When schizophrenia was first described by Krepplin, he did call it dementia precox, which gives the idea that there is cognitive decline over time. That's held up over the years. We do see a slight decline over time. This change in cognition tends to be more persistent and treatment-resistant than some of the positive symptoms, like paranoia and hallucinations, that often come with schizophrenia.
It's a difficult problem because it also affects a person with schizophrenia, their chances of having good social functioning, being employed and being able to live independently. There's been a lot of effort put into what we call cognitive rehabilitation or cognitive remediation: trying to address some of the thinking issues that affect people with schizophrenia.
So, working with people with schizophrenia on memory, on planning, on problem-solving and on thinking about things in a flexible manner. There's been a lot of effort to that. There are even computer programs that allow people with schizophrenia to work at their own independent pace or on addressing issues of cognition.
Unfortunately, in all of these studies, there have been promising, but not outstanding, results. These programs are not that widely available yet. In fact, most of the treatment efforts focus on skill building, on concrete skills and on psychotherapy and definitely on medication and self-management, rather than on cognitive remediation.