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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Zugno, A. I., Matos, M. P. P., Canever, L., Fraga, D. B., Luca, R. D. D., Ghedim, F. V., Deroza, P. F., de Oliveira, M. B., Pacheco, F. D., Valvassori, S. S., et al. (2013) · Acta Neuropsychiatrica · doi:10.1017/neu.2013.31 · Cited by 21
Phospholipase C-β1 and schizophrenia-related behaviors
Koh, H.-Y. (2013) · Advances in Biological Regulation · doi:10.1016/j.jbior.2013.08.002 · Cited by 21
Effect of time and duration of untreated psychosis on cognitive and social functioning in Chinese patients with first-episode schizophrenia: A 1-year study
Heeramun‐Aubeeluck, A., Liu, N., Fischer, F. H., Huang, N., Chen, F., He, L., Yang, C., Luo, Y., & Lu, Z. (2015) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2014.929738 · Cited by 21
The relationship of cognitive improvement after cognitive remediation with social functioning in patients with schizophrenia and severe cognitive deficits
Lindenmayer, J., Fregenti, S., Kang, G., Ozog, V., Ljuri, I., Khan, A., Goldring, A., & McGurk, S. R. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.01.007 · Cited by 22
Synaptic biomarker reduction and impaired cognition in the sub-chronic PCP mouse model for schizophrenia
Gigg, J., McEwan, F., Smausz, R., Neill, J. C., & Harte, M. (2019) · Journal of Psychopharmacology · doi:10.1177/0269881119874446 · Cited by 21
“These are severely debilitating, constant and enduring features of the illness (Elvevag and Goldberg, 2000), that occur prior to the onset of psychosis (Kahn and Keefe, 2013), are resistant to current treatment (Citrome, 2014), predict outcome and greatly reduce quality of life (Green, 1996).”
Background
A Self Administered Executive Functions Ecological Questionnaire (The Behavior Rating Inventory of Executive Function - Adult Version) Shows Impaired Scores in a Sample of Patients with Schizophrenia
Bulzacka, E., Vilain, J., Schürhoff, F., Méary, A., Leboyer, M., & Szöke, A. (2013) · Mental Illness · doi:10.4081/mi.2013.e4 · Cited by 24
Early Treatment-Induced Improvement of Negative Symptoms Predicts Cognitive Functioning in Treatment-Naive First Episode Schizophrenia: A 2-Year Followup
Schuepbach, D., Hill, S. K., Sanders, R. D., et al. (2004) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a007136 · Cited by 21
“The results of our study also lend support to the notion that early cognitive performance change predicts average negative symptom severity, and hence confirm widely accepted assumptions that cognitive deficits may represent a core feature of the illness (Elvevag and Goldberg 2000).”
Result
Handbook of neurochemistry and molecular neurobiology, schizophrenia
Lajtha, Á., Javitt, D. C., & Kantrowitz, J. T. (2009) · Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) · doi:10.1007/978-0-387-30410-6 · Cited by 21
Basic visual dysfunction allows classification of patients with schizophrenia with exceptional accuracy
González-Hernández, J. A., Pita-Alcorta, C., Padrón, A., et al. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.07.052 · Cited by 20
“Similarly, attentional deficits have been consistently observed in schizophrenia (Elvevag and Goldberg, 2000; Gooding et al., 2006).”
Background
Executive Functions in Patients with Familial versus Sporadic Schizophrenia and Their Parents
Erol, A., Bayram, S., Köşger, F., & Mete, L. (2012) · Neuropsychobiology · doi:10.1159/000337738 · Cited by 21
Robust sequential working memory recall in heterogeneous cognitive networks
Rabinovich, M. I., Sokolov, Y., & Kozma, R. (2014) · Frontiers in Systems Neuroscience · doi:10.3389/fnsys.2014.00220 · Cited by 20
Biomarcadores sanguíneos diferenciales de las dimensiones psicopatológicas de la esquizofrenia
García-Álvarez, L., García‐Portilla, M. P., González-Blanco, L., Sáiz, P. A., de la Fuente-Tomás, L., Menéndez-Miranda, I., García, C. I., & Bobes, J. (2016) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2016.04.003 · Cited by 20
“Finalmente, los fallos neurocognitivos han sido también ampliamente documentados y se han considerado una carac-terística central de la esquizofrenia 66---70 .”
Effects of transcranial direct current stimulation on the auditory mismatch negativity response and working memory performance in schizophrenia: a pilot study
Impey, D., Baddeley, A., Nelson, R., Labelle, A., & Knott, V. (2017) · Journal of Neural Transmission · doi:10.1007/s00702-017-1783-y · Cited by 20
“…by deficits in perception, attention, memory and executive functions, has been proposed to be the core feature of schizophrenia (Sz), with deficits correlating with negative symptoms and functional outcome, as well as being a treatment target (Elvevag and Goldberg 2000; Green et al. 1996, 2000).”
Background
Transient disruption of attentional performance following escalating amphetamine administration in rats
Kondrad, R. L., & Burk, J. A. (2003) · Psychopharmacology · doi:10.1007/s00213-004-1857-z · Cited by 20
“An increase in false alarms in this task is consistent with overprocessing stimulus information, a cognitive deficit thought to represent a core feature of schizophrenia (McGhie and Chapman 1961; Braff 1993; Elevag and Goldberg 2000 ).”
Background
Clinical effectiveness in adults with chronic schizophrenia
Peuskens, J. (2004) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2004.08.004 · Cited by 20
“, 2000), while neurocognitive impairment, in areas such as attention, memory and executive function, reduces the patient’s ability to function normally within the community (Elvev3g and Goldberg, 2000; Green et al., 2000; Velligan et al., 1997).”
Background
Disorganization of Oscillatory Activity in Animal Models of Schizophrenia
Speers, L. J., & Bilkey, D. K. (2021) · Frontiers in Neural Circuits · doi:10.3389/fncir.2021.741767 · Cited by 21
A family study on first episode of psychosis patients: Exploring neuropsychological performance as an endophenotype
Murillo‐García, N., Díaz‐Pons, A., Cacho, L. M. F., Miguel‐Corredera, M., Martínez‐Barrio, S., de la Foz, V. O., Neergaard, K. D., & Ayesa‐Arriola, R. (2022) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13404 · Cited by 19
Quantification of relevance of quality of life assessment for patients with cognitive impairment: the suitability indices
Baumstarck, K., Boucékine, M., Boyer, L., Aghababian, V., Parola, N., Françoise Reuter, A., Loundou, A., Lançon, C., Pelletier, J., & Auquier, P. (2014) · BMC Neurology · doi:10.1186/1471-2377-14-78 · Cited by 19
“Disease duration in years: median [range] 10 [0–31] 22 [19-27]”
Cortical Circuit Models in Psychiatry
Murray, J. D., & Wang, X. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-809825-7.00001-8 · Cited by 19
“Cognitive deficits, including in working memory and decision making, lie at the core of schizophrenia (Elvevåg and Goldberg, 2000).”
Background
Enhancing cognition through pharmacological and environmental interventions: Examples from preclinical models of neurodevelopmental disorders
Morè, L., Lauterborn, J. C., Papaleo, F., & Brambilla, R. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.02.003 · Cited by 20
Effects of Amisulpride Adjunctive Therapy on Working Memory and Brain Metabolism in the Frontal Cortex of Patients with Schizophrenia: A Preliminary Positron Emission Tomography/Computerized Tomography Investigation
Park, J. H., Hong, J. S., Kim, S. M., Min, K. J., Chung, U., & Han, D. H. (2019) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2019.17.2.250 · Cited by 19
Cortical thickness correlates of cognitive performance in cognitively-matched individuals with and without schizophrenia
Hanford, L. C., Pinnock, F., Hall, G. B., & Heinrichs, R. W. (2019) · Brain and Cognition · doi:10.1016/j.bandc.2019.04.003 · Cited by 19
Neural correlates to both emotion and cognitive functions in the monkey amygdala.
Nishijo, H., Hori, E., Tazumi, T., & Ono, T. (2008) · Behavioural Brain Research · doi:10.1016/j.bbr.2007.10.013 · Cited by 20
Progressive disability and prefrontal shrinkage in schizophrenia patients with poor outcome: A 3-year longitudinal study
Dusi, N., Bellani, M., Perlini, C., Squarcina, L., Marinelli, V., Finos, L., Altamura, C. A., Ruggeri, M., & Brambilla, P. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.09.013 · Cited by 19
“…to demonstrate progressive prefrontal alterations in POS (DeLisi et al., 1997; DeLisi et al., 1995), Also, the underlyingmechanistic processes and the functioning impact of prefrontal alterations are still under debate (Bellani et al., 2010; Elvevag and Goldberg, 2000; Tournikioti et al., 2007).”
Background
Assessing validity of retrospective recall of physical activity in individuals with psychosis-like experiences
Andorko, N. D., Rouhakhtar, P. R., Hinkle, C. E., Mittal, V. A., McAllister, M., DeVylder, J., & Schiffman, J. E. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.01.029 · Cited by 19
“Deficits in executive functioning and memory are present across the psychosis-spectrum (Elvevag and Goldberg, 2000; Fryer et al., 2013; Fusar-Poli et al., 2012; Karlsgodt et al., 2010), including in those with psychosis-like experiences (Barber et al.”
Background
Transcriptome alterations in schizophrenia: disturbing the functional architecture of the dorsolateral prefrontal cortex
Lewis, D. A., & Mirnics, K. (2006) · Progress in brain research · doi:10.1016/s0079-6123(06)58007-0 · Cited by 18
“, attention, memory, and other higher-order processes such as the ability to plan, initiate, and regulate goal-directed behavior) appear to represent the core features of the illness (Elvevåg and Goldberg, 2000).”
Background
Assessing Preferences for Schizophrenia Outcomes: Comprehension and Decision Strategies in Three Assessment Methods
Shumway, M., Sentell, T. L., Chouljian, T. L., et al. (2003) · Mental Health Services Research · doi:10.1023/a:1024415001045 · Cited by 18
“Instead, this pattern of difficulties, consistent with findings of working memory and attention deficits in schizophrenia ( Elvevag and Goldberg, 2000; Heinrichs, 2001; Velligan and Bow-Thomas, 1999), is likely to reflect the difficulties consumers experience when they are asked to provide preference judgments.”
Result
Expressions of Neuregulin 1 β and ErbB4 in Prefrontal Cortex and Hippocampus of a Rat Schizophrenia Model Induced by Chronic MK-801 Administration
Feng, Y., Wang, X., Guo, C., Yang, Y., Li, J., Su, Y., & Si, T. (2010) · BioMed Research International · doi:10.1155/2010/859516 · Cited by 18
Mouse models for studying genetic influences on factors determining smoking cessation success in humans
Hall, F. S., Markou, A., Levin, E. D., & Uhl, G. R. (2012) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2011.06415.x · Cited by 18
Temporal Information Processing in Short- and Long-Term Memory of Patients with Schizophrenia
Landgraf, S., Steingen, J., Eppert, Y., Niedermeyer, U., van der Meer, E. E., & Krüeger, F. (2011) · PLoS ONE · doi:10.1371/journal.pone.0026140 · Cited by 18
“Our results confirm that cognitive dysfunctions are a major deficit in patients with schizophrenia”
Result
Event-related brain potential correlates of prospective memory in symptomatically remitted male patients with schizophrenia
Guoliang, C., Zhang, L., Ding, W., Zhou, R., Xu, P., Lu, S., Sun, L., Jiang, Z., Li, H., Li, Y., et al. (2015) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2015.00262 · Cited by 17
“Patients with schizophrenia are characterized by cognitive deficits (Heinrichs and Zakzanis, 1998; Elvevåg and Goldberg, 2000).”
Background
Dopamine D1 receptor activation improves PCP-induced performance disruption in the 5C-CPT by reducing inappropriate responding
Barnes, S. A., Young, J. W., Bate, S. T., & Neill, J. C. (2015) · Behavioural Brain Research · doi:10.1016/j.bbr.2015.11.035 · Cited by 18
“Cognitive deficits in schizophrenia remain an unmet clinical need that contribute significantly to long-term functional and occupational impairments [1, 2].”
Background
Influence of Venus and Mars in the cognitive sky of schizophrenia. Results from the first-step national FACE-SZ cohort
Fond, G. B., Boyer, L., Leboyer, M., et al. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.09.027 · Cited by 18
“Cognitive symptoms can have a higher impact on the outcome, and quality of life, of SZ than any other symptom (Shin et al., 2016), and are considered a core feature of this disorder (Elvevåg and Goldberg, 2000).”
Understanding the circuit basis of cognitive functions using mouse models
Nakajima, M., & Schmitt, L. I. (2019) · Neuroscience Research · doi:10.1016/j.neures.2019.12.009 · Cited by 19
The feasibility and acceptability of questionnaires and accelerometry for measuring physical activity and sedentary behaviour in adults with mental illness
Chapman, J. J., Fraser, S. J., Brown, W. J., & Burton, N. W. (2015) · Journal of Mental Health · doi:10.3109/09638237.2015.1057321 · Cited by 18
The effects of eticlopride on Morris water task performance in male and female rats neonatally treated with quinpirole
Brown, R. W., Thompson, K. N., Click, I. A., Best, R. A. C., Thacker, S. K., & Perna, M. K. (2005) · Psychopharmacology · doi:10.1007/s00213-005-2148-z · Cited by 18
“Additionally, cognitive deficits were shown to be prevalent in each of these diseases (Elvevag and Goldberg 2000; Levy and Swanson 2001; Kuelz et al. 2004), although an underlying cause has yet to be identified.”

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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