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Cognitive Impairment Associated with Schizophrenia infographic

Understanding cognitive impairment in schizophrenia and its impact on daily living

The signs and symptoms of schizophrenia, termed “cognitive impairment” (also referred to as “cognitive impairment associated with schizophrenia”), are considered a distinct, core symptom domain of schizophrenia and affect >80% of people living with schizophrenia.^1–5While the cognitive and negative symptom domains are both closely linked to real-world functioning and may reinforce each other, they are distinct; negative symptoms affect motivation, whereas cognitive impairment affects abilities.⁶Cognitive impairment often presents early in the disease course⁷and can significantly impair a person’s ability to learn, solve problems, and communicate clearly.^2,8–10 The symptoms of cognitive impairment include poor memory, impaired attention and learning, executive dysfunction, and poor comprehension.^2,8 Cognitive impairment represents a key determinant of poor outcomes and is associated with a reduced ability to perform activities of daily living.⁸ Cognitive impairment makes it difficult for people with schizophrenia to live a productive and autonomous life throughout the disease course.^11–14

Challenges and advances in treating cognitive impairment in schizophrenia

Although cognitive impairment is reported by people and caregivers to be among the most burdensome signs and symptoms of schizophrenia, there are no approved pharmacotherapies that specifically target this domain.^8,15–18 The antipsychotics available for the treatment of positive symptoms of schizophrenia provide non-significant benefits to cognitive health and may even exacerbate cognitive impairment.^19,20 The available non-pharmacological and psychosocial interventions have heterogenous outcomes and are inaccessible to many people.^19,21–27 Addressing cognitive impairment remains a significant unmet need.^27–29

Explore our resource section to find additional research and practical information.

Chenghao L, et al. The relationship of cardiovascular disease risk, clozapine antipsychotic use and cognitive function in a large Chinese schizophrenia cohort. Brain Res 2024;1845:149220.
This study examines the relationship between clozapine use, cardiovascular disease risk, and cognitive function in patients with schizophrenia.
Vita A, et al. European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry 2022;65:e58.
A systemic review on the scientific literature and recommendations for the assessment of cognitive functions in schizophrenia in research settings and in real-world clinical practice.

Cite this article as Schizophrenia Primer 3 of 3: Cognitive Impairment Associated With Schizophrenia (CIAS). Connecting Psychiatry. Published February 2025. Accessed [month day, year]. [URL]

APA. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013. American Psychiatric Publishing, Arlington, VA, US.
Stahl SM. Stahl Essential Psychopharmacology. 5th ed. 2021. Cambridge University Press, UK.
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Zaragoza Domingo S, et al. Schizophr Res Cogn 2015;2:146–158.
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Hafner H, et al. Schizophr Res 1992;6:209–223.
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Kahn RS & Keefe RS. JAMA Psychiatry 2013;70:1107–1112.
The Free Library. Cognitive impairment in schizophrenia: understanding prevalence, magnitude, and scope. 2014. Available at: https://www.thefreelibrary.com/Cognitive+impairment+in+schizophrenia%3A+understanding+prevalence%2C...-a0391311466. Last accessed: September 2024.
Gold JM, et al. Am J Psychiatry 2002;159:1395–1402.
Jeste SD, et al. Schizophr Res 2003;63:49–58.
Patterson TL, et al. J Clin Psychopharmacol 2002;22:11–19.
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Fasseeh A, et al. Eur J Public Health 2018;28:1043–1049.
Keefe RSE. World Psychiatry 2019;18:165–167.
Harvey PD & Bowie CR. Psychiatr Clin North Am 2012;35:683–698.
Maroney M. Ment Health Clin 2022;12:282–299.
American Psychiatric Association. Practice Guideline For The Treatment of Patients With Schizophrenia. American Psychiatric Association, Washington, DC.
Haddad C, et al. BMC Psychiatry 2023;23:61.
Barlati S, et al. Schizophr Res Treatment 2013;2013:156084.
Wykes T, et al. Am J Psychiatry 2011;168:472–485.
Reser MP, et al. Aust N Z J Psychiatry 2019;53:624–641.
Bowie CR. World Psychiatry 2019;18:274–275.
Chien WT, et al. Neuropsychiatr Dis Treat 2013;9:1463–1481.
Allott K, et al. Schizophr Bull 2020;46:869–883.
Galderisi S, et al. Eur Psychiatry 2020;63:e26.
Barnes TR, et al. J Psychopharmacol 2020;34:3–78.
Buchanan RW, et al. Schizophr Bull 2010;36:71–93.