What over-the-counter (OTC) drugs or supplements are recommended for cognitive enhancement?

No OTC Drugs or Supplements Are Recommended for Cognitive Enhancement

Based on current evidence, no over-the-counter drugs or supplements are recommended for cognitive enhancement in healthy individuals due to lack of proven efficacy and potential risks.

Evidence Against Supplement Use for Cognitive Enhancement

• Multiple guidelines strongly recommend against the use of various supplements for cognitive enhancement, even in people with dementia, indicating they would be even less beneficial for healthy individuals 1

• The European Society for Clinical Nutrition and Metabolism (ESPEN) specifically recommends against using the following supplements for cognitive improvement:

  • Omega-3 fatty acids 1
  • Vitamin B1, B6, B12, and folic acid (unless deficiency exists) 1
  • Vitamin E 1
  • Selenium 1
  • Copper 1
  • Vitamin D 1

• Standard oral nutritional supplements (ONS) and specialized "medical foods" marketed for brain health have not shown consistent benefits for cognitive function 1

• Ketogenic interventions (including MCT oil supplements) are not recommended for cognitive enhancement 1

Common Supplements Marketed for Cognitive Enhancement Despite Limited Evidence

Despite the lack of recommendation from medical guidelines, many supplements are heavily marketed for "brain health" and cognitive enhancement:

• Ginkgo biloba is one of the most widely promoted supplements for cognitive function, but lacks strong evidence for efficacy in healthy individuals 2, 3, 4

• Other commonly marketed ingredients include:

  • Bacopa monnieri
  • Phosphatidylserine
  • Huperzine-A
  • Various B vitamins
  • Proprietary blends 4, 5

• A systematic review of dietary supplements for cognitive performance found low certainty in the evidence for nine commonly marketed ingredients (Bacopa monnieri, choline, creatine, omega-3 fatty acids, Ginkgo biloba, ginseng, Rhodiola rosea, tyrosine, and valerian root) 2

Dietary Approaches for Cognitive Health

Rather than supplements, evidence suggests dietary patterns may be more beneficial:

• The Mediterranean diet (rich in fruits, vegetables, legumes, olive oil, fish, and low in dairy products and meats) has shown some evidence for reducing the incidence of mild cognitive impairment 3, 6
• Low glycemic index foods may improve attention, memory, and functional capacity, while foods high in simple sugars are associated with concentration difficulties 6
• Diets with an appropriate omega-6:omega-3 fatty acid ratio (approximately 5:1) are associated with better memory capacity 6

Potential Risks and Concerns

• Many "brain health" supplements contain proprietary blends with undisclosed amounts of ingredients 4, 5
• Some products have been found to contain prohibited ingredients or undeclared drugs 5
• Product labels are frequently misbranded or make unsubstantiated claims 5
• These supplements are often expensive with insufficient evidence of efficacy 4

Clinical Implications

• When patients ask about cognitive enhancement supplements, clinicians should discuss the lack of evidence supporting their use 1
• For patients with concerns about cognitive function, focus on established lifestyle factors that support brain health:
  • Regular physical exercise
  • Adequate sleep
  • Stress management
  • Balanced nutrition following Mediterranean-style dietary patterns 3, 6
• Address any nutrient deficiencies (particularly B vitamins, vitamin D) through appropriate testing and targeted supplementation only when clinically indicated 1