The magnitude and variability of neurocognitive performance in first-episode psychosis: a systematic review and meta-analysis of longitudinal studies

Abstract

Neurocognitive deficits are a core feature of psychotic disorders, but it is unclear whether they affect all individuals uniformly. The aim of this systematic review and meta-analysis was to synthesize the evidence on the magnitude, progression, and variability of neurocognitive functioning in individuals with first-episode psychosis (FEP). A multistep literature search was conducted in several databases up to November 1, 2022. Original studies reporting on neurocognitive functioning in FEP were included. The researchers extracted the data and clustered the neurocognitive tasks according to the seven Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains and six additional domains. Random-effect model meta-analyses, assessment of publication biases and study quality, and meta-regressions were conducted. The primary effect size reported was Hedges g of (1) neurocognitive functioning in individuals at FEP measuring differences with healthy control (HC) individuals or (2) evolution of neurocognitive impairment across study follow-up intervals. Of 30,384 studies screened, 54 were included, comprising 3,925 FEP individuals and 1,285 HC individuals. Variability analyses indicated greater variability in FEP compared to HC at baseline and follow-up. We found better neurocognitive performance in the HC group at baseline and follow-up but no differences in longitudinal neurocognitive changes between groups. Across the 13 domains, individuals with FEP showed improvement from baseline in all studied domains, except for visual memory. Metaregressions showed some differences in several of the studied domains. The findings suggest that individuals with FEP have marked cognitive impairment, but there is greater variability in cognitive functioning in patients than in HC. This suggests that subgroups of individuals suffer severe disease-related cognitive impairments, whereas others may be much less affected. While these impairments seem stable in the medium term, certain indicators may suggest potential further decline in the long term for a specific subgroup of individuals, although more research is needed to clarify this. Overall, this study highlights the need for tailored neurocognitive interventions for individuals with FEP based on their specific deficits and progression.

Fig. 1

Flow-chart of meta-analysis.

Fig. 2. Variability between HC and FEP in the different neurocognitive domains at baseline and follow-up.

Values greater than 0 indicate greater variability in FEP group.

Fig. 3. Comparison of neurocognitive functioning between FEP and HC at baseline (domains merged).

Values greater than 0 indicate greater deficits in FEP group.

Fig. 4. Comparison of neurocognitive functioning between FEP and HC at follow-up (domains merged).

Values greater than 0 indicate greater deficits in FEP group.

Fig. 5. Differences in baseline to follow-up changes of neurocognitive functioning between FEP and HC.

Values greater than 0 indicate greater deficits in FEP group. TMT Trail Making Test, COWAT Controlled Oral Word Association Test, WAIS Weschler Adult Intelligence Scale, LNST Letter Number Sequencing Test, HVLT Hopkins Verbal Learning Test, CVLT California Verbal Learning Test, LM logical memory, BVMT-R Brief Visuospatial Memory Test-Revised, WMS VM Weschler Memory Scale Visual Memory, NAB Neuropsychological Assessment Battery, MSCEIT Mayer-Salovey-Caruso Emotional Intelligence Test, RAVLT-R Rey Auditory Verbal Learning Test-Revised, WMS VR Weschler Memory Scale Visual Reproduction, WCST Wisconsin Card Sorting Test.