The Neural Compensation Phenomenon in Schizophrenia with Mild Attention Deficits During Working Memory Task

Background Working memory (WM) and attention are essential cognitive processes, and their interplay is critical for efficient information processing. Schizophrenia often exhibits deficits in both WM and attention, contributing to function impairments. This study aims to investigate the neural mechanisms underlying the relationship between WM impairments and attention deficits in schizophrenia. Methods We assessed the functional-MRI scans of the 184 schizophrenias with different attention deficits (mild=133; severe=51) and 146 controls during an N-back WM task. We explored their whole-brain functional connectome profile by adopting the voxel-wise degree centrality (DC). Linear analysis was conducted to explore the associations among attention deficit severity, altered DC, and WM performance in patients. Results We observed that all patients showed decreased DC in the pre-supplementary area (pre-SMA), and posterior cerebellum compared to the controls, and schizophrenia patients with mild attention deficits showed decreased DC in the supramarginal gyrus, insula, and precuneus compared with the other 2 groups. DC values of the detected brain regions displayed U-shaped or inverted U-shaped curves, rather than a linear pattern, in response to increasing attention deficits. The linear analysis indicated that altered DC of the pre-SMA can modulate the relationship between attention deficits and WM performance. Conclusion The U-shaped or inverted U-shaped pattern in response to increasing attention deficits may reflect a compensation mechanism in schizophrenia with mild attention deficits. This notion is also supported by the linear analysis that schizophrenia patients with mild attention deficits can improve their WM performance by increasing the DC value of the pre-SMA.