The Relationship between Cognitive Reserve and Symptoms, Cognition, and Functioning in Schizophrenia: A Case-Control Study and Meta-Analysis

Background: Cognitive reserve (CR) is considered a positive factor in the onset, progression, and prognosis of diseases.It may also help explain the clinical heterogeneity observed in schizophrenia (SZ).Methods: This cross-sectional study included 70 patients with SZ and 64 healthy controls.Participants were assessed on CR, symptoms, cognition, and functional outcomes.Following PRISMA guidelines, we also searched PubMed, Scopus, Web of Science, Embase, the Cochrane Library, and PsycINFO for studies published up to September 25, 2025.Study quality was evaluated using the Newcastle-Ottawa Scale (NOS).Results: Patients with higher CR showed less severe negative and general psychopathological symptoms, along with better functional outcomes.Meta-analysis confirmed this relationship and further revealed positive correlations between CR and multiple cognitive domains, including speed of processing, working memory, verbal learning, visual learning, and reasoning and problem solving. Conclusions:This study demonstrates a positive association between CR and symptoms severity, cognitive performance, and functional outcomes in SZ.