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Looking beyond stable means understanding cognitive symptoms of schizophrenia

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prevalence

Cognitive symptoms may affect the majority of people living with schizophrenia1,2

Cognitive symptoms of schizophrenia can present earlier than positive symptoms and persist throughout the course of the patient journey.3,4 These symptoms are also referred to as cognitive impairment associated with schizophrenia (CIAS).5

Cognitive symptoms statistic image
After my first psychosis, I started to experience a shorter attention span, but also, I had issues with working memory…I could keep fewer things in my mind at the same time [especially when problem solving]. It was very disturbing for me because I was always a high-IQ individual.”
-Person living with schizophrenia

IDENTIFICATION

Cognitive impairment includes 7 subdomains 
of symptoms

The NIMH MATRICS™, a program designed to generate data to facilitate the development of drugs that improve cognitive symptoms of schizophrenia, has identified 7 cognitive 
subdomains3,4,7,8*:

Arriving on time icon

Reasoning and problem solving like arriving on time at work even if your bus schedule has changed
Social cognition icon

Social cognition like understanding that someone is angry with you
Visual learning icon

Visual learning and memory like remembering where you have left some objects
Speed of processing icon

Speed of processing like performing task-oriented jobs at work
Phone icon

Working memory like remembering a phone number just given to you
Paying attention to conversation icon

Attention and vigilance like being able to concentrate on reading a book

Checklist icon

Verbal learning and memory like remembering a given shopping list

*Established by the NIMH MATRICS™ to support the development of CIAS therapies.

I am a lot more forgetful than I was… I can’t remember what I did on Sunday. I don't remember Sunday at all.”
-Person living with schizophrenia

Impact

Cognitive impairment may affect people living 
with schizophrenia in multiple ways

Poor adherence to treatment image

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loss of autonomy image

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I try to make notes but it's hard for logistical reasons; to organize and keep them in the same place and to remember [where I put them].”
-Person living with schizophrenia

It’s important to recognize and monitor cognitive symptoms as they’re 
the strongest correlate of real-world functioning in people living with 
schizophrenia21 

There are currently no approved pharmacological or behavioral treatments for cognitive symptoms in people living with schizophrenia.24

Cognitive remedial therapy (CRT) has demonstrated improvements in cognition in some patients.25-29 However, the use of cognitive remediation remains limited outside research settings.26

It's important to keep track of cognitive symptoms in patients living with schizophrenia. You may want to inform them that cognitive symptoms are a normal part of disease, and ask them if signs of cognitive impairment have shown up in their daily lives—such as difficulty completing simple chores or following conversations.2-4,8,21 

cognitive let's look beyond stable

Learn more about the range of symptom domains seen in people living with schizophrenia and discover resources that can help.

#lookbeyondstable
 

  1. Mosiolek A, Gierus J, Tytus K, Szulc A. Cognitive impairment in schizophrenia across age groups: a case-control study. BMC Psychiatry. 2016;16:37. doi:10.1186/s12888-016-0749-1

  2. Keefe RS, Eesley CE, Poe MP. Defining a cognitive function decrement in schizophrenia. Biol Psychiatry. 2005;57(6):688-691. doi:10.1016/j.biopsych.2005.01.003

  3. García-Laredo E. Cognitive impairment in schizophrenia: description and cognitive familiar endophenotypes. A review of the literature. In: Irtelli F, ed. Psychosis - Biopsychosocial and Relational Perspectives. 2018:43-67.

  4. Bowie R, Harvey PD. Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatr Dis Treat. 2006;2(4):531-536. doi:10.2147/nedt.2006.2.4.531

  5. Welch LC, Trudeau JJ, Silverstein SM, Sand M, Henderson DC, Rosen RC. Initial development of a patient-reported outcome measure of experience with cognitive impairment associated with schizophrenia. Patient Relat Outcome Meas. 2017;8:71-81. doi:10.2147/PROM.S123266

  6. Correll CU, Schooler NR. Negative symptoms in schizophrenia: a review and clinical guide for recognition, assessment, and treatment. Neuropsychiatr Dis Treat. 2020;16:519-534. doi:10.2147/NDT.S225643

  7. Kitchen H, Rofail D, Heron L, Sacco P. Cognitive impairment associated with schizophrenia: a review of the humanistic burden. Adv Ther. 2012;29(2):148-162. doi:10.1007/s12325-012-0001-4

  8. Keefe RSE, Harvey PD. Cognitive impairment in schizophrenia. In: Geyer MA, Gross G, eds. Novel Antischizophrenia Treatments, Handbook of Experimental Pharmacology 213. Springer-Verlag Berlin Heidelberg; 2012:11-37.

  9. Heinrichs RW, Goldberg JO, Miles AA, Vaz SM. Predictors of medication competence in schizophrenia patients. Psychiatry Res. 2008;157(1-3):47-52. doi:10.1016/j.psychres.2007.02.015

  10. Johansson M, Hjärthag F, Helldin L. Cognitive markers related to long-term remission status in schizophrenia spectrum disorders. Psychiatry Res. 2020;289:113035. doi:10.1016/j.psychres.2020.113035

  11. Torgalsboen AK, Mohn C, Rund BR. Neurocognitive predictors of remission of symptoms and social and role functioning in the early course of first-episode schizophrenia. Psychiatry Res. 2014;216(1):1-5. doi:10.1016/j.psychres.2014.01.031

  12. Klærke LR, Baandrup L, Fagerlund B, Ebdrup BH, Pantelis C, Glenthøj BY, et al. Diagnostic stability and long-term symptomatic and functional outcomes in first-episode antipsychotic-naive patients with schizophrenia. Eur Psychiatry. 2019;62:130-137. doi:10.1016/j.eurpsy.2019.07.001

  13. de Nijs J, Zoun K; GROUP Investigators. Deficyty poznawcze a efekty schizofrenii. [The association between cognitive deficits and different outcomes of schizophrenia]. Psychiatr Pol. 2014;48(6):1087-1104. doi:10.12740/PP/37438

  14. Casso D, Phillips S, Woodcroft K, et al. SA38. Assessment of cognitive impairment, treatment adherence, and healthcare resource utilization among treated schizophrenia patients. Schizophrenia Bull. 2017;43(suppl 1):S127-S127. doi:10.1093/schbul/sbx023.037

  15. Patel A, Knapp M, Romeo R, et al. Cognitive remediation therapy in schizophrenia: cost-effectiveness analysis. Schizophr Res. 2010;120(1-3):217-224. doi:10.1016/j.schres.2009.12.003

  16. Reeder C, Harris V, Pickles A, Patel A, Cella M, Wykes T. Does change in cognitive function predict change in costs of care for people with a schizophrenia diagnosis following cognitive remediation therapy? Schizophr Bull. 2014;40(6):1472-1481. doi:10.1093/schbul/sbu046

  17. Data on file. Boehringer Ingelheim Pharmaceuticals, Inc. 2024.

  18. Millier A, Horváth M, Ma F, Kóczián K, Götze A, Toumi M. Healthcare resource use in schizophrenia, EuroSC findings. J Mark Access Health Policy. 2017;5(1):1372027. doi:10.1080/20016689.2017.1372027

  19. Mantovani LM, Ferretjans R, Marçal IM, Oliveira AM, Guimarães FC, Salgado JV. Family burden in schizophrenia: the influence of age of onset and negative symptoms. Trends Psychiatry Psychother. 2016;38(2):96-99. doi:10.1590/2237-6089-2015-0082

  20. Kalache SM, Mulsant BH, Davies SJ, et al. The impact of aging, cognition, and symptoms on functional competence in individuals with schizophrenia across the lifespan. Schizophr Bull. 2015;41(2):374-381. doi:10.1093/schbul/sbu114

  21. Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 4th ed. Cambridge University Press; 2013.

  22. Bouwmans C, de Sonneville C, Mulder CL, Hakkart-van Roijen L. Employment and the associated impact on quality of life in people diagnosed with schizophrenia. Neuropsychiatr Dis Treat. 2015;11:2125-2142. doi:10.2147/NDT.S83546

  23. Halverson TF, Orleans-Pobee M, Merritt C, Sheeran P, Fett AK, Penn DL. Pathways to functional outcomes in schizophrenia spectrum disorders: meta-analysis of social cognitive and neurocognitive predictors. Neurosci Biobehav Rev. 2019;105:212-219. doi:10.1016/j.neubiorev.2019.07.020

  24. Keefe RSE. Why are there no approved treatments for cognitive impairment in schizophrenia? World Psychiatry. 2019;18(2):167-168. doi:10.1002/wps.20648

  25. Bowie CR. Cognitive remediation for severe mental illness: state of the field and future directions. World Psychiatry. 2019;18(3):274-275. doi:10.1002/wps.20660

  26. American Psychiatric Association (APA). The American Psychiatric Association Practice Guideline for The Treatment of Patients With Schizophrenia. 3rd ed. 2020.

  27. Barlati S, Deste G, De Peri l, Ariu C, Vita A. Cognitive remediation in schizophrenia: current status and future perspectives. Schizophr Res Treatment. 2013;2013:156084

  28. Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry. 2011;168(5):472-485. doi:10.1176/appi.ajp.2010.10060855

  29. Chien WT, Lueng SF, Yueng FK, Wong WK. Current approaches to treatments for schizophrenia spectrum disorders, part ii: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatr Dis Treat. 2013;9:1463-1481.