Influence of smoking cessation treatment by varenicline to brain—a resting-fMRI study
Peng Peng1, Chun-lin Li2, Bin Jing2, Shui-lian Chu3, Qing-lei Shi4, Xiu-qin Jia1, and Tao Jiang1

1Radiology, Beijing Chao-Yang Hospital, Beijing, China, 2School of biomedical engineering, Capital medical university, Beijing, China, 3Clinical research centre, Beijing Chao-Yang Hospital, Beijing, China, 4HC NEA DI MR Siemens Healthcare Ltd, Beijing, China


This study investigated the activation changes of brain regions in smokers before and after cessation treatment using a resting state fMRI. The results demonstrated that treated smokers will have improved functions of brain regions related to emotion and memory after using varenicline. This improvement is not only the direct benefit of quitting smoking, but also helps quitters cope with the discomfort and negative emotions of quitting. All subjects showed a decrease in smoking addiction and withdrawal response, suggesting that varenicline can help quitters maintain their withdrawal status.


Smoking is an addictive disease that can easily relapse. Even if the physiological addiction has been lifted, psychological addiction may still exist and influence for a long time. Several previous studies have examined smokers’ brain response to smoking-related clues in different status, such as in nicotine abstinence status and in resting status after cessation1,2. However, little is known about the changes in brain responses caused by smoking cessation drugs. Understanding the effects of cessation drugs on brain activity, especially the changes of brain activity in resting state, will help us to comprehend and evaluate the effects of medical cessation treatment more comprehensively and provide other targeted non-drug adjuvant therapy. Finally, reduce relapse rate and increase smoking cessation success rate. Therefore, we performed the current study aiming to evaluate the changes of resting-state brain activity before and after smoking cessation treatment by using varenicline, a nicotinic receptor blocker.


Data were collected using a MAGNETOM Prisma 3T MR scanner with a 64-channel head coil from a total of 23 smokers (18 males and 5 females). They aged 23-40 (mean 30.7±4.2) years. All subjects underwent resting-fMRI data acquisition before cessation and 1.5 months after cessation treatment by varenicline. The resting state functional images were acquired using an EPI sequence with the following parameters: TR=3000 ms, TE=30 ms, field of view=220 mm× 220 mm, flip angle=90°, image matrix=64 × 64, thickness=3 mm, gap=1 mm, 36 axial slices, 180 volumes. The EPI data were preprocessed with the Data Processing Assistant for Resting State fMRI (http://www. restfmri.net/forum/DPARSF) that works with SPM12 on the Matlab 7.5 platform. The first ten volumes of the scanning sessions were removed to allow for scanner calibration and participants’ adaptation to the scanning environment. All of the subjects’ head movements were less than 1 mm maximum displacement in any direction and less than 1˚ in any angular dimension. After realignment, all of the data were normalized to Montreal Neurological Institute space, resampled with 3 mm × 3 mm ×3 mm resolution and smoothed with a Gaussian kernel of 6 mm full width. fALFF and ReHo analyses were performed. One-sample T-test was performed to compare the activation changes before and after cessation treatment (p<0.01 was considered significant). We also did Fagerström Test for Nicotine Dependence (FTND) before and after treatment to evaluate smokers' changes in smoking habits.


We found that fALFF which reflecting brain activation in smokers increased after cessation treatment. No decreased fALFF areas were found. The increased brain activation regions were concentrated in bilateral temporal lobe. ReHo also increased after treatment and the increased areas were concentrated on the right temporal lobe. Smokers generally had a lower degree of smoking dependence, and their satisfaction after smoking decreased significantly.


Previous findings suggested that brain activation of smokers in resting state was decreased in temporal gyrus than non-smokers. And severe nicotine dependent smokers also showed decreased fALFF in temporal gyrus than mild-moderate addicts3. The temporal lobe is olfactory and auditory centre and relates to memory and emotion4,5. Changes in temporal lobe activity explained previous studies’ finding that smoking reduces people’s attention and working memory, and reduces people's response to natural rewards6,7. Visual and emotional brain activation in smokers who quit smoking were reduced after treatment with varenicline by visual stimulation with smoking-inducing cues8. These findings confirmed that smokers, especially severe nicotine dependent smokers, have impaired function in the brain regions responsible for emotion and memory9,10. Varenicline can effectively reduce the effects of smoking cues on visual and memory stimuli in ex-smokers and reduce relapse risk11. Our study found that the emotional and memory functions of treated smokers in resting state without smoking clue stimulation were higher than those before treated, suggesting that medical treatment is also helpful to recover resting state brain function. We analysed both fALFF and ReHo and obtained similar results. It suggests that the improvement of brain function is not only simple increase of activation but also change of activity sate12. However, activity sate changes were lagging behind simple activation changes, so ReHo only found changes in the right temporal lobe, but neither fALFF nor ReHo found hypofunctional brain areas than pretherapy. The FTND test also showed that the dependence level of treated smokers decreased and withdrawal reaction reduced significantly, which may also be the effects of improved emotional function13. The expansion of the subjects will further confirm our findings.


Using varenicline can increase the activation of olfactory and auditory related brain regions and improve the emotional and memory functions of treated smokers just in a short period of treatment. That is very important to help the smokers to maintain the state of quitting smoking.


No acknowledgement found.


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Figure 1. Brain activation increased areas (fALFF) than that before smoking cessation treatment in the same group of 23 smokers. Warm-toned clusters indicate that brain activation are stronger than before treatment and clusters are distributed in bilateral temporal gray and white matter.

Figure 2. ReHo increased areas than that before smoking cessation treatment in the same group of 23 smokers. Warm-toned clusters indicate that ReHo increased than before treatment and clusters are distributed in right temporal gray and white matter.



Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)