Although antipsychotics improve positive symptoms effectively, their utility is limited by adverse effects and poor efficacy for the treatment of cognitive symptoms. Nevertheless, cognition is considered a core feature of schizophrenia. For this reason the focus of treatment research in schizophrenia has shifted towards cognitive enhancement the last ten years.

Earlier trials suggest that nicotine ameliorates attention and working memory deficits seen in schizophrenia.

The present study aimed to replicate these earlier findings using a strict methodological design. Additionally, we assessed the effects of nicotine on measures of social cognition and psychomotor functioning, domains that has never been investigated before in this research field. Furthermore an additional study compared the effect of age in relation to the responsivity to nicotine.

In a three-way crossover double blinded randomized placebo-controlled trial, we investigated the effect of 0, 1 and 2 mg nicotine on several cognitive domains (standard cognition, arousal, psychomotor tasks, and social cognition) in 16 smoking and 16 non-smoking schizophrenic patients and in 16 young and 16 elderly healthy volunteers.

Nicotine improves attention in both patients groups and has detrimental effects in the elderly in some cognitive and psychomotor tasks. There is no effect of nicotine on psychomotor functioning, working memory and emotion recognition in patients. Decision making seems to be influenced by nicotine in non smoking patients.

This study brings us a step further in the delineation of the cognitive effect of nicotine.