Cognitive Deficits in Schizophrenia

Introduction of Schizophrenia

Over the past decades, significant advances in neuroscience have changed how schizophrenia is viewed and deepened our understanding of better treatments. Schizophrenia is a heterogeneous and chronic mental disorder characterized by various signs and symptoms and affects approximately 0.7% of the population worldwide. Most importantly, it is abundantly clear that schizophrenia is a brain disorder with strong genetic contributions. Highly heritable and complex polygenic traits characterize it.

The positive psychotic symptoms include hallucinations and delusions, and negative symptoms include motivation, social withdrawal, and apathy. The majority of patients also have a history of mild neuropsychological abnormalities, including disorganized thought processes, poor attention, distractibility, misperception, subdelusional features, and mild motor abnormalities during their childhood-findings indicating brain abnormalities predate the clinical diagnosis of schizophrenia. Once a diagnosis is made, patients have prescribed combinations of antipsychotic drugs that they take for their entire lives.

Cognitive Deficits in Schizophrenia

Cognitive impairment is an important cause of functional disability and related outcomes in schizophrenia. Cognitive deficit in schizophrenia is an original and core abnormality of the disease and reflects the pathophysiology. Cognitive deficits are present in all patients with schizophrenia. They are the most important predictor of the quality of life, ability to maintain social relationships, the likelihood of being employed, and long-term disability in these patients. The profile of cognitive deficits in schizophrenia includes many aspects: executive functioning, attention/vigilance, memory, reasoning, processing speed, language usage, and social cognition.

Fig.1 Severity and profile of cognitive impairment in schizophrenia. (Keefe, 2012)

Impairments in these domains are associated with alterations in the neural systems known to support these cognitive functions, including impairments in the function of the medial temporal lobes, the prefrontal cortex, and a range of neurotransmitter systems known to be important for intact cognitive function. The evidence points to dorsolateral prefrontal cortical abnormalities contributing to cognitive deficits of schizophrenia. Abnormalities in intrinsic, corticocortical, and cortico-subcortical circuitries contribute to the manifestation of cognitive deficits of schizophrenia. The goal of schizophrenia research is increasingly to understand the neural and genetic mechanisms of cognitive deficits. There is a dearth of effective treatments of schizophrenia; ameliorating cognitive deficits has thus become a priority of schizophrenia research.

Cognitive Deficits as Markers

In recent years, cognitive function in many areas of schizophrenia research has been examined, reflecting a growing understanding of schizophrenia from a neurocognitive perspective. Cognitive deficits are the best predictor of functional status across several outcome domains and patient characteristics. They are markers that can help identify genes that confer an increased risk of schizophrenia. Studies of emerging mechanisms for treating cognitive impairments suggest that the need to treat these impairments has become a priority for the field. It can be modifiable through both pharmacological and psychological intervention.

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Reference

1. Keefe, R. S.; Harvey, P. D. Cognitive impairment in schizophrenia. Novel antischizophrenia treatments. 2012,11-37.