Schizophrenia is a severe mental illness characterized by both positive and negative symptoms. In addition to the traditional positive symptoms like hallucinations and negative symptoms like emotional withdrawal, there are profound cognitive symptoms. It was originally thought that cognitive deficits were only found in elderly individuals with schizophrenia. However, much research has found that impaired cognition can also be found in younger individuals with the disease.
Not only can these cognitive deficits appear among younger individuals with schizophrenia, many times there are deficits in cognition that are noted pre-diagnosis. In other words, people may experience impaired cognition in terms of planning, focus, and abstract thinking well before early symptoms of schizophrenia are noted. Once the illness has been diagnosed, the individual’s cognition typically worsens.
Cognitive Symptoms of Schizophrenia
It should be noted that up to 75% of patients with schizophrenia experience cognitive symptoms as a result of the illness. A variety of symptoms can be experienced, but the primary functions that are affected include: attention, memory, motor skills, executive functioning, and intelligence. It is important to distinguish these from both positive symptoms and negative symptoms.
It should also be noted that the cognitive impairment typically is evidenced before signs of the illness. These cognitive impairments are directly linked to social and functional deficits. Most cognitive symptoms are subtle, and as a result, may be difficult to recognize. Usually they are only detected when cognition testing is performed.
- Anosognosia: This is a cognitive symptom that involves a person having major deficits in self-awareness. In a case of schizophrenia, it may involve the person not even knowing that they have a mental illness.
- Disorganized thinking: The thinking in people with this illness may be grossly disorganized. They may not be able to organize thoughts, which is thought to lead to major social and occupational impairments.
- Poor executive functioning: This means the individual with schizophrenia has a very tough time understanding information, processing it, and using it to make logical decisions. People use their executive function to help them connect past learning or experiences with decisions or present action. It is involved in planning, organizing, strategically thinking, paying attention, memory, and time management.
- Trouble focusing/concentration: The person may have a very difficult time paying attention or focusing on a task. Even if they are able to focus for a short time, their inability to sustain focus or concentration makes tasks significantly more difficult.
- Working memory problems: Working memory helps us temporarily store visual images as well as verbal information for a short duration. The person with this illness has a tough time using information immediately after they learn it. This can make task performance such as on a job very difficult and nearly unsustainable for certain individuals with this illness. It should be noted that major deficits are associated with “passive, maintenance tasks.”
Note: One study found that individuals with schizophrenia actually perform better than the average population at “executive, manipulation” working memory tasks. Source: http://news.vanderbilt.edu/2011/01/schizophrenics-better-at-some-memory-tasks/
The cognitive symptoms that people with schizophrenia experience make it extremely difficult them to hold down a stable job and earn a living. Having impaired cognition can also lead to significant emotional distress as a result of underperformance and/or confusion. Most of these symptoms are only detected upon proper administration of a neuropsychological testing battery.
What causes cognitive symptoms of schizophrenia?
No one knows the exact cause of schizophrenia, let alone the various symptoms that are experienced. There are a variety of scientific hypotheses that have been developed that attempt to address the roots of cognitive deficits. Most research tends to point to dysfunction in various brain regions and neurotransmitter activity.
- Altered brain activity: The overarching theme among cognitive symptoms is that they involve alterations in brain activity. Researchers found that when they decreased activity in the mediodorsal thalamus region of the brain in mice, this lead to major deficits in working memory as well as other “schizophrenia-like” deficits.
- Brain structure damage: Certain cognitive symptoms may be a result of damage to brain structures. Some have stated that damage to the parietal lobe or frontal-temporal-parietal areas in the right hemisphere may contribute to the condition.
- Myelin and axon abnormalities: It is thought that abnormalities in myelin and axons can lead to deficits in neural connectivity. This is thought to cause significant cognitive deficits and overall impaired mental functioning. Researchers have noted significantly reduced myelination in white matter among schizophrenics.
- Neurotransmitter dysfunction: Some hypothesize that dysfunctions in the cholinergic, D1 dopamine, and NDMA glutamate systems all play a role in cognitive deficits. These are likely to be a result of the disease and its unknown processes.
- Antipsychotics: Although most argue that antipsychotic medications can slightly improve cognition, some would argue that they can impair it. It is well known that antipsychotics can lead to tremors, tardive dyskinesia, and motor problems.
Treatment for Cognitive Impairment in Schizophrenia
Unfortunately there are no medications that are approved to treat cognitive symptoms in schizophrenia. Using alternative psychiatric medications to address these symptoms is pretty uncommon and is considered “off label” use. In order to address the cognitive symptoms, there isn’t much that can be done. However, this does not mean giving up hope, there are still some options that can be pursued.
- Changing Antipsychotics: Certain antipsychotic medications have worse side effects than others. Some medications may actually result in greater cognitive impairment than others. An effective medication should help slightly improve cognition while treating other positive symptoms.
- Cognitive Remediation Therapy: This is a behavioral treatment that uses practice drills and various strategies to help improve cognition in people with impairments. Various areas that may be targeted with this type of therapy include: attention, memory, organization, prioritization, and ability to problem solve. The whole goal behind this therapy is to help patients improve so that they can perform basic tasks and be productive members of society.
- Exercise: Getting daily exercise may help improve cognition among patients with mental illness. There are many psychological benefits of exercise – this is well known. Cardiovascular exercise has been shown to help improve brain functioning.
- Natural Remedies: There are various natural remedies for schizophrenia that you may want to consider. Many of these remedies have been shown to be effective at reducing symptoms when used in combination with an antipsychotic. Work with your psychiatrist to figure out what you think will work best to treat your cognitive deficits.
- Psychosocial Interventions: This involves adding some form of social support network to an individual’s life. This may be in the form of friends and family members that act encouraging and help support the individual by guiding them in the right direction. Something as simple as social interaction can go a long way in people with cognitive deficits.