Abstract
Purpose of Review
Schizophrenia is a complex severe mental illness with high morbidity and mortality. It is characterized by positive symptoms, negative symptoms, and cognitive impairment. Cognitive impairment is strongly associated with functional impairment and presents a major barrier to recovery. This article reviews some of the most recent research on cognition in schizophrenia and the clinical implications.
Recent Findings
There have been recent studies related to the genomics of cognition and neural structures involved in cognition. We review recent investigations into the assessment of social cognition and the implications of impaired introspective accuracy. A recent network analysis assessed the relationship of neurocognition and social cognition to functional capacity. We further discuss the role of specific symptoms in functioning, including negative symptoms and symptoms related to autism spectrum disorder. We conclude with a discussion of a novel computerized treatment for social cognition.
Summary
Recent research has sought to better understand several dimensions of cognition including genomics, brain structure, social cognition, functional capacity, and symptomatology. This recent research brings us closer to understanding the complex clinical picture of schizophrenia and the best treatments to achieve recovery.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Vita A, Barlati S. Recovery from schizophrenia: is it possible? Curr Opin Psychiatry. 2018;31(3):246–55. https://doi.org/10.1097/yco.0000000000000407.
Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry. 1996;153(3):321–30. https://doi.org/10.1176/ajp.153.3.321.
Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the “right stuff”? Schizophr Bull. 2000;26(1):119–36. https://doi.org/10.1093/oxfordjournals.schbul.a033430.
Green MF, Kern RS, Heaton RK. Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res. 2004;72(1):41–51. https://doi.org/10.1016/j.schres.2004.09.009.
Green MF. Impact of cognitive and social cognitive impairment on functional outcomes in patients with schizophrenia. J Clin Psychiatry. 2016;77(Suppl 2):8–11. https://doi.org/10.4088/JCP.14074su1c.02.
Fett AK, Viechtbauer W, Dominguez MD, Penn DL, van Os J, Krabbendam L. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev. 2011;35(3):573–88. https://doi.org/10.1016/j.neubiorev.2010.07.001.
Schmidt SJ, Mueller DR, Roder V. Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modeling. Schizophr Bull. 2011;37(Suppl 2):S41–54. https://doi.org/10.1093/schbul/sbr079.
Granholm E, Holden J, Worley M. Improvement in negative symptoms and functioning in cognitive-behavioral social skills training for schizophrenia: mediation by defeatist performance attitudes and asocial beliefs. Schizophr Bull. 2018;44(3):653–61. https://doi.org/10.1093/schbul/sbx099.
Bowie CR, McGurk SR, Mausbach B, Patterson TL, Harvey PD. Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real-world behavior. Am J Psychiatry. 2012;169(7):710–8. https://doi.org/10.1176/appi.ajp.2012.11091337.
Fisher M, Mellon SH, Wolkowitz O, Vinogradov S. Neuroscience-informed auditory training in schizophrenia: a final report of the effects on cognition and serum brain-derived neurotrophic factor. Schizophr Res Cogn. 2016;3:1–7. https://doi.org/10.1016/j.scog.2015.10.006.
Gladsjo JA, McAdams LA, Palmer BW, Moore DJ, Jeste DV, Heaton RK. A six-factor model of cognition in schizophrenia and related psychotic disorders: relationships with clinical symptoms and functional capacity. Schizophr Bull. 2004;30(4):739–54. https://doi.org/10.1093/oxfordjournals.schbul.a007127.
Lo SB, Szuhany KL, Kredlow MA, Wolfe R, Mueser KT, McGurk SR. A confirmatory factor analysis of the MATRICS consensus cognitive battery in severe mental illness. Schizophr Res. 2016;175(1–3):79–84. https://doi.org/10.1016/j.schres.2016.03.013.
McCleery A, Green MF, Hellemann GS, Baade LE, Gold JM, Keefe RS, et al. Latent structure of cognition in schizophrenia: a confirmatory factor analysis of the MATRICS consensus cognitive battery (MCCB). Psychol Med. 2016;46(5):1119. https://doi.org/10.1017/s0033291715002433.
Schaefer J, Giangrande E, Weinberger DR, Dickinson D. The global cognitive impairment in schizophrenia: consistent over decades and around the world. Schizophr Res. 2013;150(1):42–50. https://doi.org/10.1016/j.schres.2013.07.009.
Keefe RS, Bilder RM, Harvey PD, Davis SM, Palmer BW, Gold JM, et al. Baseline neurocognitive deficits in the CATIE schizophrenia trial. Neuropsychopharmacology. 2006;31(9):2033–46. https://doi.org/10.1038/sj.npp.1301072.
Harvey PD, Aslan M, Du M, Zhao H, Siever LJ, Pulver A, et al. Factor structure of cognition and functional capacity in two studies of schizophrenia and bipolar disorder: implications for genomic studies. Neuropsychology. 2016;30(1):28–39. https://doi.org/10.1037/neu0000245.
Trampush JW, Yang ML, Yu J, Knowles E, Davies G, Liewald DC, et al. GWAS meta-analysis reveals novel loci and genetic correlates for general cognitive function: a report from the COGENT consortium. Mol Psychiatry. 2017;22(3):336–45. https://doi.org/10.1038/mp.2016.244.
Davies G, Lam M, Harris SE, Trampush JW, Luciano M, Hill WD, et al. Author correction: study of 300,486 individuals identifies 148 independent genetic loci influencing general cognitive function. Nat Commun. 2019;10(1):2068. https://doi.org/10.1038/s41467-019-10160-w.
Savage JE, Jansen PR, Stringer S, Watanabe K, Bryois J, de Leeuw CA, et al. Genome-wide association meta-analysis in 269,867 individuals identifies new genetic and functional links to intelligence. Nat Genet. 2018;50(7):912–9. https://doi.org/10.1038/s41588-018-0152-6.
Lee JJ, Wedow R, Okbay A, Kong E, Maghzian O, Zacher M, et al. Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals. Nat Genet. 2018;50(8):1112–21. https://doi.org/10.1038/s41588-018-0147-3.
• Harvey PD, Sun N, Bigdeli TB, Fanous AH, Aslan M, Malhotra AK, et al. Genome-wide association study of cognitive performance in U.S. veterans with schizophrenia or bipolar disorder. Am J Med Genet B Neuropsychiatr Genet. 2020;183(3):181–94. https://doi.org/10.1002/ajmg.b.32775. This GWAS assessed cognition in veterans with schizophrenia or bipolar disorder. They found that genomic variation influences were similar in the general population and in individuals with schziophrenia or bipolar disorder.
Kelly S, Jahanshad N, Zalesky A, Kochunov P, Agartz I, Alloza C, et al. Widespread white matter microstructural differences in schizophrenia across 4322 individuals: results from the ENIGMA schizophrenia DTI working group. Mol Psychiatry. 2018;23(5):1261–9. https://doi.org/10.1038/mp.2017.170.
van Erp TGM, Walton E, Hibar DP, Schmaal L, Jiang W, Glahn DC, et al. Cortical brain abnormalities in 4474 individuals with schizophrenia and 5098 control subjects via the enhancing neuro imaging genetics through meta analysis (ENIGMA) consortium. Biol Psychiatry. 2018;84(9):644–54. https://doi.org/10.1016/j.biopsych.2018.04.023.
Lee DK, Lee H, Park K, Joh E, Kim CE, Ryu S. Common gray and white matter abnormalities in schizophrenia and bipolar disorder. PLoS One. 2020;15(5):e0232826. https://doi.org/10.1371/journal.pone.0232826.
• Holleran L, Kelly S, Alloza C, Agartz I, Andreassen OA, Arango C, et al. The relationship between white matter microstructure and general cognitive ability in patients with schizophrenia and healthy participants in the ENIGMA consortium. Am J Psychiatry. 2020;177(6):537–47. https://doi.org/10.1176/appi.ajp.2019.19030225. This study compared the association of white matter microstructure and cognitive ability in individuals with schizophrenia and healthy controls. They found that there was an overall similar association between variation in structural connectivity and variation in IQ in both patients and healthy controls.
Harvey PD. An array of studies addressing cognition and cognitively defined neuropsychiatric conditions: many more connections than you might think. Am J Psychiatry. 2020;177(6):491–6. https://doi.org/10.1176/appi.ajp.2020.20040407.
Davis KL, Stewart DG, Friedman JI, Buchsbaum M, Harvey PD, Hof PR, et al. White matter changes in schizophrenia: evidence for myelin-related dysfunction. Arch Gen Psychiatry. 2003;60(5):443–56. https://doi.org/10.1001/archpsyc.60.5.443.
Chavarria-Siles I, White T, de Leeuw C, Goudriaan A, Lips E, Ehrlich S, et al. Myelination-related genes are associated with decreased white matter integrity in schizophrenia. Eur J Hum Genet. 2016;24(3):381–6. https://doi.org/10.1038/ejhg.2015.120.
Gouvêa-Junqueira D, Falvella ACB, Antunes A, Seabra G, Brandão-Teles C, Martins-de-Souza D, et al. Novel treatment strategies targeting myelin and oligodendrocyte dysfunction in schizophrenia. Front Psychiatry. 2020;11:379. https://doi.org/10.3389/fpsyt.2020.00379.
Penn DL, Sanna LJ, Roberts DL. Social cognition in schizophrenia: an overview. Schizophr Bull. 2008;34(3):408–11. https://doi.org/10.1093/schbul/sbn014.
Pinkham AE, Penn DL, Green MF, Buck B, Healey K, Harvey PD. The social cognition psychometric evaluation study: results of the expert survey and RAND panel. Schizophr Bull. 2014;40(4):813–23. https://doi.org/10.1093/schbul/sbt081.
Pinkham AE, Penn DL, Green MF, Harvey PD. Social cognition psychometric evaluation: results of the initial psychometric study. Schizophr Bull. 2016;42(2):494–504. https://doi.org/10.1093/schbul/sbv056.
Pinkham AE, Harvey PD, Penn DL. Social cognition psychometric evaluation: results of the final validation study. Schizophr Bull. 2018;44(4):737–48. https://doi.org/10.1093/schbul/sbx117.
Healey KM, Combs DR, Gibson CM, Keefe RS, Roberts DL, Penn DL. Observable social cognition—a rating scale: an interview-based assessment for schizophrenia. Cogn Neuropsychiatry. 2015;20(3):198–221. https://doi.org/10.1080/13546805.2014.999915.
Halverson TF, Hajdúk M, Pinkham AE, Harvey PD, Jarskog LF, Nye L, et al. Psychometric properties of the observable social cognition rating scale (OSCARS): self-report and informant-rated social cognitive abilities in schizophrenia. Psychiatry Res. 2020;286:112891. https://doi.org/10.1016/j.psychres.2020.112891.
Silberstein J, Harvey PD. Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes. Cogn Neuropsychiatry. 2019;24(1):28–39. https://doi.org/10.1080/13546805.2018.1549985.
Silberstein JM, Pinkham AE, Penn DL, Harvey PD. Self-assessment of social cognitive ability in schizophrenia: association with social cognitive test performance, informant assessments of social cognitive ability, and everyday outcomes. Schizophr Res. 2018;199:75–82. https://doi.org/10.1016/j.schres.2018.04.015.
Cornacchio D, Pinkham AE, Penn DL, Harvey PD. Self-assessment of social cognitive ability in individuals with schizophrenia: appraising task difficulty and allocation of effort. Schizophr Res. 2017;179:85–90. https://doi.org/10.1016/j.schres.2016.09.033.
Jones MT, Deckler E, Laurrari C, Jarskog LF, Penn DL, Pinkham AE, et al. Confidence, performance, and accuracy of self-assessment of social cognition: a comparison of schizophrenia patients and healthy controls. Schizophr Res Cogn. 2020;19:002–2. https://doi.org/10.1016/j.scog.2019.01.002.
• Galderisi S, Rucci P, Kirkpatrick B, Mucci A, Gibertoni D, Rocca P, et al. Interplay among psychopathologic variables, personal resources, context-related factors, and real-life functioning in individuals with schizophrenia: a network analysis. JAMA Psychiatry. 2018;75(4):396–404. https://doi.org/10.1001/jamapsychiatry.2017.4607. This study was a network analysis on how various aspects of psychopathology, functioning, and sociodemographic variables are related in patients with schizophrenia. They found that functional capacity was the most central variable.
• Galderisi S, Rucci P, Mucci A, Rossi A, Rocca P, Bertolino A, et al. The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients. World Psychiatry. 2020;19(1):81–91. https://doi.org/10.1002/wps.20700. This study was a 4-year follow-up study to the network analysis by Galderisi et al. that aimed to assess the long-term stability of the variables’ relationships and also compare networks between those who did and did not achieve recovery. They found few changes except links that suggested improvements in social cognition and neurocognition.
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):472–85. https://doi.org/10.1176/appi.ajp.2010.10060855.
• Deste G, Vita A, Nibbio G, Penn DL, Pinkham AE, Harvey PD. Autistic symptoms and social cognition predict real-world outcomes in patients with schizophrenia. Front Psychiatry. 2020;11:524. https://doi.org/10.3389/fpsyt.2020.00524. This study assessed how autism-related symptoms, negative symptoms, and other measures influence real-world functioning in individual with schizophrenia. They found that autism-related symptoms independently predicted social outcomes, but not other real-world skills.
Sasson NJ, Pinkham AE, Carpenter KL, Belger A. The benefit of directly comparing autism and schizophrenia for revealing mechanisms of social cognitive impairment. J Neurodev Disord. 2011;3(2):87–100. https://doi.org/10.1007/s11689-010-9068-x.
Barlati S, Deste G, Ariu C, Vita A. Autism spectrum disorder and schizophrenia: do they overlap? Int J Emerg Ment Health. 2016;18(1):760–3.
Kästner A, Begemann M, Michel TM, Everts S, Stepniak B, Bach C, et al. Autism beyond diagnostic categories: characterization of autistic phenotypes in schizophrenia. BMC Psychiatry. 2015;15:115. https://doi.org/10.1186/s12888-015-0494-x.
Deste G, Vita A, Penn DL, Pinkham AE, Nibbio G, Harvey PD. Autistic symptoms predict social cognitive performance in patients with schizophrenia. Schizophr Res. 2020;215:113–9. https://doi.org/10.1016/j.schres.2019.11.008.
Harvey PD, Deckler E, Jones MT, Jarskog LF, Penn DL, Pinkham AE. Autism symptoms, depression, and active social avoidance in schizophrenia: association with self-reports and informant assessments of everyday functioning. J Psychiatr Res. 2019;115:36–42. https://doi.org/10.1016/j.jpsychires.2019.05.010.
Nahum M, Fisher M, Loewy R, Poelke G, Ventura J, Nuechterlein KH, et al. A novel, online social cognitive training program for young adults with schizophrenia: a pilot study. Schizophr Res Cogn. 2014;1(1):e11–e9. https://doi.org/10.1016/j.scog.2014.01.003.
• Nahum M, Lee H, Fisher M, Green MF, Hooker CI, Ventura J et al. Online social cognition training in schizophrenia: a double-blind, randomized, controlled multi-site clinical trial. Schizophr Bull. 2020. https://doi.org/10.1093/schbul/sbaa085. SocialVille is a computerized social cognitive training program. This study was a double-blind, randomized, controlled clinical trial of SocialVille that found that the program improved functional capacity and real-world social functioning.
Ruse SA, Harvey PD, Davis VG, Atkins AS, Fox KH, Keefe RS. Virtual reality functional capacity assessment in schizophrenia: preliminary data regarding feasibility and correlations with cognitive and functional capacity performance. Schizophr Res Cogn. 2014;1(1):e21–e6. https://doi.org/10.1016/j.scog.2014.01.004.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical collection on Schizophrenia and Other Psychotic Disorders
Rights and permissions
About this article
Cite this article
Jones, M.T., Harvey, P.D. Major Neuropsychological Impairments in Schizophrenia Patients: Clinical Implications. Curr Psychiatry Rep 22, 59 (2020). https://doi.org/10.1007/s11920-020-01181-0
Published:
DOI: https://doi.org/10.1007/s11920-020-01181-0