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Cognitive Impairment in Schizophrenia Is the Core of the Disorder
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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“Another core domain of SCZ pathophysiology includes impairments in mental processes such as attention, memory, perception, executive functioning and social cognition70.”
From Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health (2021) · cites this paper as [70]
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Cortical inhibitory neurons and schizophrenia
Lewis, D. A., Hashimoto, T., & Volk, D. W. (2005) · Nature Reviews Neuroscience · doi:10.1038/nrn1648 · Cited by 2,297
“Of the many clinical features of schizophrenia, disturbances in certain cognitive processes, such as impairments in attention, memory and executive functions (that is, the ability to plan, initiate and regulate goal-directed behaviour), might represent the core features of the illnes”
BackgroundInterneuron dysfunction in psychiatric disorders
Marín, O. (2012) · Nature Reviews Neuroscience · doi:10.1038/nrn3155 · Cited by 1,190
“Although positive symptoms are the most noticeable manifestations of this disease, cognitive deficits are perhaps the most distinctiv”
BackgroundStraub, R. E., Jiang, Y., MacLean, C. J., Ma, Y., Webb, B. T., Myakishev, M. V., Harris‐Kerr, C., Wormley, B., Sadek, H., Kadambi, B., et al. (2002) · The American Journal of Human Genetics · doi:10.1086/341750 · Cited by 867
“The intermediate (schizophrenia) phenotypes, of moderately diminished premorbid IQ and related cognitive measures (Elvevag and Goldberg 2000; Weickert et al. 2000), may be an interesting connection between the function of the DPC in synaptic transmission and the observed association between…”
BackgroundResultSchizophrenia Is a Cognitive Illness: Time for a Change in Focus
Kahn, R. S., & Keefe, R. S. E. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.155 · Cited by 825
Dendritic spine pathology in schizophrenia
Glausier, J. R., & Lewis, D. A. (2013) · Neuroscience · doi:10.1016/j.neuroscience.2012.04.044 · Cited by 581
“Cognitive symptoms include deficits in multiple domains such as executive functioning, attention, and working memory (Elvevag and Goldberg, 2000; Piskulic et al., 2007).”
Background
Metadata
- 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)
- 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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