Gender differences in cognitive performance among young adults with first-episode schizophrenia in China

Background: Individuals with schizophrenia exhibit distinctive patterns of cognitive impairments, which pose difficulties in patients' everyday functionality and reduce patients' quality of life. Previous research suggests that many demographic variables, such as gender and age, influence the cognitive performance profiles of schizophrenia patients; however, the gender differences in neurocognitive dysfunction among first-episode schizophrenia (FES) patients remain less clear. Methods: In this cross-sectional study, we compared the cognitive performance of FES patients to that of healthy controls (HC), with a specific focus on gender differences within the Chinese population aged under 35 years. Cognitive performance was assessed using the raw scores from the MATRICS Consensus Cognitive Battery (MCCB). Results: FES patients show lower overall cognitive impairment across all MCCB domains compared to HCs. Significant sex effects were observed: females outperformed males in aspects of speed of processing and verbal learning in FES, while males outperformed females in parts of working memory and reasoning and problem solving among HC patients. In both FES and HC groups, females exceeded males in visual learning. Moreover, employing a three-way multivariate analysis of variance (MANOVA) displayed interaction effects between gender and clinical diagnosis in areas of speed of processing and verbal learning. Conclusions: This suggests that schizophrenia and biological sex may jointly influence performance in these domains, emphasizing the need for early intervention and gender-sensitive approaches to address cognitive deficits in schizophrenia.