Within the Alzheimer disease (AD) spectrum, metabolic alterations occur in addition to proteinopathies. While hypometabolism is frequently observed in the late symptomatic stages, characterizing the metabolic changes during early AD stages might aid in both understanding its pathophysiology and in patient selection for future treatments. In this study, we conduct an exploratory, data-driven analysis aimed at better understanding the timing and specificity of the metabolic changes in early AD. Using kinetic analysis of [18F]FDG PET brain imaging data coming from 223 individuals, including 33 preclinical individuals and 19 symptomatic individuals, we find new evidence of a more complex spatiotemporal trajectory of glucose metabolism in early AD, which includes a paradoxical regional increase in glucose phosphorylation during preclinical AD. These findings suggest that the pathologic phases of AD parallel changes in brain glucose metabolism, which is readily assessable with [18F]FDG PET imaging. Moreover, they may indicate that metabolic interventions may work differently during preclinical AD as compared to the early symptomatic phase.

Task fMRI1 and electrophysiology2 have revealed distributed, linked cortical patches with shared category preferences (e.g., faces, objects, places)1,3-5, smaller than cytoarchitectonic areas. Resting-state functional connectivity (RSFC) similarly showed that somato-cognitive action network (SCAN) nodes interleave with effectors (foot, hand, mouth), subdividing the precentral gyrus6. Here, using multiple precision functional mapping (PFM) modalities (RSFC, task, lags), we discovered that most of association cortex is organized like face processing and SCAN, with small, discrete patches interconnected into chains. Such patch-chains densely tile prefrontal cortex but are largely absent from primary cortex. Cortico-striatal connectivity is organized such that patches of the same chain connect to the same striatal location. Within chains, infra-slow fMRI signals are ordered in time. RSFC-defined chains align with task fMRI localizers (e.g., visual, motor, pain). Chains are absent at birth and emerge in the first year of life, suggesting their formation is at least partially experience-driven. Cytoarchitectonic areas are subdivided by patches, and patches in the same chain are distributed across different cytoarchitectures. Chains represent parallel ordered processing streams that are separated by information domain and behavioral goals, not cytoarchitectonics. Functional subdivision of architectonics into smaller patches, interlinked to form cross-architecture chains, enable greater parallelization and flexible specialization of processing.

Structural brain aging trajectories are increasingly well characterized in very large datasets, but metabolic trajectories remain less clear. It has been proposed that CMRglc may fall faster than CMRO2 with age, though this view has been questioned. In this context, Duffy et al. now provide a rare contribution by assembling brain arteriovenous data from >200 adults aged 19-45 years. Their results offer an opportunity to refine our understanding of brain metabolism trajectories and highlight the challenges in studying this question.

Task-evoked decreases in blood-oxygenation-level-dependent (BOLD) signals are a well-recognized phenomenon in functional magnetic resonance imaging (fMRI) studies. These deactivations are most prominent in the default mode network (DMN), a set of regions most active at rest. The metabolic basis of task-induced BOLD fMRI deactivations remains unclear. To address this question, we used PET/MRI to simultaneously measure BOLD fMRI and cerebral glucose consumption (CMRglc) during visuomotor and language tasks in 22 cognitively unimpaired older adults (15 female, 7 male). Task performance increased BOLD signals in task-relevant regions and decreased BOLD signals in the DMN. Positive BOLD responses generally coincided with increases in CMRglc. In contrast, CMRglc did not decrease in regions showing negative BOLD responses; instead, it typically increased. In particular, the posterior cingulate cortex showed significant CMRglc elevations in conjunction with negative BOLD responses. Whole-brain intensity normalization partially restored task-induced decreases in CMRglc, indicating that relative reductions appear in regions in which CMRglc increases are smaller than the global average. Overall, our results imply that BOLD fMRI deactivations can occur in conjunction with stable or even increased glucose consumption.

The red nucleus, a large brainstem structure, coordinates limb movement for locomotion in quadrupedal animals. In humans, its pattern of anatomical connectivity differs from that of quadrupeds, suggesting a different purpose. Here, we apply our most advanced resting-state functional connectivity based precision functional mapping in highly sampled individuals (n = 5), resting-state functional connectivity in large group-averaged datasets (combined n ~ 45,000), and task based analysis of reward, motor, and action related contrasts from group-averaged datasets (n > 1000) and meta-analyses (n > 14,000 studies) to precisely examine red nucleus function. Notably, red nucleus functional connectivity with motor-effector networks (somatomotor hand, foot, and mouth) is minimal. Instead, connectivity is strongest to the action-mode and salience networks, which are important for action/cognitive control and reward/motivated behavior. Consistent with this, the red nucleus responds to motor planning more than to actual movement, while also responding to rewards. Our results suggest the human red nucleus implements goal-directed behavior by integrating behavioral valence and action plans instead of serving a pure motor-effector function.

Prescription stimulants such as methylphenidate are being used by an increasing portion of the population, primarily children. These potent norepinephrine and dopamine reuptake inhibitors promote wakefulness, suppress appetite, enhance physical performance, and are purported to increase attentional abilities. Prior functional magnetic resonance imaging (fMRI) studies have yielded conflicting results about the effects of stimulants on the brain's attention, action/motor, and salience regions that are difficult to reconcile with their proposed attentional effects. Here, we utilized resting-state fMRI (rs-fMRI) data from the large Adolescent Brain Cognitive Development (ABCD) Study to understand the effects of stimulants on brain functional connectivity (FC) in children (n = 11,875; 8-11 years old) using network level analysis (NLA). We validated these brain-wide association study (BWAS) findings in a controlled, precision imaging drug trial (PIDT) with highly-sampled (165-210 minutes) healthy adults receiving high-dose methylphenidate (Ritalin, 40 mg). In both studies, stimulants were associated with altered FC in action and motor regions, matching patterns of norepinephrine transporter expression. Connectivity was also changed in the salience (SAL) and parietal memory networks (PMN), which are important for reward-motivated learning and closely linked to dopamine, but not the brain's attention systems (e.g. dorsal attention network, DAN). Stimulant-related differences in FC closely matched the rs-fMRI pattern of getting enough sleep, as well as EEG- and respiration-derived brain maps of arousal. Taking stimulants rescued the effects of sleep deprivation on brain connectivity and school grades. The combined noradrenergic and dopaminergic effects of stimulants may drive brain organization towards a more wakeful and rewarded configuration, explaining improved task effort and persistence without direct effects on attention networks.

Prescription stimulants (e.g., methylphenidate) are thought to improve attention, but evidence from prior fMRI studies is conflicted. We utilized resting-state fMRI data from the Adolescent Brain Cognitive Development Study (n = 11,875; 8-11 years old) and validated the functional connectivity findings in a precision imaging drug trial with highly sampled (n = 5, 165-210 min each) healthy adults (methylphenidate 40 mg). Stimulant-related connectivity differences in sensorimotor regions matched fMRI patterns of daytime arousal, sleeping longer at night, and norepinephrine transporter expression. Taking stimulants reversed the effects of sleep deprivation on connectivity and school grades. Connectivity was also changed in salience and parietal memory networks, which are important for dopamine-mediated, reward-motivated learning, but not the brain's attention systems (e.g., dorsal attention network). The combined noradrenergic and dopaminergic effects of stimulants may drive brain organization towards a more wakeful and rewarded configuration, improving task effort and persistence without effects on attention networks.

The brain is always intrinsically active, using energy at high rates while cycling through global functional modes. Awake brain modes are tied to corresponding behavioural states. During goal-directed behaviour, the brain enters an action-mode of function. In the action-mode, arousal is heightened, attention is focused externally and action plans are created, converted to goal-directed movements and continuously updated on the basis of relevant feedback, such as pain. Here, we synthesize classical and recent human and animal evidence that the action-mode of the brain is created and maintained by an action-mode network (AMN), which we had previously identified and named the cingulo-opercular network on the basis of its anatomy. We discuss how rather than continuing to name this network anatomically, annotating it functionally as controlling the action-mode of the brain increases its distinctiveness from spatially adjacent networks and accounts for the large variety of the associated functions of an AMN, such as increasing arousal, processing of instructional cues, task general initiation transients, sustained goal maintenance, action planning, sympathetic drive for controlling physiology and internal organs (connectivity to adrenal medulla), and action-relevant bottom–up signals such as physical pain, errors and viscerosensation. In the functional mode continuum of the awake brain, the AMN-generated action-mode sits opposite the default-mode for self-referential, emotional and memory processing, with the default-mode network and AMN counterbalancing each other as yin and yang. The brain enters an action-mode of function during goal-directed behaviour. In this Perspective, Dosenbach, Raiche and Gordon describe “action-mode” as an informative functional label that reduces anatomical network naming confusion, then characterize how the reannotated action-mode network supporting it counterbalances the default mode network.

The action-mode network (AMN) is a canonical functional brain network first identified using resting-state functional connectivity (RSFC). Based on animal and human data, we have proposed that AMN supports the brain's action mode by controlling functions required for successful goal-directed behavior. However, task fMRI averaged across groups has associated AMN regions with a variety of behaviors, contributing to uncertainty about AMN function. Here, we investigated the AMN using an inside-out approach, in which the network architecture of the AMN is first precisely mapped within individuals and then associated with behavioral functions. Individual-specific precision functional mapping with >5 h of RSFC and task functional magnetic resonance imaging (fMRI) data revealed a replicable AMN subnetwork structure. AMN subnetworks were characterized and annotated by combining a meta-analytic network association method with RSFC, intrinsic timing, and task activation profiling. We demonstrate the existence of AMN-Decision, -Action, and -Feedback subnetworks that are distributed across lobes, forming a temporally sequential within-network processing stream by which the brain adjudicates between possible goals, sets action plans, and modifies those plans in response to feedback such as pain. A subnetwork in the pars marginalis of the cingulate was distinct from the Decision, Action, and Feedback subnetworks and may be important for the construction of the bodily self.

Metabolism plays a key role in the maintenance of sleep/wake states. Brain lactate fluctuations are a biomarker of sleep/wake transitions, where increased interstitial fluid (ISF) lactate levels are associated with wakefulness and decreased ISF lactate is required for sleep. ATP-sensitive potassium (K ATP ) channels couple glucose-lactate metabolism with excitability. Using mice lacking K ATP channel activity (e.g., Kir6.2 −/− mice), we explored how changes in glucose utilization affect cortical electroencephalography (EEG) activity and sleep/wake homeostasis. In the brain, Kir6.2 −/− mice shunt glucose toward glycolysis, reducing neurotransmitter biosynthesis and dampening cortical EEG activity. Kir6.2 −/− mice spent more time awake at the onset of the light period due to altered ISF lactate dynamics. Together, we show that Kir6.2-K ATP channels act as metabolic sensors to gate arousal by maintaining the metabolic stability of sleep/wake states and providing the metabolic flexibility to transition between states.

Subcortical plasticity has mainly been studied using invasive electrophysiology in animals. Here, we leverage precision functional mapping (PFM) to study motor plasticity in the human subcortex during 2 weeks of upper-extremity immobilization with daily resting-state and motor task fMRI. We found previously that, in the cortex, limb disuse drastically impacts disused primary motor cortex functional connectivity (FC) and is associated with spontaneous fMRI pulses. It remains unknown whether disuse-driven plasticity pulses and FC changes are cortex specific or whether they could also affect movement-critical nodes in the thalamus and striatum. Tailored analysis methods now show spontaneous disuse pulses and FC changes in the dorsal posterior putamen and central thalamus (centromedian [CM], ventral-intermediate [VIM], and ventroposterior-lateral nuclei), representing a motor circuit-wide plasticity phenomenon. The posterior putamen effects suggest plasticity in stimulus-driven habit circuitry. Importantly, thalamic plasticity effects are focal to nuclei used as deep brain stimulation targets for essential tremor/Parkinson's disease (VIM) and epilepsy/coma (CM).

Multiple studies have shown that hyperglycemia increases the cerebral metabolic rate of glucose (CMRglc) in subcortical white matter. This observation remains unexplained. Using positron emission tomography (PET) and pancreatic glucose clamps with basal insulin replacement in twenty-nine healthy young adults (34.5 years, SD = 10.1) we found that acute hyperglycemia increases non-oxidative CMRglc (i.e., aerobic glycolysis (AG)) in subcortical white mater as well as in medial temporal lobe structures, cerebellum and brainstem, all areas with low CMRglc during euglycemia. Surprisingly, hyperglycemia did not change regional cerebral blood flow (CBF), the cerebral metabolic rate of oxygen (CMRO2), or the blood-oxygen-level-dependent (BOLD) response. Correlation with existing regional gene expression data showed that brain regions where CMRglc increased have greater expression of hexokinase 2 (HK2). Simulations of glucose transport revealed that, unlike hexokinase 1, HK2 is not saturated at euglycemia, and thus can accommodate increased AG during hyperglycemia.

Neural activity in awake organisms shows widespread and spatiotemporally diverse correlations with behavioral and physiological measurements. We propose that this covariation reflects in part the dynamics of a unified, arousal-related process that regulates brain-wide physiology on the timescale of seconds. Taken together with theoretical foundations in dynamical systems, this interpretation leads us to a surprising prediction: that a single, scalar measurement of arousal (e.g., pupil diameter) should suffice to reconstruct the continuous evolution of multimodal, spatiotemporal measurements of large-scale brain physiology. To test this hypothesis, we perform multimodal, cortex-wide optical imaging and behavioral monitoring in awake mice. We demonstrate that spatiotemporal measurements of neuronal calcium, metabolism, and blood-oxygen can be accurately and parsimoniously modeled from a low-dimensional state-space reconstructed from the time history of pupil diameter. Extending this framework to behavioral and electrophysiological measurements from the Allen Brain Observatory, we demonstrate the ability to integrate diverse experimental data into a unified generative model via mappings from an intrinsic arousal manifold. Our results support the hypothesis that spontaneous, spatially structured fluctuations in brain-wide physiology—widely interpreted to reflect regionally-specific neural communication—are in large part reflections of an arousal-related process. This enriched view of arousal dynamics has broad implications for interpreting observations of brain, body, and behavior as measured across modalities, contexts, and scales.

A single dose of psilocybin, a psychedelic that acutely causes distortions of space-time perception and ego dissolution, produces rapid and persistent therapeutic effects in human clinical trials1-4. In animal models, psilocybin induces neuroplasticity in cortex and hippocampus5-8. It remains unclear how human brain network changes relate to subjective and lasting effects of psychedelics. Here we tracked individual-specific brain changes with longitudinal precision functional mapping (roughly 18 magnetic resonance imaging visits per participant). Healthy adults were tracked before, during and for 3 weeks after high-dose psilocybin (25 mg) and methylphenidate (40 mg), and brought back for an additional psilocybin dose 6-12 months later. Psilocybin massively disrupted functional connectivity (FC) in cortex and subcortex, acutely causing more than threefold greater change than methylphenidate. These FC changes were driven by brain desynchronization across spatial scales (areal, global), which dissolved network distinctions by reducing correlations within and anticorrelations between networks. Psilocybin-driven FC changes were strongest in the default mode network, which is connected to the anterior hippocampus and is thought to create our sense of space, time and self. Individual differences in FC changes were strongly linked to the subjective psychedelic experience. Performing a perceptual task reduced psilocybin-driven FC changes. Psilocybin caused persistent decrease in FC between the anterior hippocampus and default mode network, lasting for weeks. Persistent reduction of hippocampal-default mode network connectivity may represent a neuroanatomical and mechanistic correlate of the proplasticity and therapeutic effects of psychedelics.

Childhood exposure to social disadvantage is a major risk factor for psychiatric disorders and poor developmental, educational, and occupational outcomes, presumably because adverse exposures alter the neurodevelopmental processes that contribute to risk trajectories. Yet, given the limited social mobility in the United States and other countries, childhood social disadvantage is frequently preceded by maternal social disadvantage during pregnancy, potentially altering fetal brain development during a period of high neuroplasticity through hormonal, microbiome, epigenetic, and immune factors that cross the placenta and fetal blood-brain barrier. The current study examines prenatal social disadvantage to determine whether these exposures in utero are associated with alterations in functional brain networks as early as birth. As part of the Early Life Adversity and Biological Embedding study, mothers were recruited during pregnancy, prenatal social disadvantage was assessed across trimesters, and their healthy, full- term offspring were imaged using resting- state functional magnetic resonance imaging during the first weeks of life. Multivariate machine learning methods revealed that neonatal functional connectivity (FC) varied as a function of prenatal exposure to social disadvantage (n = 261, R = 0.43, R2 = 0.18), with validation in an independent sample. Alterations in FC associated with prenatal social disadvantage occurred brain- wide and were most pronounced in association networks (fronto- parietal, ventral attention, dorsal attention) and the somatomotor network. Amygdala FC was altered at birth, with a pattern shared across subcortical structures. These findings provide critical insights into how early in development functional networks begin to diverge in the context of social disadvantage and elucidate the functional networks that are most impacted.

The red nucleus is a large brainstem structure that coordinates limb movement for locomotion in quadrupedal animals (Basile et al., 2021). The humans red nucleus has a different pattern of anatomical connectivity compared to quadrupeds, suggesting a unique purpose (Hatschek, 1907). Previously the function of the human red nucleus remained unclear at least partly due to methodological limitations with brainstem functional neuroimaging (Sclocco et al., 2018). Here, we used our most advanced resting-state functional connectivity (RSFC) based precision functional mapping (PFM) in highly sampled individuals (n = 5) and large group-averaged datasets (combined N ~ 45,000), to precisely examine red nucleus functional connectivity. Notably, red nucleus functional connectivity to motor-effector networks (somatomotor hand, foot, and mouth) was minimal. Instead, red nucleus functional connectivity along the central sulcus was specific to regions of the recently discovered somato-cognitive action network (SCAN; (Gordon et al., 2023)). Outside of primary motor cortex, red nucleus connectivity was strongest to the cingulo-opercular (CON) and salience networks, involved in action/cognitive control (Dosenbach et al., 2007; Newbold et al., 2021) and reward/motivated behavior (Seeley, 2019), respectively. Functional connectivity to these two networks was organized into discrete dorsal-medial and ventral-lateral zones. Red nucleus functional connectivity to the thalamus recapitulated known structural connectivity of the dento-rubral thalamic tract (DRTT) and could prove clinically useful in functionally targeting the ventral intermediate (VIM) nucleus. In total, our results indicate that far from being a 'motor' structure, the red nucleus is better understood as a brainstem nucleus for implementing goal-directed behavior, integrating behavioral valence and action plans.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The distribution of brain aerobic glycolysis (AG) in normal young adults correlates spatially with amyloid-beta (Aβ) deposition in individuals with symptomatic and preclinical Alzheimer disease (AD). Brain AG decreases with age, but the functional significance of this decrease with regard to the development of AD symptomatology is poorly understood. Using PET measurements of regional blood flow, oxygen consumption, and glucose utilization—from which we derive AG—we find that cognitive impairment is strongly associated with loss of the typical youthful pattern of AG. In contrast, amyloid positivity without cognitive impairment was associated with preservation of youthful brain AG, which was even higher than that seen in cognitively unimpaired, amyloid negative adults. Similar findings were not seen for blood flow nor oxygen consumption. Finally, in cognitively unimpaired adults, white matter hyperintensity burden was found to be specifically associated with decreased youthful brain AG. Our results suggest that AG may have a role in the resilience and/or response to early stages of amyloid pathology and that age-related white matter disease may impair this process.

Major depressive disorder (MDD) is widely hypothesized to result from disordered communication across brain-wide networks. Yet, prior resting-state-functional MRI (rs-fMRI) studies of MDD have studied zero-lag temporal synchrony (functional connectivity) in brain activity absent directional information. We utilize the recent discovery of stereotyped brain-wide directed signaling patterns in humans to investigate the relationship between directed rs-fMRI activity, MDD, and treatment response to FDA-approved neurostimulation paradigm termed Stanford neuromodulation therapy (SNT). We find that SNT over the left dorsolateral prefrontal cortex (DLPFC) induces directed signaling shifts in the left DLPFC and bilateral anterior cingulate cortex (ACC). Directional signaling shifts in the ACC, but not the DLPFC, predict improvement in depression symptoms, and moreover, pretreatment ACC signaling predicts both depression severity and the likelihood of SNT treatment response. Taken together, our findings suggest that ACC-based directed signaling patterns in rs-fMRI are a potential biomarker of MDD.