Peripheral insulin resistance attenuates cerebral glucose metabolism and impairs working memory in healthy adults

People with insulin resistance are at increased risk for cognitive decline. Insulin resistance has previously been considered primarily a condition of ageing but it is increasingly seen in younger adults. Here, we explore the question that changes in insulin function in early adulthood have both proximal effects, and moderate or even accelerate changes in cerebral metabolism in ageing. Thirty-six younger (mean 27.8 years) and 43 older (mean 75.5) participants completed a battery of tests, including blood sampling, cognitive assessment and a simultaneous PET/MR scan. Cortical thickness and cerebral metabolic rate of glucose were derived for 100 regions and 17 functional networks. Older adults had lower rates of regional cerebral glucose metabolism than younger adults across the brain even after adjusting for lower cortical thickness in older adults. In younger adults, higher insulin resistance was associated with attenuated rates of regional cerebral glucose metabolism, but this was not seen in older adults. The largest effects of insulin resistance in younger adults were in prefrontal, parietal and temporal regions; and in the control, salience ventral attention, default and somatomotor networks. Higher rates of network glucose metabolism were associated with lower reaction time and psychomotor speed. Higher levels of insulin resistance were associated with lower working memory. Our results underscore the importance of insulin sensitivity to brain health and cognitive function across the adult lifespan, even in early adulthood. Significance StatementWe show that preventing insulin resistance in early adulthood is important for ensuring efficient fuel supply for the brain and the maintenance of cognitive health across the adult lifespan. Glucose is the primary source of energy for the brain. Decreased glucose metabolism in the brain due to clinically significant levels of insulin resistance is associated with cognitive impairment. Although sub-clinical levels of insulin resistance have also been associated with brain changes, their impact on cerebral metabolism in healthy individuals is unclear. We showed for the first time that - while older adults have lower rates of cerebral metabolism - peripheral insulin resistance attenuates cerebral metabolism more so in healthy younger than healthy older adults, and impairs working memory.