Functional MRS uncovers age-related alterations in cerebral lactate dynamics during emotional-cognitive engagement, revealing metabolic vulnerability in the dACC

Abstract Introduction Lactate plays dual roles in neuronal energy metabolism and signalling. The dorsal anterior cingulate cortex (dACC), a region with high baseline glycolytic activity implicated in psychiatric disorders, may exhibit dynamic lactate responses to graded cognitive-emotional demands. Because mitochondrial function declines with age, aging may model whether fMRS-derived lactate dynamics can detect latent neurometabolic vulnerabilities. Methods Using fMRS, we monitored dACC metabolite changes in 34 healthy participants (aged 21–69) during an emotional face-processing task with escalating cognitive-emotional workload. The paradigm comprised a 2-minute baseline, 10-minute task of increasing intensity, and 10-minute recovery. Results dACC lactate increased significantly, tracking task intensity and peaking 19.5% above baseline at maximum cognitive load (z = 2.66, p = 0.004). The response showed both linear task-related increases (z = 2.08, p = 0.02) and a quadratic inverted-U profile (z = 2.72, p = 0.004). Total creatine, total NAA and Glx (Glutamate+Glutamine) exhibited no task-dependent changes. Age influenced task-period lactate AUC (z = 2.19, p = 0.014). Participants over 40 exhibited greater peak responses (54% vs 28%), steeper upslopes (14% vs 7% per block), and larger AUC (155% vs 16%) than those under 40. Sex differences were also observed. Baseline lactate did not correlate with age. Conclusions dACC lactate dynamics are sensitive to cognitive-emotional demand, with evidence of age-and sex-dependent modulation. The dissociation between static and dynamic measures establishes a metabolic stress-testing paradigm for detecting latent neuroenergetic vulnerabilities, supporting fMRS utility for probing mitochondrial function in health and psychiatric disorders.