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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“Although their diagnosis and treatment are different, there is some overlap in symptoms and treatment.1–3 Although symptoms are complex and heterogeneous, cognitive impairment is prevalent in SCZ, BD, and MDD.4 Cognitive deficit is regarded as a core symptom of SCZ and BD.5,6 Cognitive impairment is also one of the mo…”
BackgroundInfluential
Ketamine-Induced Alteration of Working Memory Utility during Oculomotor Foraging Task in Monkeys
Sawagashira, R., & Tanaka, M. (2021) · eNeuro · doi:10.1523/eneuro.0403-20.2021 · Cited by 11
“, 2001), and their defects are found in many neurodegenerative disorders including schizophrenia (Elvevåg and Goldberg, 2000; Goldman-Rakic et al., 2004; van Os and Kapur, 2009; Lett et al., 2014).”
Background
Abnormalities of mental rotation of hands associated with speed of information processing and executive function in chronic schizophrenic patients
Mazhari, S., & Tabrizi, Y. M. (2014) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12148 · Cited by 12
“COGNITIVE DYSFUNCTION IS a core feature of schizophrenia.(1,2) The aspects of cognition that are specifically impaired in schizophrenia are verbal memory, working memory, motor function, attention, executive functions, and verbal fluency.”
Background
Nicotine-induced activation of caudate and anterior cingulate cortex in response to errors in schizophrenia
Moran, L. V., Stoeckel, L. E., Wang, K., Caine, C. E., Villafuerte, R. A., Calderon, V., Baker, J. T., Öngür, D., Janes, A. C., Evins, A. E., et al. (2017) · Psychopharmacology · doi:10.1007/s00213-017-4794-3 · Cited by 13
“…1 McLean Hospital, 115Mill Street, AB3S, Belmont,MA 02478, USA 2 Department of Psychiatry, Harvard Medical School, Belmont, MA 02478, USA 3 Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA functional outcome (Elvevåg and Goldberg 2000; Green et al. 2004).”
Pharmacological characterization of JWX-A0108 as a novel type I positive allosteric modulator of α7 nAChR that can reverse acoustic gating deficits in a mouse prepulse inhibition model
Sun, L., Yang, T., Wei, N., Lu, W., Jiao, W., Zhou, Q., Miao, Y., Gao, Q. F., Wang, X., Sun, Q. L., et al. (2018) · Acta Pharmacologica Sinica · doi:10.1038/s41401-018-0163-y · Cited by 13
GM1 ganglioside reverses the cognitive deficits induced by MK801 in mice
Ni, Y., Zhang, W., Bao, X.-F., Wang, W., Song, L., & Jiang, B. (2016) · Behavioural Pharmacology · doi:10.1097/fbp.0000000000000229 · Cited by 12
“Patients with schizophrenia have an exceedingly wide range of symptoms in a variety of domains, of which the cognitive domains are at the very core of the dysfunction in this disease (Elvevag and Goldberg, 2000; Green et al., 2000).”
Background
AKT1 and Neurocognition in Schizophrenia
Pinheiro, A. P., Keefe, R. S. E., Skelly, T. J., Olarte, M., Leviel, K., Lange, L. A., Lange, E. M., Stroup, T. S., Lieberman, J. A., & Sullivan, P. F. (2007) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670601109956 · Cited by 12
“Some have argued that neurocognitive dysfunction is a defining feature of schizophrenia [36] and cognitive impairment may be the best predictor of poor outcome [9].”
Background
Evidence towards a continuum of impairment across neurodevelopmental disorders from basic ocular-motor tasks
Canu, D., Ioannou, C., Müller, K., Martin, B., Fleischhaker, C., Biscaldi, M., Beauducel, A., Smyrnis, N., van Elst, L. T., & Klein, C. (2022) · Scientific Reports · doi:10.1038/s41598-022-19661-z · Cited by 12
Cognitive dysfunction in schizophrenia: glutamatergic hypoactivity and dopaminergic failure
Holcomb, H. H., Rowland, L. M., & Tagamets, M. A. (2004) · Drug Discovery Today Disease Mechanisms · doi:10.1016/j.ddmec.2004.11.017 · Cited by 11
Cognitive Identity in Schizophrenia: Vision, Space, and Body Perception from Prodrome to Syndrome
Amado, I. (2012) · Current Psychiatry Reviews · doi:10.2174/1573400511208020119 · Cited by 11
“ment of efficient prediction measures [1-4].”
Adulthood olanzapine treatment fails to alleviate decreases of ChAT and BDNF RNA expression in rats quinpirole-primed as neonates
Brown, R. W., Perna, M. K., Maple, A. M., Wilson, T. D., & Miller, B. E. (2008) · Brain Research · doi:10.1016/j.brainres.2008.01.041 · Cited by 11
A model of memory impairment in schizophrenia: Cognitive and clinical factors associated with memory efficiency and memory errors
Brébion, G., Bressan, R. A., Ohlsen, R. I., & David, A. S. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.09.009 · Cited by 11
Positive allosteric modulators of the α7 nicotinic acetylcholine receptor potentiate glutamate release in the prefrontal cortex of freely-moving rats
Bortz, D. M., Upton, B. A., Mikkelsen, J. D., & Bruno, J. P. (2016) · Neuropharmacology · doi:10.1016/j.neuropharm.2016.08.033 · Cited by 11
The neuropsychology of emerging psychosis and the role of working memory in episodic memory encoding
Pflueger, M. O., Calabrese, P., Studerus, E., Zimmermann, R., Gschwandtner, U., Borgwardt, S., Aston, J., Stieglitz, R., & Riecher‐Rössler, A. (2018) · Psychology Research and Behavior Management · doi:10.2147/prbm.s149425 · Cited by 11
Antipsychotic-like effects of a novel phosphodiesterase 10A inhibitor T-251 in rodents
Takakuwa, M., Watanabe, Y., Tanaka, K., Ishii, T., Kagaya, K., Taniguchi, H., Kotera, J., & Hashimoto, K. (2019) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2019.172757 · Cited by 11
The Efficacy, Feasibility And Acceptability Of A Remotely Accessible Use Of CIRCuiTS, A Computerized Cognitive Remediation Therapy Program For Schizophrenia: A Pilot Study
Palumbo, D., Mucci, A., Giordano, G. M., Piegari, G., Aiello, C., Pietrafesa, D., Annarumma, N., Chieffi, M., Cella, M., & Galderisi, S. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s221690 · Cited by 11
Altered Visuospatial Processing in Schizophrenia: An Event-related Potential Microstate Analysis Comparing Patients with and without Hallucinations with Healthy Controls
Antonova, I., van Swam, C., Hubl, D., Griškova-Bulanova, I., Dierks, T., & Koenig, T. W. (2021) · Neuroscience · doi:10.1016/j.neuroscience.2021.10.014 · Cited by 11
Nicotine pretreatment alleviates MK-801-induced behavioral and cognitive deficits in mice by regulating Pdlim5/CRTC1 in the PFC
Wang, Q., Wang, M., Sun, Y., Hu, X., Geng, P., Shu, H., Wang, X., Wang, H., Zhang, J., Cheng, H., et al. (2022) · Acta Pharmacologica Sinica · doi:10.1038/s41401-022-00974-8 · Cited by 11
“The rate of smoking may be higher in schizophrenia patients because patients consume tobacco to relieve schizophreniainduced cognitive impairment [3], which is the core symptom of schizophrenia [4] and is linked with brain function impairment [5].”
Background
Effects of Add-on Ramelteon on Cognitive Impairment in Patients with Schizophrenia: An Open-label Pilot Trial
Shirayama, Y., Takahashi, M., Suzuki, M., Tsuruoka, Y., & Sato, K. (2014) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2014.12.3.215 · Cited by 11
“215 pISSN 1738-1088 / eISSN 2093-4327 Clinical Psychopharmacology and Neuroscience 2014;12(3):215-217 Copyrightc 2014, Korean College of Neuropsychopharmacology”
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Proceedings of the 13th International Workshop on Health Text Mining and Information Analysis (LOUHI)
(2022) · doi:10.18653/v1/2022.louhi-1 · Cited by 11
NRG1 knockdown rescues PV interneuron GABAergic maturation deficits and schizophrenia behaviors in fetal growth restriction mice
Dong, J., Chen, W., Liu, N., Chang, S., Zhu, W., & Kang, J. (2022) · Cell Death Discovery · doi:10.1038/s41420-022-01271-3 · Cited by 12
“Although positive symptoms are the most noticeable disease manifestation, cognitive symptoms are perhaps the most distinctive [13].”
Background
Characteristics of cognitive impairment in schizophrenia
Harvey, P. D. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9781139003872.002 · Cited by 10
The effect of auditory and visual training on the mismatch negativity in schizophrenia
Kärgel, C., Sartory, G., Kariofillis, D., Wiltfang, J., & Müller, B. W. (2016) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2016.03.003 · Cited by 10
“, 2005), since neuropsychological deficits are considered a hallmark of schizophrenia (Elvevag and Goldberg, 2000; Gold, 2004).”
Background
Automatic Intra-/Extra-Dimensional Attentional Set-Shifting Task in Adolescent Mice
Ciampoli, M., Scheggia, D., & Papaleo, F. (2021) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2021.704684 · Cited by 11
“Early detection and early intervention could be potentially more effective in mitigating or reversing the pathological trajectories and ultimately the life quality of individuals with cognitive deficits (Elvevåg and Goldberg, 2000; Hintze and Borkowska, 2015).”
Background
Compliance with command hallucinations: the role of power in relation to the voice, and social rank in relation to the voice and others
Reynolds, N., & Scragg, P. (2009) · Journal of Forensic Psychiatry and Psychology · doi:10.1080/14789940903194111 · Cited by 10
“Cognitive impairments are common in individuals with a diagnosis of schizophrenia (Elvevag & Goldberg, 2000 ) and might have led to participants' memories being less accurate.”
Background
The involvement of Type II Neuregulin-1 in rat visuospatial learning and memory
Taylor, A. R., Taylor, S. B., & Koenig, J. I. (2012) · Neuroscience Letters · doi:10.1016/j.neulet.2012.10.018 · Cited by 9
“These cognitive impairments have been shown to be strong predictors of overall outcome in patients with schizophrenia [12] and are core features of the illness [2,8,18].”
Background
Investigating the association between symptoms and functional activity in brain regions in schizophrenia: A cross-sectional fmri-based neuroimaging study
Chatterjee, I., & Hilal, B. (2024) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2024.111870 · Cited by 9
“Cognitive deficits encompass attention, memory, reasoning, and processing speed, and remarkably, these impairments are evident even before the clinical onset of the illness Keefe and Harvey (2012); O ’ Carroll (2000); Elvevag and Goldberg (2000).”
Background
Can the role of genetic factors in schizophrenia be enlightened by studies of candidate gene mutant mice behaviour?
Mazzoncini, R., Zoli, M., Tosato, S., Lasalvia, A., & Ruggeri, M. (2009) · The World Journal of Biological Psychiatry · doi:10.1080/15622970902875152 · Cited by 9
Association between developmental milestones and age of schizophrenia onset: Results from the Northern Finland Birth Cohort 1966
Štochl, J., Whittier, A., Wagner, A. P., Veijola, J. M., Jääskeläinen, E., Miettunen, J., Khandaker, G. M., & Jones, P. B. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.02.013 · Cited by 9
“There has been longitudinal work implicating various forms and manifestations of cognitive impairment in schizophrenia, with some even arguing these deficits are the defining feature of the illness – perhaps even above and beyond the psychotic elements (Elvevag and Goldberg, 2000; Kahn and Keefe, 2013).”
Personality and risk of hospital diagnosed mental disorder: a 35 years’ prospective study
Christensen, D. S., Flensborg‐Madsen, T., Andersen, N., Rosenkær, I. B., & Mortensen, E. L. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-02001-9 · Cited by 10
Correlation of neurocognitive deficits with positive and negative symptoms in schizophrenia
Priyamvada, R., Ranjan, R., Jha, G. K., & Chaudhury, S. (2021) · Industrial Psychiatry Journal · doi:10.4103/ipj.ipj_44_20 · Cited by 10
“[14] Attention, memory, reasoning, and processing speed are the primary cognitive deficits in schizophrenia.”
Time Perception and Psychiatric Disorders
Bahadırlı, N. B., Tutug, C., Ceviz, H., & Çalıyurt, O. (2013) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.5455/cap.20130524 · Cited by 6
Relationship of psychological symptoms, antipsychotics and social data with psychosocial function in schizophrenia patients in M alaysia
Norlelawati, A. T., Abdullah, K., Norsidah, K.-Z., Ramli, M., Azizi, W. S. W., & Tariq, A. R. (2013) · Asia-Pacific Psychiatry · doi:10.1111/appy.12089 · Cited by 9
“The overwhelming cognitive impairments that accompany schizophrenia (Elvevag and Goldberg, 2000) could possibly have masked the importance of education status in determining social function.”
Background
Hit-to-lead investigation of a series of novel combined dopamine D2 and muscarinic M1 receptor ligands with putative antipsychotic and pro-cognitive potential
Sams, A. G., Larsen, K., Mikkelsen, G. K., et al. (2012) · Bioorganic & Medicinal Chemistry Letters · doi:10.1016/j.bmcl.2012.05.048 · Cited by 9
Cocaine- and Amphetamine-Regulated Transcript Peptide (CART) Alleviates MK-801-Induced Schizophrenic Dementia-Like Symptoms
Borkar, C. D., Bharne, A. P., Balasubramanian, N., Sakharkar, A. J., Subhedar, N. K., & Kokare, D. M. (2018) · Neuroscience · doi:10.1016/j.neuroscience.2018.01.056 · Cited by 10

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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