Cognitive Impairment in Schizophrenia Across Different Clinical Manifestations and Its Association With Symptom Severity and Functional Status.

OBJECTIVE: To explore the cognitive impairment in patients with schizophrenia of different clinical manifestations and its relationship with symptom severity and functional status. METHODS: The clinical data of 160 patients with schizophrenia who were treated in our hospital from April 2019 to December 2025 were selected for the study. The Positive and Negative Syndrome Scale (PANSS) scores were used to classify patients into the positive group (n = 93) and the negative group (n = 67). The recorded cognitive scores, PANSS scores, and Personal and Social Performance (PSP) scores were compared. Distributional assumptions were examined before analysis; Welch's t-test and Spearman rank correlation were used, and Hedges' g with 95% confidence intervals was reported for significant between-group comparisons. RESULTS: The positive group had higher PANSS positive symptom and PSP scores but lower PANSS negative symptom scores than the negative group (all p < 0.001). The positive group also showed higher recorded cognitive total and domain scores (all p < 0.001). Spearman analysis showed that PANSS negative symptom scores were inversely correlated with the recorded cognitive total score and PSP score (rho = -0.350 and -0.464, respectively), whereas PANSS positive symptom scores were positively correlated with these outcomes (rho = 0.652 and 0.781, respectively; all p < 0.001). The recorded cognitive total score was positively correlated with PSP score (rho = 0.655, p < 0.001). CONCLUSION: Cognitive performance differs across clinical symptom profiles in schizophrenia. Patients with predominant negative symptoms showed poorer cognitive performance and social functioning than patients with predominant positive symptoms. These findings support assessment of symptom profile, cognition, and functioning together, without implying causality.