Sex differences in cognitive functioning of patients at-risk for psychosis and healthy controls: Results from the European Gene–Environment Interactions study

Abstract

Background. Sex differences in cognitive functioning have long been recognized in schizophrenia patients and healthy controls (HC). However, few studies have focused on patients with an at-risk mental state (ARMS) for psychosis. Thus, the aim of the present study was to investigate sex differences in neurocognitive performance in ARMS patients compared with HC. Methods. The data analyzed in this study were collected within the multicenter European Gene–Environment Interactions study (11 centers). A total of 343 ARMS patients (158 women) and 67 HC subjects (33 women) were included. All participants completed a comprehensive neurocognitive battery. Linear mixed effects models were used to explore whether sex differences in cognitive functioning were present in the total group (main effect of sex) and whether sex differences were different for HC and ARMS (interaction between sex and group). Results. Women performed better in social cognition, speed of processing, and verbal learning than men regardless of whether they were ARMS or HC. However, only differences in speed of processing and verbal learning remained significant after correction for multiple testing. Additionally, ARMS patients displayed alterations in attention, current IQ, speed of processing, verbal learning, and working memory compared with HC. Conclusions. Findings indicate that sex differences in cognitive functioning in ARMS are similar to those seen between healthy men and women. Thus, it appears that sex differences in cognitive performance may not be specific for ARMS, a finding resembling that in patients with schizophrenic psychoses.

Sex differences in symptom severity, cognition and psychosocial functioning among individuals with at‐risk mental state for psychosis

“…Our results showed that men displayed significantly poorer social functioning than women upon presentation, while the levels of role functioning did not differ between sexes. In fact, the observed sex difference in social functioning is in keeping with many (Barajas et al, 2015;Rietschel et al, 2017;Walder et al, 2013), although not all (Cocchi et al, 2014;Menghini-Müller et al, 2020) previous studies which demonstrated that females with ARMS displayed better global psychosocial functioning relative to male counterparts. This is also in line with earlier research indicating that men had worse premorbid social adjustment than women in ARMS sample (Tarbox et al, 2013).…”

“…However, very few studies have examined sex difference in cognitive functions in at-risk populations (Ittig et al, 2015;Menghini-Müller et al, 2020;Riecher-Rössler et al, 2018). These limited data generally indicate lack of difference between sexes in cognitive performance or much less pronounced differences as compared to those observed in chronic schizophrenia (Ittig et al, 2015;Mendrek & Mancini-Marïe, 2016;Menghini-Müller et al, 2020). We also failed to find significant sex differences in cognitive functions in ARMS.…”

“…It is recognized that cognitive impairment is a core feature of psychotic disorders (Kahn & Keefe, 2013) and has been observed in ARMS individuals (Bora et al, 2014;Chu et al, 2019;Hauser et al, 2017). However, very few studies have examined sex difference in cognitive functions in at-risk populations (Ittig et al, 2015;Menghini-Müller et al, 2020;Riecher-Rössler et al, 2018). These limited data generally indicate lack of difference between sexes in cognitive performance or much less pronounced differences as compared to those observed in chronic schizophrenia (Ittig et al, 2015;Mendrek & Mancini-Marïe, 2016;Menghini-Müller et al, 2020).…”

“…Existing data suggested either comparable cognitive performance between men and women or similar sex difference profiles in cognitive functions between ARMS and general population (Ittig et al, 2015;Menghini-Müller et al, 2020;Riecher-Rössler et al, 2018). Of note, atrisk samples of a number of past studies were overrepresented by men (up to approximately 70% of the sample; Cocchi et al, 2014;Walder et al, 2013;Willhite et al, 2008), thereby compromising the statistical power to detect potentially subtle sex differences.…”

Peri- and Post-Menopausal Women with Schizophrenia and Related Disorders Are a Population with Specific Needs: A Narrative Review of Current Theories

“…There is reason to believe that the loss of oestrogen takes this female advantage away [ 3 ]. Prior to menopause, cognitive defects are much more marked in men with schizophrenia when compared to women [ 4 ]. This female advantage also appears to wane with oestrogen decrease [ 5 , 6 ].…”