Cognitive Insight Impairment May Precede Neurocognitive Decline in Schizophrenia

person filling out feelings checklist
person filling out feelings checklist
This research suggests that interventions to improve cognitive insight may bolster neurocognition in schizophrenia.

According to the results of research published in Clinical Psychological Science, neurocognitive performance impairment was preceded by reduced cognitive insight in adults with schizophrenia.

To evaluate the correlation between neurocognition and cognitive insight in schizophrenia, researchers evaluated patients with schizophrenia or schizoaffective disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision, criteria from 2 longitudinal studies: a 6-month naturalistic follow-up (study 1; n=168) and a 24-month clinical trial of cognitive therapy (study 2; n=60). Cognitive insight and neurocognition were measured with the Beck Cognitive Insight Scale (BCIS) and the University of Pennsylvania Computerized Neurocognitive Battery, respectively.

In study 1, follow-up BCIS scores and neurocognitive performance were significantly associated in cross-sectional analyses (P =.02). Furthermore, the baseline BCIS scores were associated with follow-up neurocognitive performance after adjustment for baseline neurocognitive performance (P <.01). In contrast, baseline neurocognitive performance was not significantly correlated with follow-up BCIS scores (P =.79).

Similar results were reported for study 2: BCIS scores at 18 months were positively associated with neurocognitive performance at 24 months after adjustment for 12-month BCIS scores and 18-month cognitive performance (P <.01). Similarly, 6-month BCIS scores were predictive of 12-month neurocognitive performance scores (P =.02), but this association was nonsignificant after adjustment for confounding variables.

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The study authors explained that “the present research is the first to show that reduced cognitive insight prospectively predicts — and thus may temporally precede — decrements in neurocognitive performance in individuals with schizophrenia.” They concluded that the results “support the proposal that reduced cognitive insight may contribute to the etiology of neurocognitive impairment in schizophrenia.”


Bredemeier K, Beck AT, Grant PM. Exploring the temporal relationship between cognitive insight and neurocognition in schizophrenia: a prospective analysis. Clin Psychol Sci. 2017;6(1):76-89.