What are brain supplements, also known as nootropics?

Brain Supplements (Nootropics): Evidence and Recommendations

Brain supplements, also known as nootropics, are not recommended for preventing or treating cognitive decline as current evidence does not support their effectiveness for improving cognitive function in persons with dementia or cognitive impairment. 1

What Are Brain Supplements?

Brain supplements (nootropics) are compounds or supplements marketed to enhance cognitive performance by potentially improving:

• Memory, attention, and learning capacity 2
• Creativity, motivation, and mental focus 2, 3
• Brain metabolism and neuronal function 3

These supplements can be categorized into several groups:

• Classical nootropic compounds (synthetic drugs) 3
• Substances aimed at increasing brain metabolism 3
• Cholinergic compounds targeting acetylcholine pathways 3
• Plant-derived extracts with claimed cognitive effects 4, 5

Evidence on Brain Supplements

Lack of Evidence for Systematic Use

• Current guidelines do not recommend the systematic use of nutrient supplements to prevent or correct cognitive decline in persons with dementia 1
• For all nutrients examined in clinical trials, supplements are unlikely to be effective in treating dementia 1
• Studies on brain supplements are limited and heterogeneous regarding type and stage of dementia, supplement dose, duration, and sample size 1

Specific Supplements and Their Evidence

1. Omega-3 Fatty Acids

   • Despite being important brain constituents with anti-inflammatory effects, omega-3 supplements showed no effect on cognition in people with dementia in multiple RCTs 1
   • Some potential benefits were observed in early stages of cognitive impairment, but these require confirmation 1

2. B Vitamins

   • No recommendation for vitamin B1, B6, B12, or folic acid supplements when there is no indication of deficiency 1
   • Single trials have shown some beneficial effect of B vitamin supplementation on memory performance in MCI patients with high homocysteine, but evidence is inconsistent 1

3. Special Medical Foods

   • Products like Souvenaid (containing omega-3 fatty acids, uridine monophosphate, choline, phospholipids, vitamins) showed limited benefits in specific cognitive domains but no general cognitive improvement 1
   • No significant effects on activities of daily living or quality of life were observed 1

4. Plant-Based Nootropics

   • Common plant-based nootropics include Ginkgo biloba, American ginseng, and Bacopa monnieri 4, 5
   • While some studies suggest potential benefits (e.g., Ginkgo biloba for perceptual functions, Bacopa monnieri for memory), evidence quality is often poor 5
   • The U.S. Preventive Services Task Force review found no evidence that dietary supplements provide benefits in global cognitive function 1

Important Considerations

When Supplements May Be Appropriate

• In cases of specific nutrient deficiencies (due to malabsorption, metabolic disorders, increased excretion, or long-term unbalanced diets), the respective nutrients should be supplemented in normal doses 1
• Potentially toxic effects of high doses should be taken into account 1

Alternative Approaches with Better Evidence

1. Cognitive Stimulation Therapy (CST)

   • Group activities that implicitly stimulate memory, executive functioning, and language skills 1
   • A Cochrane systematic review found consistent benefits of CST on cognitive function 1

2. Physical Exercise

   • Growing evidence for positive effects of aerobic training on global cognition 1
   • Consistent medium effect sizes reported from systematic reviews and meta-analyses 1

3. Balanced Diet

   • Providing adequate amounts of all essential nutrients through a balanced dietary pattern is recommended over supplementation 1

Common Pitfalls and Caveats

• Many supplements are marketed with exaggerated claims not supported by high-quality evidence 4
• The nootropic market is growing rapidly (estimated to reach $5.8 billion by 2023) despite limited scientific support 4
• Supplement quality, purity, and potential contamination are concerns 6
• Interactions with medications and other supplements are possible but often understudied 3
• Baseline nutrient status and dietary intake, important determinants of supplementation effects, are generally not considered in studies 1

Conclusion for Clinical Practice

When patients inquire about brain supplements:

• Explain that current evidence does not support their use for preventing or treating cognitive decline 1
• Consider testing for specific nutrient deficiencies in at-risk individuals and supplement only if deficiencies are confirmed 1
• Recommend evidence-based approaches like cognitive stimulation therapy, physical exercise, and a balanced diet 1
• Emphasize that potentially toxic effects can occur with high-dose supplementation 1