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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“Schizophrenia is a chronic and often severe psychiatric disorder that affects approximately 20 million people worldwide, profoundly disrupting perception, thought, affect and behaviour [1, 2].”
Insights from the examination of verbal and spatial memory errors in relation to clinical symptoms of patients with recent-onset schizophrenia
Cellard, C., Tremblay, S., Lefèbvre, A.-A., Laplante, L., Achim, A. M., Bouchard, R.-H., & Roy, M. (2009) · Cognitive Neuropsychiatry · doi:10.1080/13546800903272059 · Cited by 2
“Schizophrenia (SZ) is a heterogeneous disorder characterised by cognitive dysfunctions in addition to the clinical symptoms on which the diagnosis is based (Elvevag & Goldberg, 2000 ; Harvey & Sharma, 2002 ; Heinrichs, 2005 ; Joyce & Roiser, 2007 ; Seaton, Goldstein, & Allen, 2001 ).”
Background
What Drives Animal Fluency Performance in Cantonese-Speaking Chinese Patients with Adult-Onset Psychosis?
Hui, C. L. M., See, S. H. W., Chiu, T.-C., Pintos, A. S., Kroyer, J. M., Suen, Y. N., Lee, E. H. M., Chan, S. K. W., Chang, W. C., Elvevåg, B., et al. (2023) · Brain Sciences · doi:10.3390/brainsci13030372 · Cited by 2
Self-citation
Prevalence of depression in persons with schizophrenia – a cross-sectional study from a tertiary psychiatric hospital
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Clinical practice guidelines – An overview of cognitive remediation for various neuropsychiatric disorders
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Schizophrenia Management Approaches: A Look at Progress and Challenges
Patel, K. P., & Oroszi, T. L. (2025) · World Journal of Neuroscience · doi:10.4236/wjns.2025.151003 · Cited by 2
Short Neuropsychological Assessment in Schizophrenic Patients
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Cognitive impairment and symptom dimensions in psychosis
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Interactions of Timing and Motivational Impairments in Schizophrenia
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Evaluierung der Testbatterie zur Aufmerksamkeitsprüfung (TAP) als kognitiver Endophänotyp der Schizophrenie
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Toward Predicting Impact of Common Genetic Variants on Schizophrenia Clinical Responses With Antipsychotics: A Quantitative System Pharmacology Study
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“The cortical schizophrenia pathology as mentioned in Section 1, has been calibrated to reﬂect a decrease in cognitive readout which is 1.5 standard deviations below the average of the normal subjects (Elvevag and Goldberg, 2000).”
MethodInfluential
High-definition transcranial direct current stimulation for treating cognitive and negative symptoms in chronic schizophrenia – A sham-controlled proof of concept study
Yadav, B., Goyal, N., Roy, C., et al. (2023) · Archives of Biological Psychiatry · doi:10.25259/abp_20_2023 · Cited by 1
Prevalence of neurocognitive deficits in patients with first-episode schizophrenia in an African sample and its relationship with dimensions of psychopathology and psychosocial outcome
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“These deficits are experienced across a variety of cognitive domains, and the deficits are both general and domain specific [4, 5].”

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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