tremendous pace in recent years. For example, several methods have been developed to combat loneliness, anxiety, and depression, which are common in OA Examples include online and mobile delivery of established clinical treatments, such as cognitive behavioral therapy ; VR paradigms for fostering greater feelings of connectedness and boosting mood ; artificial-intelligence-driven voice-activated technologies for example, Alexa that not only help with organization and access to news and media, but also increase connectedness through human—machine conversations ; and therapeutic robots in the form of appealing animals that help OA cope with anxiety and memory loss These technologies are exciting and add to the emerging ecosystem of methods that can be tailored to the specific needs of an individual.

The impact of these therapeutic technologies could be augmented through combinatorial approaches as discussed above and by the incorporation of closed-loop systems for example, a robotic companion that receives passive physiological signals from a wearable device and uses those data to guide its real-time engagement with its OA companion.

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Your nutrition, vitamins and supplements, and prescribed medications all fall into this category. Even the coffee you drink and the air you breathe can impact your cognitive abilities by interacting with the chemicals in your body.

Did you know that many of your daily activities can support neuroenhancement? For example, physical exercise, sleep, meditation, and learning languages all contribute to augmenting brain function in healthy individuals.

In other words, cognitive enhancement aims to enhance your cognitive performance by stimulating your brain. If that sounds complicated, don't worry. It means multiple activities and specific supplements can make it easier for you to increase brain connectivity and kick distractions to the curb.

Do you often wonder how you end up in the same headspace day after day? You know you have a thousand things on your schedule for the week, but you just can't seem to get organized enough to stay ahead. Or, maybe you lose your focus during daily tasks or feel like your concentration is not what it used to be.

It can be discouraging to realize your plans aren't going as smoothly as you'd like, but you don't have to blame yourself. This happens even among the most healthy people. You might feel like paying attention and focusing are nearly impossible for several reasons.

Stress from daily life, fatigue, and medical conditions you're dealing with can all affect your mindset and ability to stay present. Stress can cause you to feel off when it comes to your ability to focus.

Even if you don't think you're going through stressful life events, some types of stress can build up slowly and lead to a lack of focus, causing you to feel disorganized or overwhelmed in your thoughts. Many experiences and events can cause stress, even if you don't realize it. From illness and injury to relationship conflict or work obligations, stress can creep into many different areas of life.

Even something as small as an average daily inconvenience can sometimes feel like a larger-than-life stressor when it is stacked against other sources of worry. Going through stress can make it more challenging to slow down and focus.

Luckily, being aware of stress is an essential first step in getting un-distracted and finding well-being. Being fatigued is more than feeling a little tired at the end of each day. When you're dealing with fatigue, you can feel drained. Lack of sleep, overworking, taking certain medications, and your nutrition can significantly affect how energized and clear-headed you feel each day.

When you're not getting your needs met or exceeding your boundaries, your body may respond with fatigue and an inability to think clearly. One essential question to ask is why you're experiencing fatigue.

In many cases, fatigue can signify that something bigger is going on with your physical well-being, mental health, or lifestyle. If you've experienced long stretches of physical and mental exhaustion, consider speaking to your healthcare provider about why that might be the case.

In addition to stress and fatigue, many medical conditions correlate with brain fog and cognitive decline. In some cases, you might have co-occurring stress and exhaustion from a persistent medical illness.

Various medical conditions may have side effects impacting your memory performance and cognitive abilities, and you should consult your doctor if you suspect there may be a medical condition at play. Your doctor may ultimately refer you to a specialist to help you develop a medical approach that accounts for your condition.

Once you can identify the reasons you may have difficulty with focus and attention, you can begin to address these issues in your life and begin to see better days. Here are a few excellent steps you can take when you're moving onward and upward toward sustained focus.

In addition to stress and fatigue, many medical conditions correlate with brain fog and cognitive decline. In some cases, you might have co-occurring stress and exhaustion from a persistent medical illness. Various medical conditions may have side effects impacting your memory performance and cognitive abilities, and you should consult your doctor if you suspect there may be a medical condition at play.

Your doctor may ultimately refer you to a specialist to help you develop a medical approach that accounts for your condition. Once you can identify the reasons you may have difficulty with focus and attention, you can begin to address these issues in your life and begin to see better days.

Here are a few excellent steps you can take when you're moving onward and upward toward sustained focus. Thanks to something called plasticity, your mind can grow and change to help you adopt new habits and mindsets and enhance your focus.

By testing out methods of cognitive enhancement, you can train your brain to commit to new habits. You deserve to step into stress-free clarity that lasts all day — and with a bit of trial and error, you just might find the cognitive enhancement strategy that works for you. Fatigue Cleveland Clinic.

How Meditation Can Help You Focus Columbia University School of Professional Studies. Taking Breaks Student Learning Programs Stanford University. Lemme Chill Gummies. Matcha is a green tea powder that can offer unique wellness benefits. Lemme is here to talk about how matcha compares to other caffeine sources.

Lemme is here to talk about prebiotics and probiotics, including their differences and how each contributes to digestive health. Prebiotics can support a well-balanced gut microbiome, which can in turn offer many health benefits.

Your gut health can impact your immune system. Lemme is here to talk about the connection and how the interplay can affect your overall wellness.

lemme get the full routine Notify me. lemme toss these in Add to Bag. What Is Cognitive Enhancement? Biochemical The biochemical level of cognitive enhancement essentially refers to the chemical processes occurring within your body and how they affect your cognitive function.

Behavioral Did you know that many of your daily activities can support neuroenhancement? What Can Cause Trouble Focusing? Stress Stress can cause you to feel off when it comes to your ability to focus. Fatigue Being fatigued is more than feeling a little tired at the end of each day.

Medical Conditions In addition to stress and fatigue, many medical conditions correlate with brain fog and cognitive decline. How Can I Improve My Focus? Regular Exercise: Getting active is one of the best things you can do to get your mind active. When you move your body, your dopamine, serotonin, and norepinephrine levels boost to give you a lifted mood and more sustained focus.

Mindful Meditation: You might think you don't have time in your schedule to meditate or practice mindfulness , but even a few minutes each day can make a difference.

This piece is part of a series of featured posts from the International Neuroethics Society Meeting. Strategies for cognitive enhancement include a variety of approaches such as exogenous agents, e. Traditionally, pro-cognitive drugs, such as methylphenidate, have been used for treatment purposes in neurodevelopmental disorders, like Attention Deficit Hyperactivity Disorder ADHD.

From a clinical deficit perspective, there is a clear understanding that children fall below the norm due to an underlying condition, and therefore the use of cognitive enhancement to help a child achieve their full potential is largely acceptable to parents and society.

Would children from disadvantaged backgrounds who fail to reach their true cognitive potential be considered to fall below the norm and be a potential target for cognitive enhancement? Farah et al.

For some, this suggests that children from disadvantaged backgrounds, who are at high-risk of not achieving their full cognitive potential, should be offered cognitive enhancers as a way to potentially equalise the playing field and optimize brain development for those most in need.

However, the use of cognitive enhancement raises many neuroethical concerns, including those related to opportunity, medical safety, coercion, and fairness Schelle et al, Theoretically, cognitive enhancers like pro-cognitive drugs, nutritional supplements, and stimulants could be widely distributed to help such children overcome the limitations of living in adverse circumstances.

An advantage of such cognitive enhancers, compared to e. providing more broad-based social changes, is its potential to be scaled up at comparatively low cost, thereby benefitting more children Butcher, This debate argues that cognitive enhancement could help disadvantaged children attain their true cognitive potential, and benefit from advantages like improvements in academic performance, thereby opening avenues for upward social mobility.

This has been a focus of academic deliberations, and neuroethicists have questioned whether it is our moral and social responsibility to provide children growing up in sub-optimal environments cognitive enhancement.

However, cognitive enhancement research in children has almost exclusively been carried out in High Income Countries HICs , and we know little about how this idea is viewed in LMIC contexts where parents and children could be potential end users and beneficiaries.

Image courtesy of Anders Sandberg on Flickr Our ongoing work through the NeuroGenE project aims to throw light on these questions, and for the first time tries to understand how parents across different socioeconomic strata in India view cognitive enhancement.

Through discussions about vignettes on cognitive enhancement techniques, we have been exploring parental attitudes and are trying to understand which techniques are most acceptable.

Our initial findings indicate that in general, parents are skeptical about non-traditional approaches, e. Issues parents raised included concerns about safety and side effects as well as challenges of accessibility and affordability. Instead, parents across socioeconomic strata emphasized the importance of more traditional approaches, such as education and good nutrition not in the form of supplements.

Parents highlighted the need for effective implementation of good quality education to help children attain their true cognitive potential and succeed in later life. Unfortunately, the most significant event of was the COVID pandemic, which has impacted education systems globally.

Schools across the world have been struggling with disruptions to the academic year and India has been one of the countries to institute nation-wide school closures in an attempt to reduce the spread of COVID. It is estimated that this has impacted million learners across the country.

To help children continue with their schooling, there has been a sudden and unprecedented shift to online education. Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey.

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Centre for Medicine Use and Safety, Monash University Parkville Campus , Melbourne, Australia. Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. School of Pharmacy, University of Otago, Dunedin, New Zealand.

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