Sex differences in higher-order cognition in schizophrenia and unaffected first-degree relatives: a longitudinal, family study

Eur Arch Psychiatry Clin Neurosci. 2026 Jun 22. doi: 10.1007/s00406-026-02292-0. Online ahead of print.

ABSTRACT

BACKGROUND: Although sex differences in the epidemiology and clinical expression of schizophrenia (SZ) are well established, sex differences in cognition during the chronic stage of SZ remains controversial and merits further investigation. We aimed to examine sex differences in executive function and working memory within a longitudinal family study of SZ, hypothesizing that sex effects would be negligible.

METHODS: A total of 266 participants, including 113 individuals with SZ, 58 unaffected first-degree relatives (SZR), and 95 healthy controls (HC), were assessed twice over one year using a comprehensive neuropsychological battery. Mixed one-way analyses of covariance were performed to compare these participant groups, accounting for sex.

RESULTS: No significant sex differences were found in performance on executive functioning and working memory tasks across SZ and SZR (p > 0.05). This performance pattern was also maintained for HC. However, the SZ group performed significantly worse than other two groups in most tasks (p < 0.0001; η²p = 0.09 to 0.14).

CONCLUSION: The present results support previous evidence reporting the absence of sex differences in higher-order cognition in schizophrenia and provide new evidence that there are no sex effects in these domains in unaffected relatives of individuals with SZ.

PMID:42329320 | DOI:10.1007/s00406-026-02292-0