Objective <p>Mahjong, a traditional Chinese tile-based game, has been widely reported to be closely associated with better cognitive function. However, its effects on the cognitive function of patients with schizophrenia have not yet been studied.</p> Method <p>In a pilot study, 49 patients diagnosed with schizophrenia were randomly assigned to the intervention group (Mahjong combined with standard treatment) and the control group (standard treatment). The intervention group engaged in cognitive training through Mahjong for 2&#xa0;h per day, 4 days per week for 12 weeks. Primary cognitive outcomes were assessed using Cambridge Neuropsychological Test Automated Battery (CANTAB), while secondary outcomes include quality of life, clinical symptoms, anhedonia, treat side effects, and personal and social functioning. Assessments were conducted at baseline (T0), the 4th week (T1), the 8th week (T2), and the 12th week (T3).</p> Results <p>The intervention group exhibited progressive improvements in both reaction time and movement time throughout the study. No significant differences were found between the intervention and control groups regarding visual memory, novel learning, strategy utilization, spatial memory performance or complex visual task accuracy. The intervention group demonstrated gradual improvements in quality of life, whereas no significant changes were noted in other secondary outcomes.</p> Conclusion <p>While this exploratory study suggests that Mahjong intervention may benefit certain cognitive functions and quality of life in patients with schizophrenia, these findings should be interpreted with caution. Further research with larger, more diverse samples and longer intervention is necessary to confirm and extend these findings.</p> Trial registration <p>The trial is registered with <a href="https://www.chictr.org.cn/">https://www.chictr.org.cn/</a> under registration number ChiCTR2400080268 on January 25th, 2024.</p>