Cognition in schizophrenia across phases of illness: A systematic review and meta-analysis

Cognitive deficits among individuals with schizophrenia spectrum disorders are a well-documented feature of the syndrome associated with a variety of adverse functional outcomes. While cross sectional research comparing clinical to control populations has proliferated in the field, the trajectory of cognitive functioning in schizophrenia across the lifespan is less clear. Improved understanding of the progression of cognitive symptoms may help to inform optimal treatment planning and identify effective periods for intervention. A systematic review and meta-analysis was conducted to examine cognition across phases of illness in schizophrenia. A search for peer-reviewed journal articles published prior to July 1st, 2025, was performed using the PRISMA guidelines. Sixty-nine studies met inclusion criteria for the current review. Results were reported for six cognitive domains (complex attention, executive function, perceptual-motor function, language, learning and memory, and social cognition) and for two comparisons of illness phases: prodrome - first-episode psychosis (FEP), and FEP - multi-episode/chronic (ME). Meta-analysis results suggest a progression of small to moderate decline in cognitive functioning from prodrome to FEP in all domains, and a negligible to small decline from FEP to ME in all domains except for language. Conclusions, limitations, and future directions are discussed.