A meta-analysis comparing cognitive function between individuals at clinical high-risk for psychosis and individuals at family high-risk for psychosis
Abstract
BACKGROUND: Cognitive impairment is detectable before psychosis onset, yet no quantitative synthesis has directly contrasted neurocognition between clinical high risk (CHR) and familial high risk (FHR). We aimed to clarify domain-level differences to inform assessment and early intervention. METHODS: Following PRISMA/MOOSE, we searched PubMed, Embase, and PsycINFO (1996–May 2025) for peer-reviewed studies reporting standardized neurocognitive outcomes in both CHR and FHR groups. Outcomes were organized by MATRICS domains. Effect sizes were Hedges’ g (coded CHR − FHR; negative = poorer CHR) synthesized with random-effects. When multiple outcomes occurred within a study/domain, a within-study fixed-effects composite (r = 0.50) was used. Heterogeneity (Q, I²), small-study effects (Egger’s test), and prespecified meta-regression (when k ≥ 10) were performed. RESULTS: Fourteen studies were included (CHR n = 1,160; FHR n = 813). Processing speed: CHR underperformed FHR (pooled g = − 0.290, 95% CI: −0.521 to − 0.059, p = 0.014;); task-level analyses showed significant effects for TMT-A and Stroop baselines. Attention, working memory, executive function, and visual learning showed no robust between-group differences at the domain level (all p > 0.10; moderate–high heterogeneity). Verbal learning: subgroups indicated CHR deficits in list-learning—immediate (g = − 0.558, 95% CI − 1.099 to − 0.017, p = 0.043) and list-learning—delayed (g = − 0.296, 95% CI − 0.526 to − 0.067, p =…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,160 participants or records.
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