Changes in cognitive function during neuroleptic treatment

The effects of long-term neuroleptic administration on cognitive and psychomotor function have been the subject of many studies. Some of the early studies undertaken during the 1960s reported that acute doses of phenothiazine neuroleptics caused cognitive impairment in schizophrenic patients, whereas chronic treatment led to improvement. More recent studies, however, have reported improvement in attention and in cognitive function following short-term administration. Detailed studies revealed that memory and fine motor coordination were impaired by many neuroleptics, the amnesic effects probably being related to the central anticholinergic effects of the drugs while the effects on motor control may be ascribed to the blockade of dopamine receptors. In general, it would appear that the hyperarousal state that occurs in schizophrenia is reduced by neuroleptics, thereby leading to an improvement in attention. However, the consensus would now appear to be that a general decrease in brainstem arousal does not account for the beneficial effect of neuroleptics, and it seems more probable that these drugs correct a frontal lobe dysfunction. It should be noted that tardive dyskinesia is almost invariably associated with a deterioration of intellectual function.

Thus it would appear that neuroleptics have little effect on higher cognitive functioning in schizophrenic patients and that the improvement in attention is facilitated by a non-mesocortical-mesolimbic mechanism. There is also evidence that neuroleptics improve asymmetry in hippo-campal function which may be deranged in the illness. It is generally agreed that studies of the effects of neuroleptics on normal subjects, which frequently show impaired cognitive and psychomotor function, are of only limited relevance to our understanding of the beneficial effects which these drugs produce in schizophrenic patients.

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