# A meta-analysis comparing cognitive function between individuals at clinical high-risk for psychosis and individuals at family high-risk for psychosis

## TL;DR

This study compares cognitive function in individuals at clinical high risk for psychosis with those at family high risk, finding specific cognitive differences.

## Contribution

The study provides the first meta-analysis directly comparing neurocognition in clinical and familial high-risk groups for psychosis.

## Key findings

- CHR individuals show significant impairments in processing speed compared to FHR individuals.
- Verbal list-learning deficits are observed in CHR individuals, particularly in immediate and delayed recall.
- Other cognitive domains like attention and working memory do not show robust differences between the groups.

## Abstract

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.

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.

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 = 0.011). Wechsler Memory Scale (WMS) Logical Memory (immediate/delayed) was under-represented (k < 3). Meta-regression (processing speed): region moderated effects (Non-Asian vs. Asian: β = 0.486, 95% CI 0.051–0.921, p = 0.0287; R²_analog ≈ 24%); age difference, publication year, and study quality were not significant. Egger’s tests did not indicate small-study effects (all p > 0.05).

Compared with FHR, CHR shows reliable impairments in processing speed and verbal list-learning, while other domains do not differ robustly. Findings refine the cognitive phenotype of CHR beyond familial liability and highlight processing speed and list-learning as pragmatic markers for risk stratification and monitoring. Clinical trial number: not applicable.

The online version contains supplementary material available at 10.1186/s12888-025-07717-z.