Schizophrenia

Impaired Cognition in Schizophrenia: Why It Happens and What Can Be Done About It

Here’s how to manage cognitive symptoms like memory issues or attention problems and their effects on your life.

Shelby House, BSN-RN
By
Allison Young, MD
by
Published on February 20, 2024
female mental health professional with male patient
Seeing a professional for cognitive remediation therapy can help with managing cognitive symptoms of schizophrenia.iStock
Cognitive impairment is a core symptom of schizophrenia. More than 80 percent of people with schizophrenia have cognitive symptoms of some kind. They’re one of the main obstacles to managing schizophrenia and often cause substantial disability among those with the condition.

“These impairments often persist even during periods of symptom remission and can have a profound impact on daily functioning and quality of life,” says Caroline Fenkel, a doctor of social work, a licensed clinical social worker, and the co-founder and chief clinical officer at Charlie Health, a virtual mental health care practice for young people that offers treatment for schizophrenia and related mental health conditions.

If you or a loved one has been diagnosed with schizophrenia, here’s what to know about the causes of impaired cognition, its health effects, and how to manage it.

What Types of Cognitive Issues Can Happen in Schizophrenia?

Schizophrenia-related cognitive dysfunction can appear in the following ways:

Memory Problems

Cognitive deficits related to functions like memory are extremely common, affecting as many as 98 percent of people with schizophrenia.

“Memory issues can manifest as difficulties recalling recent events (short-term memory) or remembering information from the past (long-term memory),” says Joel Frank, PsyD, a clinical neuropsychologist in private practice in Los Angeles. “Everyday tasks such as remembering appointments, finding items, or following instructions can become challenging.”

Attention Deficits

Ample research has shown that attention deficits are also very common among people with schizophrenia.

“These difficulties could involve struggles maintaining focus on tasks or conversations, being easily distracted, or having trouble shifting attention from one task to another,” explains Dr. Frank.

Impaired Social Cognition

Social cognition refers to our ability to interpret social cues, understand the perspectives of others, and respond appropriately to social situations, says Frank. “Schizophrenia can affect this ability, leading to misinterpretations of others' intentions or difficulties in managing social interactions,” he explains.

Impaired Executive Functioning

“Executive functions refer to a set of cognitive processes that include problem-solving, planning, organizing, and decision-making,” says Frank. “Schizophrenia can impact these abilities, making it harder for individuals to plan their day, make decisions, or solve problems.”

Language Difficulties

Cognitive abilities that usually evolve throughout adult life, such as language, appear to deteriorate over time among people with schizophrenia.

Some people with schizophrenia may speak very little, even when forced to interact with others, speak in a monotonous tone, or have trouble organizing their thoughts and words in a way that makes sense to others, sometimes resulting in jumbled speech.

Concentration Issues

“Concentrating for extended periods can be particularly challenging for people with schizophrenia,” Frank says. “They may find it hard to engage in activities that require sustained mental effort, such as reading, studying, or even watching a movie.”

What Causes Cognitive Impairment in Schizophrenia?

“The causes of cognitive impairment in people with schizophrenia are multifaceted and not fully understood, but several factors are thought to contribute: neurobiological factors, genetics, and environmental factors,” says Frank.

Abnormal brain development may contribute to these cognitive deficits, according to research. This appears to begin before birth, intensifies during childhood, and persists until adulthood. As a result, there are physical differences in the brain of a person diagnosed with schizophrenia compared with people without schizophrenia.

Disruptions to genes linked to brain health and development — such as DISC1, NRG 1, and Akt1 — may also play a role.

In addition, research has shown that some antipsychotic medications used to treat schizophrenia, such as haloperidol (Haldol), have side effects that may exacerbate cognitive impairment.

How Can Schizophrenia-Related Cognitive Impairment Affect Your Health?

Research has shown that cognitive impairment can have many health consequences for people with schizophrenia.

“Adverse health outcomes can include difficulties in social and occupational functioning, decreased quality of life, poorer treatment adherence, and higher rates of unemployment and homelessness,” Fenkel says.

Cognitive dysfunction associated with schizophrenia can also affect a person’s ability to manage their self-care and personal hygiene, to comprehend and follow through with health-related instructions, and to be fully engaged in their treatment plan, notes Frank. These issues can make managing their overall mental and physical health much more challenging.

How to Manage Cognitive Impairment Associated With Schizophrenia

Although medications like antipsychotics are the main treatment option for managing most symptoms of schizophrenia,

 the trouble is that these medications often do little to improve cognitive functioning.

 And as mentioned earlier, certain antipsychotics like haloperidol may worsen cognitive symptoms.

Experts widely consider cognitive remediation therapy to be the best available option for managing cognitive symptoms of schizophrenia.

“Cognitive remediation therapy for schizophrenia is a structured treatment approach designed to target the cognitive deficits associated with schizophrenia,” says Frank. “It involves various exercises and activities aimed at improving memory, attention, problem-solving, and other cognitive functions.”

The goal is to enhance overall cognitive abilities and improve daily functioning and quality of life for those with schizophrenia, Frank adds.

Most cognitive remediation treatment programs involve approximately 24 hours of therapy administered by a trained health professional over three to six months.

If you need help finding a cognitive remediation program, try reaching out to your doctor, a local mental health center, or an organization such as the National Alliance on Mental Illness for recommendations. Unfortunately, there aren’t many professionals trained in this type of therapy, and it can be difficult to locate one. Some cognitive remediation software programs for use at home are available for purchase, but it’s not yet known how effective they are without involvement from a health professional.

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Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Harvey PD et al. Cognitive Dysfunction in Schizophrenia: An Expert Group Paper on the Current State of the Art. Schizophrenia Research: Cognition. September 2022.
  2. Tripathi A et al. Cognitive Deficits in Schizophrenia: Understanding the Biological Correlates and Remediation Strategies. Clinical Psychopharmacology and Neuroscience. February 2018.
  3. Zanelli J et al. Cognitive Change in Schizophrenia and Other Psychoses in the Decade Following the First Episode. The American Journal of Psychiatry. October 2019.
  4. Schizophrenia: Diagnosis & Treatment. Mayo Clinic. January 7, 2020.
  5. Cognitive Remediation for Psychiatric Disorders. Association for Behavioral and Cognitive Therapies.
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Allison Young, MD

Medical Reviewer

Allison Young, MD, is a board-certified psychiatrist providing services via telehealth throughout New York and Florida.

In addition to her private practice, Dr. Young serves as an affiliate professor of psychiatry at Florida Atlantic University Charles E. Schmidt College of Medicine. She previously taught and mentored medical trainees at the NYU Grossman School of Medicine. She speaks at national conferences and has published scientific articles on a variety of mental health topics, most notably on the use of evidence-based lifestyle interventions in mental health care.

Young graduated magna cum laude from Georgetown University with a bachelor of science degree in neurobiology and theology. She obtained her doctor of medicine degree with honors in neuroscience and physiology from the NYU Grossman School of Medicine. She continued her training at NYU during her psychiatry residency, when she was among a small group selected to be part of the residency researcher program and studied novel ways to assess and treat mental distress, with a focus on anxiety, trauma, and grief.

During her psychiatry training, Young sought additional training in women’s mental health and cognitive behavioral therapy. She has also studied and completed further training in evidence-based lifestyle interventions in mental health care, including stress management, exercise, and nutrition. She is an active member of the American College of Lifestyle Medicine, through which she helps create resources as well as educate physicians and patients on the intersection of lifestyle medicine and mental health.

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Shelby House, BSN-RN

Author
Shelby House is a registered nurse and freelance health writer. She enjoys covering health and wellness, mental health, and nursing topics. Much of her writing has been for health businesses aiming to increase brand awareness.

She also runs a lifestyle and career blog for nurses and enjoys mentoring new nurses, providing support as they begin their often-challenging career. She believes nurses are the delivering hands of healthcare and that supporting nurses is the key to success for healthcare systems.

When she isn’t writing, Shelby enjoys playing with her two young children and soaking up the countryside scenery of rural America where she lives.
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