Individuals with attention-deficit/hyperactivity disorder (ADHD) have elevated smoking prevalence and reduced cessation rates compared to the general population. However, the effects of cigarette smoking on underlying brain activity in smokers with ADHD are not well characterized. Non-invasive near-infrared spectroscopy (NIRS) was used to characterize how cigarette smoking affects prefrontal brain hemodynamics in smokers with and without ADHD. Prefrontal changes of oxy- and deoxyhemoglobin (HbO2 and HHb) were measured in six male adult smokers with ADHD and six age- and gender-matched control smokers. NIRS measurements were separated into four sequential time intervals, i.e., before smoking, during smoking, after smoking, and during a breath hold. Prefrontal HbO2 was lower during smoking in smokers with ADHD compared to control smokers. More specifically, smokers with ADHD showed decreased prefrontal HbO2 during smoking compared to breath hold, before and after smoking periods. In contrast, control smokers showed increased prefrontal HbO2 from before smoking to breath hold. Decreased prefrontal HbO2 in smokers with ADHD may reflect a smoking-induced change in prefrontal brain activity and microvasculature, which is not found in smokers without ADHD. The lower prefrontal HbO2 may be a biomarker for increased susceptibility to tobacco smoke in smokers with ADHD. Smoking in individuals with ADHD may increase vasoconstriction of cerebral arteries in the prefrontal cortex, which may contribute to a reduction in HbO2. The findings highlight the importance of smoking cessation, in particular in those smokers who use nicotine to self-medicate ADHD symptoms.

The beneficial effects of pharmacotherapy on children with attention-deficit hyperactivity disorder (ADHD) are well documented. We use near-infrared spectroscopy (NIRS) methodology to determine reorganization of brain neurovascular properties following the medication treatment. Twenty-six children with ADHD (ages six through 12) participated in a modified laboratory school protocol to monitor treatment response with lisdexamfetamine dimesylate (LDX; Vyvanse®, Shire US Inc.). All children refrained from taking medication for at least two weeks (washout period). To detect neurovascular reorganization, we measured changes in synchronization of oxy (HbO2) and deoxy (HHb) hemoglobin waves between the two frontal lobes. Participants without medication displayed average baseline HbO2 phase difference at about -7-deg. and HHb differences at about 240-deg.. This phase synchronization index changed after pharmacological intervention. Medication induced an average phase changes of HbO2 after first medication to 280-deg. and after medication optimization to 242-deg.. Instead first medication changed of the average HHb phase difference at 186-deg. and then after medication optimization to 120-deg. In agreement with findings of White et al., and Varela et al., we associated the phase synchronization differences of brain hemodynamics in children with ADHD with lobe specific hemodynamic reorganization of HbO2- and HHB oscillations following medication status.

Individuals with attention-deficit/hyperactivity disorder (ADHD) have elevated smoking prevalence and reduced cessation rates compared to the general population. However, the effects of cigarette smoking on underlying brain activity in smokers with ADHD are not well characterized. Non-invasive near-infrared spectroscopy (NIRS) was used to characterize how cigarette smoking affects prefrontal brain hemodynamics in smokers with and without ADHD. Prefrontal changes of oxy- and deoxyhemoglobin (HbO2 and HHb) were measured in six male adult smokers with ADHD and six age- and gender-matched control smokers. NIRS measurements were separated into four sequential time intervals, i.e., before smoking, during smoking, after smoking, and during a breath hold. Prefrontal HbO2 was lower during smoking in smokers with ADHD compared to control smokers. More specifically, smokers with ADHD showed decreased prefrontal HbO2 during smoking compared to breath hold, before and after smoking periods. In contrast, control smokers showed increased prefrontal HbO2 from before smoking to breath hold. Decreased prefrontal HbO2 in smokers with ADHD may reflect a smoking-induced change in prefrontal brain activity and microvasculature, which is not found in smokers without ADHD. The lower prefrontal HbO2 may be a biomarker for increased susceptibility to tobacco smoke in smokers with ADHD. Smoking in individuals with ADHD may increase vasoconstriction of cerebral arteries in the prefrontal cortex, which may contribute to a reduction in HbO2. The findings highlight the importance of smoking cessation, in particular in those smokers who use nicotine to self-medicate ADHD symptoms.

Object

There is great value in monitoring for signs of ischemia during neurovascular procedures. Current intraoperative monitoring techniques provide real-time feedback with limited accuracy. Quantitative frequency-domain near-infrared spectroscopy (Q-NIRS) allows measurement of tissue oxyhemoglobin (HbO2), deoxyhemoglobin (HHb), and total hemoglobin (tHb) concentrations and brain tissue oxygen saturation (SO2), which could be useful when monitoring for evidence of intraoperative ischemia.

Methods

Using Q-NIRS, the authors monitored 25 neurovascular procedures including aneurysm clip placement, arteriovenous malformation resection, carotid endarterectomy, superficial temporal artery-middle cerebral artery (MCA) bypass surgery, external carotid artery-MCA bypass surgery, encephaloduromyosynangiosis, and balloon occlusion testing. The Q-NIRS technology provides measurable cerebral oxygenation values independent from those of the scalp tissue. Thus, alterations in the variables measured with Q-NIRS quantitatively reflect cerebral tissue perfusion. Bilateral monitoring was performed in all cases. Five of the patients exhibited evidence of clinical ischemic events during the procedures. One patient suffered blood loss with systemic hypotension and developed diffuse brain edema intraoperatively, one patient suffered an ischemic event intraoperatively and developed an occipital stroke postoperatively, and one patient showed slowing on electroencephalography intraoperatively during carotid clamping; in two patients balloon occlusion testing failed. In all cases of ischemic events occurring during the procedure, Q-NIRS monitoring showed a decrease in HbO2, tHb, and SO2, and an increase in HHb.

Conclusions

. Quantitative frequency-domain near-infrared spectroscopy provides quantifiable and continuous real-time information about brain oxygenation and hemodynamics in a noninvasive manner. This continuous intraoperative oxygenation monitoring is a promising method for detecting ischemic events during neurovascular procedures.

The basic parameters for physiological measurements provided by near-infrared spectroscopy are the local absorption and scattering coefficients. For the adult human head, they have been difficult to measure noninvasively because of the layered structure of the head. The results of measurements of absorption and reduced scattering coefficients through the forehead on 30 adult volunteers using a multidistance frequency domain method are reported. The optode separation distance ranged from 10 to 80 mm and measurements were recorded at 758 and 830 nm. The measured absorption and reduced scattering coefficients of the forehead were used to evaluate the hemoglobin content in the scalp and brain as well as cerebral oxygen saturation. We found that cerebral oxygenation was relatively narrowly distributed within the subject group (the standard deviation was about 3% for scalp and 6% for brain, respectively), whereas hemoglobin concentrations had a relatively broader distribution. We found that as the optode distance increased, the absorption coefficients increased and the scattering coefficients decreased, retrieving the optical values of scalp and brain for shorter and longer optode distances, respectively. We present the transition curves of the absorption and reduced scattering coefficients as functions of the optode distance. In order to verify the values for each layer, a comparison between the experimental data and a prediction based on the two-layer model of the adult head was carried out. The thicknesses of scalp and skull for the two-layer model were obtained by magnetic resonance imaging of a subject's head. The optical parameters obtained from the two-layer model agreed very well with those measured by the multidistance method.

Cerebral hemodynamic responses due to normal aging may interfere with hormonal changes, drug therapy, diseases, life style, and other factors. Age-correlated alterations in cerebral vasculature and autoregulatory mechanisms are the subject of interest in many studies. Near-infrared spectroscopy (NIRS) is widely used for monitoring cerebral hemodynamics and oxygenation changes at the level of small vessels. We believe that the compensatory ability of cerebral arterioles under hypoxic conditions and the dilatatory ability of cerebral vessels due to vasomotion may decline with normal aging. To test this hypothesis we used frequency-domain NIRS to measure changes in cerebral tissue oxygenation and oxy- and deoxy-hemoglobin concentrations caused by hypoxia during breath holding. We also assessed cerebral vasomotion during profound relaxation. Thirty seven healthy volunteers, 12 females and 25 males, ranging from 22 to 56 years of age (mean age 35 +/- 11 years) participated in the study. We observed age-correlated changes in the cerebral hemodynamics of normal subjects: diminished cerebral hemodynamic response to hypoxia due to breath holding in middle-aged subjects (38-56 years) and reduced amplitude of cerebral hemodynamic changes due to vasomotion during rest. Snoring related changes in cerebral hemodynamics did not allow us to observe the effect of age in a group of snorers. The prolonged supine position influenced measured changes due to hypoxia. In this investigation NIRS methodology allowed detection of age-correlated changes in cerebral oxygenation and hemodynamics. Other variables, such as snoring or posture impacted the observations in our group of healthy volunteers.