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Published online: 2019-09-25 Review Article Current understandings about cognition and the neurobiological correlates in schizophrenia Sujita Kumar Kar, Meha Jain1 Department of Psychiatry, King George’s Medical University, Lucknow, 1District Mental Health Program, National Health Mission, Raebareli, Uttar Pradesh, India ABSTRACT Schizophrenia is a severe mental disorder. Cognitive deficits are one of the core features of schizophrenia. Multiple domains of cognition (executive function, attention/vigilance, working memory, verbal fluency, visuospatial skills, processing speed, and social cognition) are affected in patients with schizophrenia. Deficits in cognition led to impairment in the real world functioning. Identifying the cognitive deficits and early intervention is required for better functional outcome. This review focuses on conceptual understanding of cognition with its neurobiological correlates in schizophrenia and its different clinical implications. Key words: Cognition, cognitive deficits, neurobiological correlates, schizophrenia Introduction Evolution of Understandings about Cognition in Schizophrenia Schizophrenia is a severe mental disorder with complex and multifactorial etiology. The prevalence Previously, cognitive symptoms in schizophrenia are of schizophrenia is about 1% worldwide. It is the most considered to be the major symptoms of schizophrenia, common psychotic disorder worldwide with point which led to the perception that probably schizophrenia [1] prevalence of about 4.6/1000 population. is like premature onset dementia; hence, Benedict Morel and Emil Kraepelin acknowledged this disorder The symptoms of schizophrenia can be broadly as “demence precoce” and “dementia praecox,” categorized into – positive symptoms, negative symptoms, respectively. Subsequently (in the early part of the 19th affective symptoms, cognitive symptoms, and aggressive century), this perception was rejected and schizophrenia symptoms. Cognitive impairment in schizophrenia causes is presented as a distinct mental disorder with quite impairment in real-world functioning and significantly different pathophysiology and psychopathology. [2] impairs the quality of life. Schizophrenia causes Whatever, cognitive symptoms observed in patients dysfunction of the prefrontal cortex by several mechanisms with schizophrenia were considered to be secondary such as perfusion defect, defective metabolism, and to positive or negative symptoms. However, very defective synaptic pruning, which is responsible for the recently in the last two decades, it was understood that higher cognitive functions such as planning, regulation, cognitive deficits in schizophrenia are primary and core [2] and execution of goal-directed activities. deficits.[3-5] The reasons for which the cognitive deficits in schizophrenia were given special attention as a Address for correspondence: distinct domain of symptoms are, due to a characteristic Dr. Sujita Kumar Kar, Department of Psychiatry, King George’s pattern of the cognitive symptoms in schizophrenia, Medical University, Lucknow - 226 003, Uttar Pradesh, India. E-mail: [email protected] stable deficits in cognition persisting throughout the Access this article online This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows Quick Response Code: others to remix, tweak, and build upon the work non-commercially, as long as the Website: author is credited and the new creations are licensed under the identical terms. www.ruralneuropractice.com For reprints contact: [email protected] DOI: How to cite this article: Kar SK, Jain M. Current understandings about 10.4103/0976-3147.176185 cognition and the neurobiological correlates in schizophrenia. J Neurosci Rural Pract 2016;7:412-8. 412 © 2016 Journal of Neurosciences in Rural Practice | Published by Wolters Kluwer - Medknow Kar and Jain: Neurobiologic correlates of cognitive dysfunction in schizophrenia course of illness and persistence of cognitive deficits independent of remission of other symptoms of schizophrenia.[5] It is also recently understood that the socio-occupational decline in patients with schizophrenia was mostly due to core cognitive deficits.[3,4] Even during the phases of symptomatic remission, these cognitive deficits persist, which can be explained by the persistent brain changes in these patients.[4] Structural brain changes in schizophrenia are frequently seen in the frontotemporal region, which attributes to the impairments in neuropsychological functions.[6] The impairment of cognition is not only limited to patients suffering from schizophrenia; research evidence are also Figure 1: Major domains of cognition suggestive of cognitive dysfunction in otherwise normal individuals with high risk of psychosis, first-degree include verbal memory, working memory, motor speed, [14-17] relatives of patients with schizophrenia.[7-9] Cognitive attention, executive functions, and verbal fluency. deficits are found to exist in patients with schizophrenia Nearly four out of every five individuals suffering from as early as before the onset of illness, early phase of illness schizophrenia exhibit some sort of cognitive deficits which and remain stable over time in patients not receiving any hamper the normal functioning of the individuals.[18] The specific intervention.[9,10] Few recent studies had revealed that cognitive deficits in schizophrenia depend on the age cognitive deficits in schizophrenia can be attributed to [19] of onset; earlier is the onset, more will be the deficits.[11-13] the under-activity of N-methyl-d-aspartate receptors. Duration of schizophrenia has little impact on the already Nair et al., in a recent meta-analysis, established that existing cognitive deficits.[11-13] The deficits in cognition insight for psychosis has strong correlation with the persist even during the phase of remission.[9] important cognitive parameters such as executive function, memory, and intelligence as well as total cognition.[20] Cognitive dysfunction in schizophrenia Understanding Cognition and Cognitive is believed to be an endophenotype which manifests Deficits in Schizophrenia across the schizophrenia spectrum disorders.[21] Most dysfunctional cognitive functions attribute to the Cognition is an important brain function. It is the sum disrupted cortico-striato-thalamo-cortical network.[21] total of mental processes that enables us to acquire knowledge and keeps us aware of our surroundings and Attention and vigilance thus enable us to arrive at appropriate judgments. It is Attention refers to processes of how an individual cognition that determines skills such as problem-solving, becomes receptive for external or internal stimuli.[22] decision-making, and creativity. Some major cognitive The critical attributes of attention are focus, selectivity, domains are summarized in Figure 1. exclusiveness, and vigilance. Attention requires rapid encoding of information. Cognition helps an individual for functioning in the real world. Attention, concentration, memory, intelligence, In schizophrenia, attention impairment is a core judgment, executive functions, and social cognition are cognitive deficit.[23] Perhaps deficient rapid encoding of some major cognitive functions. These cognitive processes information is responsible for attention impairments in help in delivering various functions. Processing speed is schizophrenia.[24] the fastness to deliver these functions, which is dependent on the integrity of neuronal network as well as white Learning and memory matters. Impairment in cognitive processing results in Memory is the outcome of learning. The human memory difficulty in delivering different tasks leading to disability. is a complex system by which an individual registers, stores, retains, and retrieves information.[22] Cognitive impairments are one type of core symptoms in schizophrenia. Patients with chronic schizophrenia are In schizophrenia, different domains of learning and impaired in a wide range of cognitive functions which memory are affected. Studies suggest that working Journal of Neurosciences in Rural Practice | July - September 2016 | Vol 7 | Issue 3 413 Kar and Jain: Neurobiologic correlates of cognitive dysfunction in schizophrenia memory, visuospatial memory, and verbal memory independent of each other.[38] Dysfunction of the are common to be affected in schizophrenia.[3] In executive function is not only limited to patients schizophrenia, there also occurs impairment of emotional of schizophrenia but also reported in their healthy modulation of memory and attention.[25] They initially first-degree relatives.[39,40] Executive dysfunction in take longer time to encode information than do normal schizophrenia leads to impairment in maintenance and people; however, they tend to perform better with shifting of the responses according to situation and repeated exposure.[26-28] They do not use effective learning dysfunctional goal-directed activity.[23,41,42] strategies, such as semantic clustering, not even when told to cluster the information. However, they tend to Information processing and processing speed show intact recognition memory[29] thus, suggesting The term information processing is used to describe more impairment in explicit compared with implicit the process of taking information and encoding it in memory.[30] such a way that it can be understood and recalled when appropriately cued. Memory and perception are stages Working memory
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