Cognitive impairment and its influencing factors in patients with stable schizophrenia on regular medication: a real-world clinical study

Cognitive dysfunction is a core characteristic of schizophrenia, independent of positive and negative symptoms. It significantly impacts social reintegration, quality of life, and imposes a burden on families and society. This study investigates the prevalence and influencing factors of cognitive impairment in patients with stable schizophrenia on regular medication, with the hope of providing assistance to the cognitive improvement of patients. A multistage stratified sampling approach was implemented to screen and enroll eligible patients with stable schizophrenia from five specialized psychiatric hospitals in Henan Province. Psychiatrists who had received standardized training conducted questionnaire responses and cognitive assessments for the patients, and quality control personnel reviewed the questionnaires. Binary Logistic analysis was used to detect the influencing factors of cognitive function. The valid questionnaires of 1,274 patients were collected from January 1, 2022, to December 31, 2023. The cognitive dysfunction rate of the patients with stable schizophrenia on regular medication was 66.2%. The risk factors for cognitive function, in descending order, are: first-generation antipsychotics (FGAs) (OR: 9.246, 95%CI: 1.021,1.093), family history (OR: 2.535, 95%CI: 1.349,4.762), negative symptoms (OR: 2.532, 95%CI: 1.735,3.695), mood stabilizers (OR: 1.882, 95%CI: 1.356,2.613), anticholinergic drugs (OR: 1.616, 95%CI: 1.161,2.249), combined medication (OR: 1.332, 95%CI: 1.009,1.760), high body mass index (BMI) (OR: 1.069, 95%CI: 1.030,1.111), longer duration of education (OR: 1.057, 95%CI: 1.021,1.093), and long duration of disease (OR: 1.045, 95%CI: 1.028,1.063). The protective factors, in descending order, are: taking 5-HT1A receptor partial agonist (OR: 0.657, 95%CI: 0.503,0.857) and having more children (OR: 0.817, 95%CI: 0.732,0.912). The sensitivity of the regression model for predicting cognitive function was 66.5%, and the specificity was 88.0%. Findings highlight the complex interplay of personal, familial, psychiatric, physical, and pharmacological factors in cognitive impairment. Medication use, especially FGAs, significantly influences cognitive function, underscoring the need for psychiatrists to closely monitor treatment regimens to mitigate cognitive decline and improve long-term outcomes in patients with stable schizophrenia.