Near-Infrared Spectroscopy in Schizophrenia: A Possible Biomarker for Predicting Clinical Outcome and Treatment Response

Office for Mental Health Support, Division for Counseling and Support, The University of Tokyo , Tokyo , Japan
Frontiers in Psychiatry 11/2013; 4:145. DOI: 10.3389/fpsyt.2013.00145
Source: PubMed


Functional near-infrared spectroscopy (fNIRS) is a relatively new technique that can measure hemoglobin changes in brain tissues, and its use in psychiatry has been progressing rapidly. Although it has several disadvantages (e.g., relatively low spatial resolution and the possibility of shallow coverage in the depth of brain regions) compared with other functional neuroimaging techniques (e.g., functional magnetic resonance imaging and positron emission tomography), fNIRS may be a candidate instrument for clinical use in psychiatry, as it can measure brain activity in naturalistic position easily and non-invasively. fNIRS instruments are also small and work silently, and can be moved almost everywhere including schools and care units. Previous fNIRS studies have shown that patients with schizophrenia have impaired activity and characteristic waveform patterns in the prefrontal cortex during the letter version of the verbal fluency task, and part of these results have been approved as one of the Advanced Medical Technologies as an aid for the differential diagnosis of depressive symptoms by the Ministry of Health, Labor and Welfare of Japan in 2009, which was the first such approval in the field of psychiatry. Moreover, previous studies suggest that the activity in the frontopolar prefrontal cortex is associated with their functions in chronic schizophrenia and is its next candidate biomarker. Future studies aimed at exploring fNIRS differences in various clinical stages, longitudinal changes, drug effects, and variations during different task paradigms will be needed to develop more accurate biomarkers that can be used to aid differential diagnosis, the comprehension of the present condition, the prediction of outcome, and the decision regarding treatment options in schizophrenia. Future fNIRS researches will require standardized measurement procedures, probe settings, analytical methods and tools, manuscript description, and database systems in an fNIRS community.

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Available from: Yukika Nishimura, Feb 15, 2014
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    • "Despite some limitations , such as low spatial resolution (approximately 20 mm) and difficulties exploring deep brain regions, NIRS has many advantages, including compaction, mobility, silence and high temporal resolution. Also, NIRS can measure brain activation in a natural position non-invasively (Koike et al. 2013). NIRS has been increasingly adopted in the field of neuropsychiatric research to detect characteristic cerebral hemodynamic changes during cognitive tasks among patients with various mental disorders (Koike et al. 2011; Takizawa et al. 2014). "
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    ABSTRACT: Methamphetamine abuse and dependence, frequently accompanied by schizophrenia-like psychotic symptoms [methamphetamine-associated psychosis (MAP)], is a serious public health problem worldwide. Few studies, however, have characterized brain dysfunction associated with MAP, nor investigated similarities and differences in brain dysfunction between MAP and schizophrenia. We compared prefrontal cortical activity associated with stop-signal inhibitory task in 21 patients with MAP, 14 patients with schizophrenia and 21 age- and gender-matched healthy controls using a 52-channel near-infrared spectroscopy (NIRS) system. Both the MAP and the schizophrenia groups showed significantly reduced activation in the bilateral ventrolateral prefrontal cortex compared with controls; however, only the MAP group showed reduced activation in the frontopolar prefrontal cortex. The MAP group demonstrated significant positive correlations between task performance and hemodynamic responses in the bilateral ventrolateral, polar and left dorsolateral regions of the prefrontal cortex. The MAP and schizophrenia groups demonstrated a significant difference in the relationship of impulsivity to hemodynamic changes in the bilateral premotor cortex. These findings characterize similarities and differences in prefrontal cortical dysfunction between psychosis associated with methamphetamine and schizophrenia. The reduced hemodynamic changes in the bilateral ventrolateral prefrontal cortex suggest a common underlying pathophysiology of MAP and schizophrenia, whereas those in the frontopolar prefrontal cortex point to an impaired state that is either inherent or caused specifically by methamphetamine use.
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    • "Based on these findings, some studies have attempted to apply the NIRS signal as a diagnostic tool with different pattern recognition methods (Azechi et al., 2010; Chuang et al., 2014; Hahn et al., 2013; Koike et al., 2013; Takizawa et al., 2014). Azechi et al. measured the changes of the [oxy-Hb] signal during multiple cognitive tasks from two NIRS channels located in the bilateral prefrontal areas and then applied stepwise linear discriminant analysis to distinguish patients with schizophrenia from healthy subjects (Azechi et al., 2010). "
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    ABSTRACT: Based on near-infrared spectroscopy (NIRS), recent converging evidence has been observed that patients with schizophrenia exhibit abnormal functional activities in the prefrontal cortex during a verbal fluency task (VFT). Therefore, some studies have attempted to employ NIRS measurements to differentiate schizophrenia patients from healthy controls with different classification methods. However, no systematic evaluation was conducted to compare their respective classification performances on the same study population. In this study, we evaluated the classification performance of four classification methods (including linear discriminant analysis, k-nearest neighbors, Gaussian process classifier, and support vector machines) on an NIRS-aided schizophrenia diagnosis. We recruited a large sample of 120 schizophrenia patients and 120 healthy controls and measured the hemoglobin response in the prefrontal cortex during the VFT using a multichannel NIRS system. Features for classification were extracted from three types of NIRS data in each channel. We subsequently performed a principal component analysis (PCA) for feature selection prior to comparison of the different classification methods. We achieved a maximum accuracy of 85.83% and an overall mean accuracy of 83.37% using a PCA-based feature selection on oxygenated hemoglobin signals and support vector machine classifier. This is the first comprehensive evaluation of different classification methods for the diagnosis of schizophrenia based on different types of NIRS signals. Our results suggested that, using the appropriate classification method, NIRS has the potential capacity to be an effective objective biomarker for the diagnosis of schizophrenia. Copyright © 2014. Published by Elsevier B.V.
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    • "They described for the first time that patients with schizophrenia had reduced [oxy-Hb] in the left prefrontal cortex during the VFT. Till now, their sample size for schizophrenia patient is the largest in related NIRS studies (Koike et al., 2013). Then, Suto et al. described the spatial–temporal patterns of NIRS activation in the prefrontal and temporal cortices using two 24 multichannel NIRS systems (Suto et al., 2004). "
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    ABSTRACT: Near-infrared spectroscopy (NIRS) has been applied to examine the possible functional alternations during the performance of cognitive tasks in schizophrenia. With this technique, previous studies have observed that patients with schizophrenia are often associated with reduced brain activations in the prefrontal cortex during the verbal fluency task (VFT) of English version or Japanese version. However, it remains unclear whether there are the brain functional impairment for Chinese-speaking patients with schizophrenia. In this study, we designed a Chinese version VFT and performed a multichannel NIRS study in a large group of patients with schizophrenia and healthy controls. We investigated the brain activations during the task period of the Chinese version VFT within schizophrenia group and healthy group, respectively, and compared their relative changes between two groups. Our results confirmed that Chinese-speaking patients with schizophrenia had the significant lower brain activations in the prefrontal cortex and superior temporal cortex when compared with healthy controls. Such findings based on NIRS data provided us the reliable evidences about the brain functional deficits in Chinese-speaking patients with schizophrenia. Copyright © 2014. Published by Elsevier Inc.
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