Animal studies implicate the amygdala and its connections in the recognition of aversive stimuli. A recent PET study demonstrated that the human amygdala and left orbitofrontal cortex show substantial increases in regional cerebral blood flow (rCBF) during exposure to aversive odourants. To examine if aversive gustatory stimuli similarly activate these regions, nine healthy women tasted an aversive saline solution, pure water and chocolate while rCBF was measured with PET. The aversive saline condition, when contrasted with the water condition, increased activity in the right amygdala, left anterior orbitofrontal cortex, medial thalamus, pregenual and dorsal anterior cingulate, and the right hippocampus. The right amygdala, left orbitofrontal cortex and pregenual cingulate remained significantly activated when saline was compared with chocolate. The present results indicate that the amygdala and orbitofrontal cortex respond to aversive stimuli in both the olfactory and gustatory modalities, and highlight the role of the pregenual cingulate in negative emotional processing.

Even healthy adults worry about declines in mental efficiency with aging. Subjective changes in mental flexibility, self-regulation, processing speed, and memory are often cited. We show here that focal decreases in brain activity occur with normal aging as measured with fluorodeoxyglucose and positron emission tomography. The largest declines localize to a medial network including the anterior cingulate/medial prefrontal cortex, dorsomedial thalamus, and sugenual cingulate/basal forebrain. Declining metabolism in this network correlates with declining cognitive function. The medial prefrontal metabolic changes with aging are similar in magnitude to the hypometabolism found in Mild Cognitive Impairment or Alzheimer's disease. These results converge with data from healthy elderly indicating dysfunction in the anterior attention system. The interaction of attention in the anterior cingulate cortex with memory in the medial temporal lobe may explain the global impairment that defines dementia. Despite the implications for an aging population, the neurophysiologic mechanisms of these metabolic decreases remain unknown.

Vagus nerve stimulation (VNS) is used as an adjunctive therapy for treatment-resistant depression (TRD). Its mechanism of action is not fully understood. Longitudinal measurement of changes in brain metabolism associated with VNS can provide insights into this new treatment modality. Eight severely depressed outpatients who were highly treatment-resistant underwent electrical stimulation of the left vagus nerve for approximately one year. The main outcome measures were resting regional brain glucose uptake measured with positron emission tomography (PET) and the 24-item Hamilton Depression Scale. The most significant and extensive change over one year of chronic VNS localized to the ventromedial prefrontal cortex extending from the subgenual cingulate to the frontal pole. This region continued to decline in metabolism even toward the end of the study. Clinically, this cohort showed a trend for improvement. No correlations surfaced between change in glucose uptake and depression scores. However, the sample size was small; none remitted; and the range of depression scores was limited. Chronic VNS as adjunctive therapy in patients with severe TRD produces protracted and robust declines in resting brain activity within the ventromedial prefrontal cortex, a network with dense connectivity to the amygdala and structures monitoring the internal milieu.

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