How Might Cognition Be Enhanced?

If a drug is developed that safely enhances memory, speed of information processing, problem-solving skills, and other aspects of cognition, would it make a real difference in the lives of patients with schizophrenia?

How and under what conditions might such a drug be used in clinical practice?

Several decades of experience with cognitive remediation strategies show that patients' thinking skills can be enhanced. But are those behavioral strategies actually remolding the brain, or are they teaching the brain compensatory skills?

Those are critical questions as researchers and drug companies search for agents that target cognitive impairment.

William Carpenter, M.D., director of the Maryland Psychiatric Research Center, believes that one pathway by which an agent for cognition might be useful is by enhancing compensatory skills. If so, a drug for cognition may be useful as an adjunct to cognitive remediation strategies, giving them a more robust effect, he said. And it is likely that the earlier such intervention is started, the better.

“It will be a great challenge to have a small change in cognition at, say, age 25 make a meaningful difference in complex functional outcomes,” Carpenter said. “However, if successful with a safe and effective drug, we may find ways to intervene much earlier. Intervention during the developmental years might make for a more substantial change.

“Early intervention now means detecting psychosis earlier and giving antipsychotics and psychosocial care,” he said. “However, cognitive impairments are present years before psychosis. My guess is a drug that helps with cognitive impairments in schizophrenia may assist remediation programs in the already diagnosed patient, but will have more promise if given years earlier to `high-risk' young people who may benefit from the effect on cognition even if they do not eventually develop the psychosis.”