Cognitive impairment in schizophrenia: when, what, and is it remediable?

Cognitive impairment in schizophrenia (SCZ) is very common and functionally relevant, being a consistent predictor of the ability to perform critical functional skills and real-world activities, such as residential independence, self-care, productive, and social activities. These impairments are not exclusive to individuals with SCZ; they are also observed in people with bipolar disorder and other mood disorders. Here, we review recent findings in the nature, determinants, and treatment of cognitive impairments with a focus on SCZ and linkage to other closely related conditions.

Recent studies have identified multiple levels of similarity in cognitive functioning across psychiatric conditions and identified a number of efficacious treatments. So much successful work has taken place in training-focused treatment domains that multiple meta-analyses have catalogued the level of gains, the predictors of gains, the optimal strategies, and the durability of improvement. There is also convincing evidence for the first time of pharmacological cognitive enhancement with a mechanism that is plausible for cross-diagnostic impact.

Clinicians need to consider cognitive functioning and not just in people with SCZ. Available treatments should be considered, including suggesting computerized cognitive and skills training across the full spectrum of conditions and the lifespan. Attending to new developments in pharmacological interventions will be critical, as there is at least one very promising candidate compound approved for the general treatment of SCZ with evidence of wide-ranging benefits. Other medications are in phase 2 and 3 trials and may be approved.