A Prospective, Open-label, Single-arm, Multicenter Study Evaluating the Efficacy of One Year Treatment With Xanomeline/Trospium on Cognitive Impairment in Clinically Stable Adult Participants With Schizophrenia.

Inclusion Criteria: 1. Be between 18 and 55 years of age. 2. Be willing and able to provide informed consent, after the nature of the study has been fully explained. 3. Have a current DSM-5 diagnosis of schizophrenia, schizoaffective order or schizophreniform disorder, which needs to be confirmed by MINI. 4. Have all PANSS positive items + G8 and G10 ≤4 at screening. 5. Be on a stable dose of any second generation antipsychotic drug (in monotherapy) prescribed to treat psychosis, for at least 4 weeks prior to the screening visit. 6. Have a SCIP total below 70. 7. Test negative for pregnancy at the screening visit and must be using a dual method contraceptive method during the study and 30 days after the study, if being a female of childbearing potential Exclusion Criteria: 1. Be pregnant or breast-feeding, in case of female participant. 2. Be at significant risk of committing suicide. This is defined as: participants with active suicidal ideation with some intent to act, without specific plan ("Yes" to question 4 of the Columbia-Suicide Severity Rating Scale (C-SSRS)) or active suicidal ideation with specific plan and intent ("Yes" to question 5 of the C-SSRS), followed by an assessment by the treating clinician who determines it is not safe for the participant to participate in the study . 3. Currently meet DSM-5 criteria for a manic episode or major depressive disorder as confirmed by the MINI. 4. Currently meeting DSM-5 criteria for severe substance and/or alcohol use disorder as confirmed by the MINI (≥6 on module K for alcohol use disorder and/or ≥6 on module J for substance use disorder, unless being in early or sustained remission). A positive urine toxicology for phencyclidine, amphetamines, opiates (unless participant has a valid prescription for short-term use), cocaine, or alcohol (clinically significant alcohol use in the opinion of the Investigator). Nicotine and caffeine use is allowed. Stimulants and cannabis is allowed when used sporadically and recreationally as per the judgement of the clinician. 5. Present with intellectual disability, drug-induced psychosis, or history of clinically significant brain trauma as per the judgement of the clinician. 6. Have urinary retention, moderate or severe hepatic impairment, gastric retention, history of hypersensitivity to Xanomeline/Trospium or trospium chloride, untreated narrow-angle glaucoma, or any other medical condition (as per the participant's medical files) that makes, as per the judgement of the clinician, the patient unsuitable for the study. 7. Currently use clozapine, a long-acting injectable antipsychotic, or anticholinergic treatment\*. 8. Expect to require more than the allowed psychotropic concomitant medication during the study (from baseline on). This is defined as: needing benzodiazepines of more than 2 mg lorazepam equivalent (daily), quetiapine, antidepressants, mood stabilizers or benzodiazepines at a dose exceeding the allowed threshold. If these treatments are used at the screening visit, they must be tapered down before the baseline visit. 9. An eGFR of \< 60 mL/min 10. Elevations in hepatic transaminases at screening ≥ 3× ULN for ALT and AST and/or bilirubin \> 3 × ULN, unless in the context of Gilbert's syndrome. Note: Gilbert syndrome is an inherited disorder characterized by mild elevation of unconjugated bilirubin in the absence of hemolysis or other cause. 11. History of unstable hypertension or tachycardia as evidenced by: Blood pressure of ≥ 160/100 mmHg at screening and/or a heart rate of ≥ 110 bpm at screening 12. Clinically significant abnormal finding on the physical examination, medical history, ECG (at screening), or clinically significant laboratory results at screening.