Schizophrenia is a serious mental health condition that can have many symptoms. Some of the ones you may be familiar with are related to psychosis. Psychosis is a loss of connection with reality. Symptoms of psychosis include hallucinations and delusions. People with schizophrenia may be socially isolated or have changes in appearance, too.1,2
But there are other, sometimes less visible symptoms of schizophrenia. For example, cognitive symptoms often occur. Cognitive, or cognition, refers to the way you think and the way the brain operates. It also refers to your ability to plan and remember things.3
What are cognitive symptoms with schizophrenia?
In people with schizophrenia, cognitive symptoms can happen at any time. These symptoms are sometimes hard to notice. They often get worse slowly over time. But in some people, major changes in cognition can happen quickly. This can most clearly noticed during and after an episode of psychosis.4,5
There are many types of cognitive issues that can occur with this condition. They include:1,3-5
- Poor attention
- Trouble remembering things
- Issues learning new facts
- Trouble planning tasks or problem solving (called poor executive functioning)
- Not understanding social cues
- Problems understanding things that are said (poor verbal comprehension)
- Slower processing or understanding of information
- Not being able to concentrate
- Difficulty maintaining a train of thought or taking a long time to conclude a thought
Why do cognitive symptoms happen with schizophrenia?
It is unclear exactly why people with schizophrenia have cognitive symptoms. They may be related to changes in brain structure and function. For example, schizophrenia may affect connections between certain cells in the brain. This can impact the way people process and respond to information.4-6
Also, some areas of the brain can be different sizes in people who have schizophrenia. For example, changes in areas called the frontal lobes and hippocampus may lead to issues with decision making, memory, and thinking.4-6
Drug side effects also can cause cognitive issues. These side effects can come from antipsychotic drugs used to treat schizophrenia. Or they can come from other prescribed drugs. They can come from recreational drugs, too.5,7
People with schizophrenia also have an increased risk of dementia. Experts do not yet understand the reason for this. But dementia can have similar brain changes as schizophrenia. The 2 conditions can have similar cognitive symptoms.5
What is anosognosia?
Anosognosia is an important cognitive symptom of schizophrenia. A person with anosognosia lacks insight (personal awareness) or understanding about their condition. They do not know they are having symptoms. For example, a person may believe a celebrity is in love with them. Even when provided evidence it is not true – for instance, they are reminded that they have never met the celebrity – they still believe this to be true. This is a lack of awareness that symptoms are happening.8
Anosognosia can make treating schizophrenia challenging. It is often hard to convince someone to treat symptoms they do not believe they have. People with anosognosia may resist visiting their doctor regularly, taking medication, or meeting with a counselor. Without consistent treatment, symptoms and outcomes often get worse.5,8
How are cognitive symptoms treated?
Treating cognitive symptoms can be tough. Some drugs needed to control psychosis may make cognitive issues worse. Even the newer, second-generation antipsychotics (atypical antipsychotics) often do not treat cognitive symptoms well.5,9
Experts are looking into whether one of these newer drugs, aripiprazole, may help. So far, there is potential but no clear answer. Research also is ongoing about the effects of certain anti-inflammatory and anti-dementia drugs on schizophrenia symptoms. But more research is needed to show which drugs work best. You and your doctor will work together to figure out what drug or combination of drugs might be best for you.9,10
In addition to medicine, therapy and self-management are helpful. A healthy lifestyle including exercise, diet, and rest can also be beneficial. Social skills training or certain forms of psychotherapy may provide coping skills for those with cognitive symptoms.2,9
Certain types of therapy, like cognitive behavioral therapy (CBT), help people recognize when symptoms are present. Then, they help people look at those symptoms in a different way. This can help with issues like anosognosia.2,8,11
There is also a newer type of computer-based therapy aimed at cognitive function. It is called cognitive enhancement therapy (CET). More research is needed to understand how helpful this actually is, though.2,11