Abstract
Background: The insula is instrumental in integrating the emotional, cognitive, and sensory-motor systems. This manuscript lays a foundational framework for understanding the insula’s mechanistic role in moderating brain networks in illness and wellness. Methods: Reviewed here is the select literature on the brain anatomy and function relevant to the insula’s role in psychiatrically ill and normative populations. Results: The insula is a hub for moderating social cognition, empathy, reward-driven decision-making, arousal, reactivity to emotional stimuli, and somatic pain processing. Findings indicate a spectrum of increasing complexity in insular function – from receiving and interpreting sensorimotor sensations in the posterior insula to subjective perception of emotions in the anterior insula. The insula plays a key role at the interface of cognitive and emotional domains, functioning in concert with other brain regions that share common cytoarchitecture, such as the ventrolateral prefrontal cortex and the anterior cingulate cortex. Pharmacotherapy and mindfulness-based interventions can alter insular activation. Conclusion: The insula serves as a receiver and interpreter of emotions in the context of cognitive and sensory-motor information. Therefore, insular function and connectivity may potentially be utilized as a biomarker for treatment selection and outcome.
Highlights
As basic and clinical neuroscience advance one another, generating new data from imaging genetics [1] and pharmacological functional magnetic neuroimaging [2,3], the insula is gaining recognition as an instrumental hub in brain networks
This review accomplishes the following: 1) provides an anatomical and physiological overview; 2) presents the role of the insula in brain networks pertaining to the interfacing emotional and cognitive function, social cognition, empathy, reward-driven decision-making, arousal, reactivity to emotional stimuli, and somatic pain processing; and 3) introduces how insular activity can serve as a biomarker for interventions through pioneering clinical functional magnetic neuroimaging (fMRI) and positron emission tomography(PET) studies[7]
The anterior insula or anterior insular cortex (AIC) is functionally distinct, with its dorsal part serving a predominantly cognitive role and its ventral part working as a hub for emotional networks[5,10]
Summary
As basic and clinical neuroscience advance one another, generating new data from imaging genetics [1] and pharmacological functional magnetic neuroimaging (fMRI) [2,3], the insula is gaining recognition as an instrumental hub in brain networks. This review accomplishes the following: 1) provides an anatomical and physiological overview; 2) presents the role of the insula in brain networks pertaining to the interfacing emotional and cognitive function, social cognition, empathy, reward-driven decision-making, arousal, reactivity to emotional stimuli, and somatic pain processing; and 3) introduces how insular activity can serve as a biomarker for interventions through pioneering clinical fMRI and positron emission tomography(PET) studies[7]
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