Psychoactive drugs and pilot performance: a comparison of nicotine, donepezil, and alcohol effects.
The cholinergic system plays a major role in cognitive abilities that are essential to piloting an aircraft: attention, learning, and memory. In previous studies, drugs that enhance the cholinergic system through different pharmacologic mechanisms have shown beneficial effects on cognition; but dissimilar cognitive measures were used and samples were not comparable. A comparison within the same cognitive tasks, within comparable samples appears desirable. Toward this aim, we compared effect sizes (ES) of performance-enhancing doses of nicotine (a nicotinic receptor agonist) and donepezil (an acetylcholinesterase inhibitor) as found in our prior work on pilot performance. We also compared cholinergic ES to those of performance-impairing doses of alcohol. In three randomized, placebo-controlled trials, we assessed the flight performance of aircraft pilots in a Frasca 141 simulator, testing I: the acute effects of nicotine gum 2 mg; II: the effects of administration of 5 mg donepezil/day for 30 days; and III: the acute and 8 h-carryover effects of alcohol after a target peak BAC of 0.10%. We calculated the ES of nicotine, donepezil, and alcohol on a flight summary score and on four flight component scores. Compared to placebo, nicotine and donepezil significantly improved, while alcohol significantly impaired overall flight performance: ES (nicotine)=0.80; ES (donepezil)=1.02; ES (alcohol acute)=-3.66; ES (alcohol 8 h)=-0.82. Both cholinergic drugs showed the largest effects on flight tasks requiring sustained visual attention. Although the two tested cholinergic drugs have different pharmacologic mechanisms, their effects on flight performance were similar in kind and size. The beneficial effects of the cholinergic drugs on overall flight performance were large and the absolute (ie nondirectional) sizes were about one-fourth of the absolute ES of acute alcohol intoxication and roughly the same as the absolute 8 h-carryover ES of alcohol.
Mumenthaler
Martin S
MS
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA. msm@stanford.edu
Yesavage
Jerome A
JA
Taylor
Joy L
JL
O'Hara
Ruth
R
Friedman
Leah
L
Lee
Hana
H
Kraemer
Helena C
HC
D000328:Adult; D000401:Aircraft; D019540:Area Under Curve; D002492:Central Nervous System Depressants / Q000494:pharmacology*; D002800:Cholinesterase Inhibitors / Q000494:pharmacology*; D000077265:Donepezil; D004311:Double-Blind Method; D000431:Ethanol / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007189:Indans / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000187:drug effects*; D009538:Nicotine / Q000494:pharmacology*; D018722:Nicotinic Agonists / Q000494:pharmacology*; D010880:Piperidines / Q000494:pharmacology*; D011597:Psychomotor Performance / Q000187:drug effects*; D011619:Psychotropic Drugs / Q000494:pharmacology*; D018561:Space Simulation / Q000379:methods; D013997:Time Factors
D002492:Central Nervous System Depressants; D002800:Cholinesterase Inhibitors; D007189:Indans; D018722:Nicotinic Agonists; D010880:Piperidines; D011619:Psychotropic Drugs; D000431:Ethanol; D009538:Nicotine; D000077265:Donepezil