[Cognitive predictors of the community functioning dimensions in schizophrenia: state of the art and future...

Despite progress in antipsychotic medication, psychosocial functioning limitations remain a major source of disability in schizophrenia. For this purpose, rehabilitation programs, aimed at enhancing community functioning, are currently developed. An important question raised by rehabilitation programs is to identify clinical predictors of psychosocial functioning which could in turn be targets of intervention.

It has been suggested that a greater part of the variance in community functioning may be explained by cognitive functioning rather than by symptoms. Moreover, cognitive factors predict community functioning improvement over time. However, community functioning is a multidimensional construct and little is known about the specificity of associations between community functioning dimensions and cognitive factors. Recent studies suggest that functions like memory and executive processes are particularly associated with instrumental and social dimensions of community functioning. Memory processes are associated with both dimensions, whereas executive processes are more related to instrumental aspects of functioning. They could be specifically targeted in interventions aimed at enhancing functioning in those particular dimensions. However, these associations need to be further explored.

A lot of methodological and theoretical difficulties limit the possibility to compare studies and to draw clinically useful information. Theoretical models of disability could help in better defining particular community abilities, their level of complexity and the way they could be related to specific cognitive factors. Future results will provide relevant information for enhancing the usefulness of cognitive evaluation, as well as improving the efficiency of rehabilitation programs.