Pattern and Determinants of Cognitive Impairment among Cigarette-Smoking Patients with Schizophrenia: A Cross-Sectional Study from Pakistan

Abstract

Background: Schizophrenia is a chronic psychiatric disorder that can affect several aspects of cognition, including attention, memory, executive functioning, and information processing. Cognitive difficulties may persist even when prominent psychotic symptoms improve. Cigarette smoking is also considerably more common among people with schizophrenia than in the general population, although the relationship between smoking and cognitive functioning remains complex.

Objective: This study aimed to assess cognitive functioning in patients with schizophrenia who smoke cigarettes and to identify demographic and clinical factors associated with cognitive performance.

Methods: A hospital-based cross-sectional study was conducted at Sir Cowasjee Jahangir Institute of Psychiatry, Hyderabad, Pakistan. A total of 323 patients with schizophrenia who were active cigarette smokers were enrolled using non-probability consecutive sampling. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), and the data were analyzed using SPSS version 20.

Results: The mean age of participants was 44.11±10.63 years, and the mean MMSE score was 18.65±4.09. Lower MMSE scores were significantly associated with increasing age (p=0.004), lower educational attainment (p=0.0005), lower socioeconomic status (p=0.0005), and longer duration of cigarette smoking (p=0.0005). No statistically significant association was found between duration of schizophrenia and cognitive performance.

Conclusion: Cognitive impairment was common among cigarette-smoking patients with schizophrenia. Older age, longer smoking exposure, lower educational attainment, and lower socioeconomic status were associated with poorer cognitive performance. These findings support the value of routine cognitive assessment and smoking-cessation interventions as part of comprehensive psychiatric care.