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. 2025 Feb 19:40:100352.
doi: 10.1016/j.scog.2025.100352. eCollection 2025 Jun.

The awareness, characterization, and burden of Cognitive Impairment Associated with Schizophrenia (CIAS) in clinical practice: Results from a nationwide survey in Italy

Antonio Vita  1   2 , Stefano Barlati  1   2 , Roberto Cavallaro  3   4 , Riccardo Cipelli  5 , Giulio Corrivetti  6 , Dario Delmonte  7 , Eleonora Lusito  5 , Elisabetta Maia  7 , Maria Michela Marino  7 , Giuseppe Nicolò  8 , Paola Rocca  9 , Silvana Galderisi  10
Affiliations

The awareness, characterization, and burden of Cognitive Impairment Associated with Schizophrenia (CIAS) in clinical practice: Results from a nationwide survey in Italy

Antonio Vita et al. Schizophr Res Cogn. .

Abstract

Introduction: Cognitive Impairment (CIAS) is a core aspect of schizophrenia and one of the main obstacles to clinical and functional recovery in patients. People with CIAS have difficulties with learning and using information in real world. Despite its well-recognized role, it is not yet a diagnostic criterion in DSM-5 and ICD system. The effective management of CIAS represents a critical unmet need of schizophrenia treatment.

Methods: To evaluate the awareness of CIAS in the Italian landscape, we conducted a quantitative survey on psychiatrists highly specialized in schizophrenia, focused on its awareness, assessment, burden, and treatment.

Results: Of 152 participants, 139 (91.4 %) consider CIAS assessment important. The terminology most frequently used to describe CIAS is 'cognitive impairment'. CIAS is assessed, clinically or with formal tools, in approximately 43 % of patients after stabilisation either during follow-up visits (N = 88, 67.7 %) or during hospital stay (N = 57, 43.8 %). 65 % of evaluated patients are considered affected by CIAS. Formal assessment tools (tests, questionnaires, interviews) are used in about 20 % of the centers. The Mini Mental State Examination (MMSE) (N = 75, 72.1 %) and the Wechsler Adult Intelligence Scale (WAIS) (N = 62, 59.6 %) are the most frequently used tools for CIAS evaluation.

Conclusions: The clinical characteristics of the patient, structural barriers like the lack of trained personnel or inadequate economic resources, and organizational problems influence the assessment rate. Despite this awareness, greater effort must be made to overcome the barriers, especially economic and organizational ones, which prevent the assessment and treatment of CIAS from becoming established in routine clinical care.

Keywords: Assessment; CIAS; Cognitive remediation; Evidence-based; Psychosocial functioning; Recovery; Schizophrenia.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: In the last two years, Prof. Vita has received, directly or indirectly, support for clinical studies or trials, conferences, consultancies, congress presentations, advisory boards from: Alkermes, Angelini Pharma, Boehringer Ingelheim, Janssen-Cilag, Lundbeck, Otsuka, Roche, Rovi, and Teva. In the last two years Prof. Barlati has received advisory board, lecture, or consulting fees, outside the present work, from: Angelini Pharma, Janssen Pharmaceuticals, Lundbeck, Otsuka, and Rovi. In the last two years Prof. Cavallaro has received fees for participation in National Boards from Angelini Pharma, Boehringer Ingelheim and for congress Faculty participation from Rovi. In the last two years, Prof. Galderisi received advisory board/consultant fees, or honoraria/expenses from the following drug companies: Angelini Pharma, Boehringer Ingelheim, Gedeon Richter-Recordati, Janssen, Lundbeck, Otsuka, and Rovi. Riccardo Cipelli and Eleonora Lusito have disclosed that they are employees of IQVIA Solutions SRL. The remaining authors declare that they have no competing interests. The authors did not receive payment related to the development of the manuscript.

Figures

Fig. 1
Fig. 1
The geographic distribution of the survey participants. The regions of origin of the psychiatrists participating in the survey are shown with relative percentages out of 152 total participants colored as follows: regions with <5 % participants in light red, regions with participants in the range 5–10 % in red and regions with >10 % participants in dark red. The least represented regions are indicated in grey. The actual percentages for these regions are masked due to the small numbers. Overall, participants from the least represented regions accounted for 12.5 %.
Fig. 2
Fig. 2
A schematic representation of CIAS assessment. CIAS: Cognitive Impairment Associated with Schizophrenia.
Fig. 3
Fig. 3
CIAS evaluation setting in the Italian clinical practice. The principal moments of cognitive impairment assessment in patients with schizophrenia by the Italian psychiatrists. CIAS: Cognitive Impairment Associated with Schizophrenia.
Fig. 4
Fig. 4
Assessment tools used for CIAS evaluation. The most used tools for the assessment of Cognitive Impairment Associated with Schizophrenia (CIAS) in daily practice. Tests and test batteries (MMSE, WAIS, MCCB, BACS, UPSA) and interview-based assessment tools (CAI, SCoRS). The percentages on the x-axis refer to the centers that perform neuropsychological testing for CIAS assessment (N = 104) adopting the methodologies reported on the y-axis and are not mutually exclusive.
Fig. 5
Fig. 5
Therapeutic options for CIAS treatment The frequently adopted therapeutic strategies to treat the Cognitive Impairment Associated with Schizophrenia (CIAS) (CIAS) are reported. Percentages on the x-axis refer to the total number of participants (N = 152).
See this image and copyright information in PMC

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