Deficits in working memory (WM) and executive cognitive control are core features of schizophrenia. However, findings regarding functional activation strengths are heterogeneous, partly due to differences in task demands and behavioral performance. Previous investigators proposed integrating these heterogeneous findings into a comprehensive model of cortical inefficiency assuming the inverted U-shaped relationship between performance and neuronal activation to be shifted in patients. The present study pursued a novel approach of precise performance balancing potentially resolving a number of discrepancies with regard to performance related cognitive activation patterns in schizophrenia. Error-related WM activity was examined in 55 patients and 55 controls by balancing the mean number of incorrect responses between the groups and analyzing remaining incorrect trials. A modified Sternberg Item Recognition task (SIRT) allowing for the segregation of encoding, executive maintenance and retrieval-related activation was applied. Relative to healthy controls, patients showed extended hypoactivations in inferior temporal, superior parietal, inferior, middle and superior frontal as well as cerebellar regions during encoding of incorrectly remembered items. During erroneous retrieval of information patients exhibited a significantly decreased activation in an executive control network comprising inferior and middle frontal areas, precuneus and cerebellum. Present data suggest that in patients with schizophrenia encoding of erroneously retrieved items as well as erroneous retrieval itself is associated with extended activation abnormalities in task-relevant regions even after balancing performance. Thus, present results clearly indicate that disorder-characteristic activation abnormalities become manifest during dysfunctional executive processing even when the moderating effect of performance is largely eliminated.
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