The treatment of cognitive impairment in schizophrenia

Cognitive deficits are major contributors to disability in schizophrenia. Many pharmacologic targets have been identified for cognitive enhancing agents, including receptors involved in dopaminergic, glutamatergic, GABAergic, serotonergic and cholinergic neurotransmission. In addition, new approaches to drug development have been directed towards neuroprotection and the facilitation of neuroplasticity. While several pharmacologic agents and cognitive remediation have shown promise in early trials, no treatment has yet demonstrated efficacy in large replication trials. The experience with different pharmacologic targets is reviewed and methodologic issues are discussed with recommendations for future research.

Research Highlights
► Cognitive deficits are a major cause of disability in schizophrenia.
► A wide range of approaches to cognitive enhancement have yielded largely disappointing results.
► One possible explanation is the heterogeneity of mechanisms underlying cognitive impairment.
► Promising results from cognitive remediation suggest a role for promotion of neuroplasticity.
► Novel paradigms are required to tackle this problem.