Earlier research suggested that psychotic experiences (PEs), the extended-psychosis phenotype, are associated with cognitive impairment. Recent studies, however, revealed more mixed findings, and patterns and magnitude of cognitive deficits in PEs remain uncertain. We aimed to systematically review and quantitatively synthesize estimates of cognitive functioning covering a wide array of domains in individuals with versus without PEs. We systematically searched four databases from inception to 6 July 2023. We generated pooled effect size (Hedges’g) using random-effects models. Subgroup analyses and meta-regression examining the moderating effect of sex, age at PE assessment, study design, cognitive task, and PE assessment instrument on cognitive functioning were performed when applicable. The study was registered with PROSPERO (CRD42023442528). Twenty-seven and six studies were included for meta-analysis of cognitive functioning comparing individuals with versus without PEs (n = 82,561; 10,251 individuals with PEs) and individuals with high-level versus low-level PEs (n = 8062; 813 individuals with high-level PEs), respectively. Individuals with PEs exhibited worse cognitive performance in general cognition (Hedges’g = −0.10 [95%CI = −0.18 to −0.02]), verbal fluency (Hedges’g = −0.05 [95%CI = −0.10 to −0.00]), visual memory (Hedges’g = −0.21 [95%CI = −0.38 to −0.03]), and working memory (Hedges’g = −0.16 [95%CI = −0.28 to −0.04]). Meta-regression revealed that general cognition associated with PEs was related to younger age (z = 3.37, p = 0.001), male sex (z = −2.59, p = 0.010), and cognitive assessment before PE assessment (z = −2.15, p = 0.031), whereas working memory in individuals with PEs was associated with concurrent cognitive and PE assessment (z = 6.19, p < 0.001). We failed to find moderating effect of the choice of PE assessment instrument or cognitive task on cognitive functioning in PEs. Additional analysis showed no significant difference in the performance of any cognitive domains between individuals with high-level versus low-level PEs. Limitations included studies primarily derived from Western countries, no social-cognitive domains, and varied PE measurement. In sum, PEs are associated with milder and more circumscribed cognitive impairment relative to psychotic disorders. Future research is required to clarify differential cognitive trajectories between individuals with transient PEs and persistent/recurrent-PEs.

早期研究表明，精神病经历 （PE） 是扩展精神病表型，与认知障碍有关。然而，最近的研究揭示了更多复杂的发现，PE 认知缺陷的模式和程度仍然不确定。我们旨在系统地回顾和定量综合涵盖 PE 与无 PE 个体的广泛领域的认知功能的估计。我们系统检索了从建库到 2023 年 7 月 6 日的四个数据库。我们使用随机效应模型生成了合并效应大小 （Hedges'g）。在适用时，进行亚组分析和 meta 回归分析，检查性别、PE 评估年龄、研究设计、认知任务和 PE 评估工具对认知功能的调节作用。该研究已在 PROSPERO （CRD42023442528） 注册。纳入 27 项研究和 6 项研究，分别对有肺栓塞和无肺栓塞的个体（n = 82,561;10,251 名肺栓塞）和有高水平肺栓塞与低水平肺栓塞的个体（n = 8062;813 个有高水平 PE 的个体）的认知功能进行荟萃分析。患有 PE 的个体在一般认知 （Hedges'g = -0.10 [95%CI = -0.18 至 -0.02]）、语言流畅性 （Hedges'g = -0.05 [95%CI = -0.10 至 -0.00]）、视觉记忆 （Hedges'g = -0.21 [95%CI = -0.38 至 -0.03]）和工作记忆 （Hedges'g = -0.16 [95%CI = -0.28 至 -0.04]）方面表现出较差的认知表现。Meta 回归分析显示，与 PE 相关的一般认知与年轻 （z = 3.37，p = 0.001）、 男性 （z = −2.59，p = 0.010） 和 PE 评估前的认知评估 （z = −2.15，p = 0. 031），而 PE 个体的工作记忆与同时进行的认知和 PE 评估相关 （z = 6.19，p < 0.001）。我们未能发现 PE 评估工具或认知任务的选择对 PE 认知功能的调节作用。其他分析显示，高水平 PE 个体与低水平 PE 个体之间任何认知领域的表现均无显著差异。局限性包括主要来自西方国家的研究、没有社会认知领域以及不同的 PE 测量。总之，相对于精神障碍，PE 与更轻微和更局限的认知障碍相关。需要进一步的研究来阐明短暂性 PE 和持续性/复发性 PE 个体之间的差异认知轨迹。