Improving care for cognitive impairment in schizophrenia: current perspectives and opportunities in Portugal (a consensus development conference)

Background Cognitive impairment is a key contributor to the functional disability seen in schizophrenia, yet it remains one of the most underdiagnosed and poorly managed aspects of the disorder. In Portugal, schizophrenia imposes a significant socio-economic burden, with notable gaps in the assessment and treatment of cognitive impairment. Method A panel of Portuguese healthcare professionals, including six psychiatrists with clinical and academic expertise, a neuropsychologist, a psychiatric nurse, and two representatives from patient associations, reviewed current evidence and practices for managing cognitive impairment in schizophrenia. The panel addressed three primary clinical questions using a consensus development conference methodology (1): What is the current state of CIAS (cognitive impairment associated with schizophrenia) assessment and management in Portugal? (2) What are the major barriers to optimal care? (3) What recommendations can improve CIAS care within the Portuguese healthcare system? Results Several challenges hinder the routine assessment and treatment of cognitive impairment in Portugal, including the lack of validated assessment tools, the absence of national guidelines, insufficient trained healthcare professionals, and limited access to cognitive remediation therapy (CRT). Key opportunities that could improve care include establishing national guidelines for cognitive assessment and management, using validated and practical assessment tools, training healthcare professionals, integrating CRT into standard care pathways, engaging caregivers, and strengthening collaboration between healthcare institutions. Conclusion Despite significant challenges, the Portuguese healthcare system has numerous opportunities to improve the management of cognitive impairment in schizophrenia. Critical unresolved issues include the need for additional validated Portuguese assessment instruments and the establishment of cost-effectiveness data for CRT implementation in the Portuguese context.