Cognitive Symptoms of Schizophrenia: What to Know
Mental Health ConditionsSchizophrenia
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Cognitive Symptoms of Schizophrenia: Why They Happen and What Can Be Done About Them

Here’s how to manage cognitive symptoms like memory issues or attention problems and their effects on your life.
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Updated on January 24, 2025
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The Possible Cognitive Symptoms of Schizophrenia

Explore the cognitive symptoms of schizophrenia.
The Possible Cognitive Symptoms of Schizophrenia

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Cognitive issues are core symptoms of schizophrenia. More than 80 percent of people with schizophrenia have cognitive symptoms of some kind. They’re one of the main obstacles to managing schizophrenia, often causing substantial disability among those with the condition.

“These impairments often persist even during periods of symptom remission and can have a profound impact on daily functioning and quality of life,” says Caroline Fenkel, a doctor of social work, a licensed clinical social worker, and a cofounder and the chief clinical officer at Charlie Health, a virtual mental health care practice for young people that offers treatment for schizophrenia and related mental health conditions.

If you or a loved one has been diagnosed with schizophrenia, here’s what to know about the causes of cognitive symptoms, their health effects, and how to manage them.

What Are the Cognitive Symptoms of Schizophrenia?

The following cognitive symptoms are associated with schizophrenia.

Memory Problems

Cognitive symptoms relating to memory are extremely common, affecting as many as 98 percent of people with schizophrenia.

“Memory issues can manifest as difficulties recalling recent events (short-term memory) or remembering information from the past (long-term memory),” says Joel Frank, PsyD, a clinical neuropsychologist in private practice in Los Angeles. “Everyday tasks such as remembering appointments, finding items, or following instructions can become challenging.”

Attention Deficits

Research shows that attention deficits are very common among people with schizophrenia.

“These difficulties could involve struggles maintaining focus on tasks or conversations, being easily distracted, or having trouble shifting attention from one task to another,” says Dr. Frank.

Impaired Social Cognition

Social cognition refers to our ability to interpret social cues, understand the perspectives of others, and respond appropriately to social situations, says Frank. “Schizophrenia can affect this ability, leading to misinterpretations of others' intentions or difficulties in managing social interactions,” he says.

Impaired Executive Functioning

“Executive functions refer to a set of cognitive processes that include problem-solving, planning, organizing, and decision-making,” says Frank. “Schizophrenia can impact these abilities, making it harder for individuals to plan their day, make decisions, or solve problems.”

Language Difficulties

Cognitive abilities that usually evolve throughout adult life, such as language, appear to deteriorate over time among people with schizophrenia.

Some people with schizophrenia may speak very little, even when forced to interact with others. They may also speak in a monotonous tone or have trouble organizing their thoughts and words in a way that makes sense to others. This can sometimes result in jumbled speech.

Concentration Issues

“Concentrating for extended periods can be particularly challenging for people with schizophrenia,” Frank says. “They may find it hard to engage in activities that require sustained mental effort, such as reading, studying, or even watching a movie.”

What Causes the Cognitive Symptoms of Schizophrenia?

The causes of the cognitive symptoms of schizophrenia are multifaceted and not fully understood. “Several factors may contribute, including neurobiological factors, genetic factors, and environmental factors,” says Frank.

Abnormal brain development may contribute to cognitive effects, according to research. This abnormal brain development seems to begin before birth, intensifies during childhood, and persists until adulthood. As a result, there are physical differences in the brain of a person diagnosed with schizophrenia compared with people without schizophrenia.

Disruptions to genes linked to brain health and development — such as DISC1, NRG 1, and Akt1 — may play a role, too.

Research also suggests that some antipsychotic medications used to treat schizophrenia, such as haloperidol (Haldol), can have side effects that may exacerbate cognitive symptoms further.

How Can the Cognitive Symptoms of Schizophrenia Affect Your Health?

Research has shown that cognitive impairment can have many health consequences for people with schizophrenia.

“Adverse health outcomes can include difficulties in social and occupational functioning, decreased quality of life, poorer treatment adherence, and higher rates of unemployment and homelessness,” Dr. Fenkel says.

Cognitive symptoms associated with schizophrenia can affect a person’s ability to manage their self-care and personal hygiene as well. They may also affect a person’s ability to comprehend and follow through with health-related instructions, and to be fully engaged in their treatment plan. These issues can make managing their overall mental and physical health much more challenging.

How to Manage the Cognitive Symptoms of Schizophrenia

Although medications like antipsychotics are the main treatment for managing most symptoms of schizophrenia,

 most of these medications do little to improve cognitive functioning. And certain antipsychotics, like haloperidol, may actually worsen cognitive symptoms.
Research suggests that a new type of antipsychotic, xanomeline and trospium chloride (Cobenfy), is associated with significant improvements in cognitive symptoms among people with schizophrenia. Although these findings are promising, more studies are needed to confirm them.

 Cobenfy was approved by the U.S. Food and Drug Administration in September 2024 to treat adults with schizophrenia.

Experts widely consider cognitive remediation therapy to be the best available option for managing the cognitive symptoms of schizophrenia.

“Cognitive remediation therapy for schizophrenia is a structured treatment approach designed to target the cognitive deficits associated with schizophrenia,” says Frank. “It involves various exercises and activities aimed at improving memory, attention, problem-solving, and other cognitive functions.”

The goal is to enhance overall cognitive abilities and improve daily functioning and quality of life for those with schizophrenia, Frank adds.

Most cognitive remediation treatment programs involve approximately 24 hours of therapy administered by a trained health professional over three to six months.

If you need help finding a cognitive remediation program, try reaching out to your doctor, a local mental health center, or an organization such as the National Alliance on Mental Illness for recommendations. Unfortunately, there aren’t many professionals trained in this type of therapy, and it can be difficult to locate one. Some cognitive remediation software programs for use at home are available for purchase, but it’s not yet known how effective they are without involvement from a health professional.

The Takeaway

  • Cognitive symptoms are common with schizophrenia and can include issues with memory, attention, language, and social functioning.
  • Although medication is key to treating schizophrenia, it often doesn’t help with cognitive symptoms.
  • Cognitive remediation therapy is the best available treatment for the cognitive symptoms of schizophrenia.

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Angela-Harper-bio

Angela D. Harper, MD

Medical Reviewer
Castle Connolly Top Doctor

Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.  

A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.

Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.

Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.

She and her husband are avid travelers and have been to over 55 countries and territories.

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Shelby House, RN, BSN

Author

Shelby House, RN, BSN, has been a registered nurse for almost 10 years. She currently serves as a nursing director for a program that provides healthcare services to underserved Missourians, specifically aiding those with mental health disorders in achieving their best state of physical health.

She received her bachelor's degree in nursing from Maryville University in Missouri. She has worked in the specialty areas of medical-surgical nursing, cardiopulmonary rehabilitation nursing, mental health nursing, and nursing leadership.

Outside of the office, Shelby enjoys spending time with her husband and two young children, volunteering in her local community, and soaking up the countryside scenery of rural America where she lives.

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Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Harvey PD et al. Cognitive Dysfunction in Schizophrenia: An Expert Group Paper on the Current State of the Art. Schizophrenia Research: Cognition. September 2022.
  2. Tripathi A et al. Cognitive Deficits in Schizophrenia: Understanding the Biological Correlates and Remediation Strategies. Clinical Psychopharmacology and Neuroscience. February 28, 2018.
  3. Zanelli J et al. Cognitive Change in Schizophrenia and Other Psychoses in the Decade Following the First Episode. The American Journal of Psychiatry. July 2019.
  4. Schizophrenia. Mayo Clinic. October 16, 2024.
  5. Horan WP et al. The Impact of Xanomeline and Trospium Chloride on Cognitive Impairment in Acute Schizophrenia: Replication in Pooled Data From Two Phase 3 Trials. The American Journal of Psychiatry. December 11, 2024.
  6. What Is Cognitive Remediation? Association for Behavioral and Cognitive Therapies.