Cited by 836Schizophrenia research and treatmentMental Health and PsychiatryDementia and Cognitive Impairment Research

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Cognitive Impairment in Schizophrenia Is the Core of the Disorder

Elvevag, Brita, Goldberg, Terry E.·2000·Critical Reviews™ in Neurobiology

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Abstract

Patients with schizophrenia exhibit an exceedingly wide range of symptoms from a variety of domains. The cardinal features are abnormal ideas (such as delusions); abnormal perceptions (such as hallucinations); formal thought disorder (as evidenced by disorganized speech); motor, volitional, and behavioral disorders; and emotional disorders (such as affective flattening or inappropriateness). In addition to these diverse, and sometimes bizarre symptoms, it has become increasingly apparent that the disorder is, to variable degrees, accompanied by a broad spectrum of cognitive impairments. This review addresses the question of whether the cognitive deficits seen in schizophrenic patients are the core features of the disorder. In other words, we explore whether schizophrenia is best characterized by symptoms or cognitive deficits (we suggest the latter) and moreover, whether there is a specific cognitive deficit profile that may assist in diagnosis. First, we discuss what the cognitive deficits are. Then we address in turn the reality, frequency, predictive validity, specificity, course and susceptibility to neuroleptic effects of these cognitive impairments. In brief, we argue that various cognitive deficits are enduring features of the schizophrenia illness, that they are not state-related and are not specific to subtypes of the illness, and, more specifically, that working memory and attention are characteristically impaired in patients with schizophrenia, irrespective of their level of intelligence. Last, we conclude that problems in these cognitive domains are at the very core of the dysfunction in this disease.

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Glen, W. B., Horowitz, B. L., Carlson, G. C., Cannon, T. D., Talbot, K., Jentsch, J. D., & Lavı́n, A. (2013) · Hippocampus · doi:10.1002/hipo.22215 · Cited by 34
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Hilti, C. C., Delko, T., Orosz, A., Thomann, K., Ludewig, S., Geyer, M. A., Vollenweider, F. X., Feldon, J., & Cattapan-Ludewig, K. (2009) · Neuropsychobiology · doi:10.1159/000265133 · Cited by 33
“We therefore propose that impairments in maintaining and rapidly updating these rules, as well as problems in rapidly screening numbers, could account for RVIP problems . Referring to the second issue, Elvevag and Goldberg [”
Influence of chronic treatment with olanzapine, clozapine and scopolamine on performance of a learned 8-arm radial maze task in rats
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“Working memory and attention are characteristically im- paired in patients with schizophrenia (Elvevag and Goldberg, 2000).”
Background
Scaling and clustering in the study of semantic disruptions in patients with schizophrenia: a re-evaluation
Elvevåg, B., & Storms, G. (2002) · Schizophrenia Research · doi:10.1016/s0920-9964(02)00331-6 · Cited by 33
“The pathological process of schizophrenia is played out in higher cognitive function (for reviews, see Goldberg and Gold, 1995; Elvevåg and Goldberg, 2000).”
BackgroundSelf-citation
The Adenosine Neuromodulation System in Schizophrenia
Rial, D., Lara, D. R., & Cunha, R. A. (2014) · International review of neurobiology · doi:10.1016/b978-0-12-801022-8.00016-7 · Cited by 35
Impaired processing speed and attention in first-episode drug naive schizophrenia with deficit syndrome
Chen, C., Jiang, W., Zhong, N., Wu, J., Jiang, H., Du, J., Li, Y., Ma, X., Zhao, M., Hashimoto, K., et al. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.09.005 · Cited by 32
“Cognitive impairment is a core feature of schizophrenia, often persisting evenwhenpsychotic symptomshave been treated successfully (Green, 1996; Elvevag and Goldberg, 2000; Harvey and Keefe, 2001; Keefe and Harvey, 2012).”
Background
Chronic MK-801 Application in Adolescence and Early Adulthood: A Spatial Working Memory Deficit in Adult Long-Evans Rats But No Changes in the Hippocampal NMDA Receptor Subunits
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Differential of Frequency and Duration Mismatch Negativity and Theta Power Deficits in First-Episode and Chronic Schizophrenia
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The amphetamine sensitization model of schizophrenia: relevance beyond psychotic symptoms?
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“…impairments, including deficits in working memory (Goldman-Rakic 1994; Weinberger and Gallhofer 1997), episodic memory, attention, cognitive flexibility, and executive functioning (Elvevag and Goldberg 2000; Gold et al. 1997; Goldberg et al. 1987, 1998; Pantelis et al. 1999; Pantelis et al. 2004).”
Background
Effects of metabotropic glutamate receptor 2/3 agonism and antagonism on schizophrenia-like cognitive deficits induced by phencyclidine in rats
Amitai, N., & Markou, A. (2010) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2009.12.040 · Cited by 32
“Introduction Cognitive dysfunction constitutes a core deficit in schizophrenia (Elvevåg and Goldberg, 2000) that is highly correlated with long-term disability (Green et al., 2004; McGurk and Meltzer, 2000; Sharma and Antonova, 2003).”
Background
Working Memory Performance in Poor Outcome Schizophrenia: Relationship to Age and Executive Functioning
McGurk, S. R., Coleman, T. M., Harvey, P. D., Reichenberg, A., WHITE, L. E., Friedman, J. I., Parrella, M. J., & Davis, K. L. (2004) · Journal of Clinical and Experimental Neuropsychology · doi:10.1076/jcen.26.2.153.28079 · Cited by 32
“The sum of the research data suggest that these are multiple aspects of the cognitive deficit in schizophrenia (for review, see, Elvevåg & Goldberg, 2000), and the impairments seen in these apparently disparate functions implicates deficits in the central executive.”
Background
Comprehensive family therapy: an effective approach for cognitive rehabilitation in schizophrenia
Zhang, C., Cai, J., Zhu, Y., Zhang, W., & Wang, Y. (2015) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s83569 · Cited by 31
“impairment is at the core of this disorder.(7,8) Collectively, these different lines of evidence only highlight some of the reasons why finding more effective methods of cognitive improvement has become an increasingly important target for research into schizophrenia and schizophrenia treatment.”
Reelin Supplementation Into the Hippocampus Rescues Abnormal Behavior in a Mouse Model of Neurodevelopmental Disorders
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“On the other hand, the most studied and reproducible cognitive impairments in schizophrenics is working memory deficit (Elvevåg and Goldberg, 2000).”
Background
Validation of a functional remission threshold for the Functional Remission of General Schizophrenia (FROGS) scale
Boyer, L., Richieri, R. M., Guedj, É., Faget, C., Loundou, A., Llorca, P., Auquier, P., & Lançon, C. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.04.008 · Cited by 31
“008 can result in physical, psychological and social disorders related to both the disease and the potential side effects of its treatment [1–5].”
Background
Schizophrenia: an integrative approach to modelling a complex disorder
Robertson, G. S., Hori, S. E., & Powell, K. J. (2006) · Journal of Psychiatry and Neuroscience · doi:10.1139/jpn.0619 · Cited by 34
The NCAN gene: schizophrenia susceptibility and cognitive dysfunction
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“Cognitive dysfunction is recognized as a cardinal feature of schizophrenia that implicates functional outcome.(2,3) There is a realm of evidence showing that patients with schizophrenia exhibit impairment across a range of cognitive domains, such as correspondence: chen Zhang schizophrenia Program, shanghai Mental hea…”
Background
Classification of Schizophrenia by Seed-based Functional Connectivity using Prefronto-Temporal Functional Near Infrared Spectroscopy
Ji, X., Quan, W., Yang, L., Chen, J., Wang, J., & Wu, T. (2020) · Journal of Neuroscience Methods · doi:10.1016/j.jneumeth.2020.108874 · Cited by 30
Cognitive predictors of skill acquisition on social problem solving in patients with schizophrenia
Üçok, A., Çakır, S., Duman, Z. Ç., Discigil, A. G., Kandemir, P., & Atlı, H. (2006) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-006-0651-9 · Cited by 30
“By reviewing the existing large body of literature, various cognitive deficits, especially the working memory and attention impairments were determined as core features of the schizophrenia, regardless of the phase and subtypes of the illness [4].”
ENU-mutagenesis mice with a non-synonymous mutation in Grin1 exhibit abnormal anxiety-like behaviors, impaired fear memory, and decreased acoustic startle response
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“Patients with schizophrenia display various forms of memory defects, including impaired working and episodic memory [68,69].”
Background
Rorschach measures of cognition relate to everyday and social functioning in schizophrenia.
Moore, R. C., Viglione, D. J., Rosenfarb, I. S., Patterson, T. L., & Mausbach, B. T. (2012) · Psychological Assessment · doi:10.1037/a0030546 · Cited by 30
“…1896), studies have documented reduced ability to remember, think, concentrate, formulate ideas, reason, and communicate in schizophrenia (Elvevåg & Goldberg, 2000; Reichenberg, 2010), and these have been linked to impairments in everyday, social, and community functioning (Bowie,…”
Background
Network Profiles of the Dorsal Anterior Cingulate and Dorsal Prefrontal Cortex in Schizophrenia During Hippocampal-Based Associative Memory
Woodcock, E. A., Wadehra, S., & Diwadkar, V. A. (2016) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2016.00032 · Cited by 30
“The illness is characterized by cognitive dysfunction (Elvevåg and Goldberg, 2000; Fioravanti et al., 2005), with learning and memory deficits particularly evident (Aleman et al., 1999; Diwadkar et al., 2008).”
Background
A comparison between the Mini-Mental State Examination and the Montreal Cognitive Assessment Test in schizophrenia
Rademeyer, M., & Joubert, P. (2016) · South African Journal of Psychiatry · doi:10.4102/sajpsychiatry.v22i1.890 · Cited by 31
The Brazilian standardization of the MATRICS consensus cognitive battery (MCCB): Psychometric study
Fonseca, A. O., Berberian, A. D. A., de Meneses-Gaya, C., Gadelha, A., Vicente, M. O., Nuechterlein, K. H., Bressan, R. A., & Lacerda, A. L. T. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.01.006 · Cited by 30
“The cognitive deficits in schizophrenia, originally described by Kraepelin in 1896 (Kraepelin, 1971), and Bleuler in 1911 (Bleuler, 1950), are well documented in the literature (Bowie and Harvey, 2005; Tamminga, 2006) and are considered the core components of the disease (Elvevåg and Goldberg, 2000).”
Background
Pharmacological treatment to augment hole board habituation in prenatal Vitamin D-deficient rats
Becker, A., & Grecksch, G. (2005) · Behavioural Brain Research · doi:10.1016/j.bbr.2005.07.010 · Cited by 30
Neural and neuronal discoordination in schizophrenia: from ensembles through networks to symptoms
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Inhibition of neuronal nitric oxide synthase prevents alterations in medial prefrontal cortex excitability induced by repeated cocaine administration
Nasif, F. J., Hu, X., Ramírez, O. A., & Pérez, M. F. (2010) · Psychopharmacology · doi:10.1007/s00213-010-2105-3 · Cited by 30
“Physiological dopaminergic (DA) modulation in the mPFC is required for several cognitive processes, such as decision making, working memory, and goal planning, impairments of which contribute to addiction and other diseases such as schizophrenia (Elvevag and Goldberg 2000; Goto and Grace 2005; Jentsch et al. 2000).”
Background
Clinical and biochemical study of D-serine metabolism among schizophrenia patients
El-Tallawy, H. N., Saleem, T. H., El-Ebidi, A. M., Hassan, M. H., Gabra, R. H., Farghaly, W. M. A., El‐Maali, N. A., & Sherkawy, H. S. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s126979 · Cited by 29
erbb4 Deficits in Chandelier Cells of the Medial Prefrontal Cortex Confer Cognitive Dysfunctions: Implications for Schizophrenia
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An investigation of 3 neurocognitive subtypes in schizophrenia
Ammari, N., Heinrichs, R. W., & Miles, A. A. (2010) · Schizophrenia Research · doi:10.1016/j.schres.2010.04.014 · Cited by 28
“Research in the last two decades has produced consistent evidence that a majority of schizophrenia patients exhibit impairments in various cognitive domains including sustained attention, verbal declarative memory, spatial working memory, language, abstraction and other executive functions, as well as in general cogni…”
Clinical and cognitive predictors of vocational outcome in first-episode schizophrenia: A prospective 3 year follow-up study
Chang, W. C., Tang, J. Y. ‐., Hui, C. L. M., Chan, S. K. W., Lee, E. H. M., & Chen, E. Y. H. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.09.012 · Cited by 30
“In addition, although cognitive impairment is a core feature of schizophrenia (Elvevag and Goldberg, 2000; Kahn and Keefe, 2013) and is associated with functional disability (Green et al.”
Background
Investigation of gene effects and epistatic interactions between Akt1 and neuregulin 1 in the regulation of behavioral phenotypes and social functions in genetic mouse models of schizophrenia
Huang, C.-H., Pei, J.-C., Luo, D.-Z., Chen, C., Chen, Y., & Lai, W. (2015) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2014.00455 · Cited by 28
“In addition, cognitive impairment, especially deficits in social cognition, is a core feature of schizophrenia that strongly influences the quality of life and function of people with this illness (Elvevåg and Goldberg, 2000; Green, 2006).”
Background
A Pilot Study of iPad-Assisted Cognitive Training for Schizophrenia
Dang, J., Zhang, J., Guo, Z., Lu, W., Cai, J., Shi, Z., & Zhang, C. (2014) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2014.01.003 · Cited by 28
Preserved, deteriorated, and premorbidly impaired patterns of intellectual ability in schizophrenia.
Ammari, N., Heinrichs, R. W., Pinnock, F., Miles, A. A., Muharib, E., & Vaz, S. M. (2014) · Neuropsychology · doi:10.1037/neu0000026 · Cited by 27
“They also persist following the amelioration of clinical symptoms and over the course of the illness (Elvevag & Goldberg, 2000; Heinrichs & Zakzanis, 1998; Hoff et al., 1999; Hughes et al., 2003; Martinez-Aran et al., 2002; Rund et al., 2004); exist in the pre-psychotic period and at the onset of…”
Small non-coding RNA expression from anterior cingulate cortex in schizophrenia shows sex specific regulation
Ragan, C., Patel, K., Edson, J., Zhang, Z. H., Gratten, J., & Mowry, B. J. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2016.11.024 · Cited by 27
Cognitive enhancer ST101 improves schizophrenia-like behaviors in neonatal ventral hippocampus-lesioned rats in association with improved CaMKII/PKC pathway
Yabuki, Y., Wu, L., & Fukunaga, K. (2019) · Journal of Pharmacological Sciences · doi:10.1016/j.jphs.2019.07.015 · Cited by 27
Not Just a Bystander: The Emerging Role of Astrocytes and Research Tools in Studying Cognitive Dysfunctions in Schizophrenia
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“Cognitive impairments are considered a core feature of schizophrenia [120].”
Background

Authors: Elvevag, B., & Goldberg, T. E.
Affiliations: National Institutes of Health (US)
ORCID: Goldberg, Terry E.
Venue: Critical Reviews™ in Neurobiology
Publisher: Begell House
Published: 2000
Volume: 14
Issue: 1
Pages: 21
ISSN: 0892-0915 (ISSN-L)
DOI: 10.1615/critrevneurobiol.v14.i1.10
OpenAlex: W1993560189
Cited by: 835
References: 0
Citations by year: 2026: 14 · 2025: 13 · 2024: 19 · 2023: 14 · 2022: 26 · 2021: 38 · 2020: 25 · 2019: 40 · 2018: 34 · 2017: 39 · 2016: 38 · 2015: 52 · 2014: 44 · 2013: 68 · 2012: 51
FWCI: 5.62
Type: journal article
Language: en
Open access: closed
Locations: Critical Reviews in Neurobiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords: schizophrenia, cognitive impairment, working memory, attention deficits, core symptoms, diagnostic validity, antipsychotic effects, delusions and hallucinations, formal thought disorder
MeSH terms: Cognition Disorders, Humans, Schizophrenia

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Cognitive Impairment in Schizophrenia Is the Core of the Disorder

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