Lack of neural load modulation explains attention and working memory deficits in first-episode schizophrenia

Objective: Although working memory (WM) deficits are well-recognized core features of schizophrenia, the underlying pathophysiological substrates of impairment in early psychosis before medication remain unclear. One possibility is that deficits in selective attention contribute to WM impairment. Methods: EEG was acquired from 25 first-episode drug-naive schizophrenia patients and 26 matched controls while they performed a WM task. Results: Compared with controls, schizophrenia patients showed a deficit in WM capacity in both behavioral and electrophysiological measures. Notably, the increased parieto-occipital pre-encoding stimulus alpha power in patients with schizophrenia predicted their subsequent reduced N2pc and symptom severity, whereas this relationship was absent in controls. Moreover, lacking load effect in neural activities predicted the serious impairment in behavior for schizophrenia. Conclusions: This pilot study provides preliminary evidence that the lack of load effect in neural activities may serve as potential underlying mechanisms for the impaired selective attention and WM capacity in schizophrenia. Our results emphasize the importance of pre-encoding stimulus alpha power in first episode drug-naive schizophrenia. Significance: These findings provide a neurophysiological correlate for the subjective reports of working memory deficits in schizophrenia and indicate the potential effective targets for clinical intervention.CO 2022 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.