An Overview of Cerebral Atrophy

The medical term for a shrinking brain

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Brain atrophy, or cerebral atrophy, is a condition in which the brain or regions of the brain literally shrink in size. It ranges in severity, the extent of which determines its impact. A mild degree of brain atrophy is not always a concern. Substantial brain atrophy can be associated with major neurological diseases, such as a large stroke or progressive dementia. In some instances, it isn't clear whether cerebral atrophy caused the medical condition or vice versa.

Based on what experts know about brain atrophy, there may be some ways of preventing it or slowing it down. If you or a loved one has been diagnosed, it helps to understand the implications and to learn if there is anything you can do about this condition.

Brain scans, MRI scans
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Causes

There are a variety of causes of cerebral atrophy. It may be the consequence of a progressive neurological disease, brain damage, or be present at birth.

Progressive Diseases

A number of neurological syndromes are characterized by degeneration of certain cells in the brain. Parkinson's disease and Alzheimer's disease are the most recognized neurodegenerative conditions that affect the brain. Others include Lewy body dementia, Huntington's disease, and fronto-temporal dementia.

It is not clear why these conditions develop, and experts suggest that there may be a mix of genetic and environmental factors involved.

Sometimes, an acquired condition, such as AIDS, can be associated with cerebral atrophy and degenerative dementia. And Wernicke-Korsakoff syndrome can cause progressive brain atrophy and behavioral changes in association with alcohol abuse.

Some experts suggest that aging is associated with slowly progressive atrophy, and researchers aren't sure whether this has any effect on a person's abilities or not.

Brain Damage

In some instances, cerebral atrophy occurs due to sudden brain damage, such as a stroke, head trauma, a brain infection (encephalitis), or a brain tumor. These causes differ from degenerative neurological disease because they involve an episode rather than a progression of damage.

Recurrent head trauma can cause multiple episodes of brain damage, resulting in severe cerebral atrophy and a condition described as chronic traumatic encephalopathy (CTE). And recurrent strokes can cause multiple areas of atrophy, typically with behavioral changes and vascular dementia. Sometimes multiple sclerosis (MS) can cause areas of brain atrophy as well.

After a region of the brain becomes damaged, the area may be exposed to inflammation and swelling. Eventually, this can cause necrosis of the affected brain cells.

Cerebral palsy (CP), a congenital condition, may also be associated with cerebral atrophy, but brain atrophy is not always present in CP.

Congenital

It is also possible for cerebral atrophy to be present at birth.

Symptoms

Brain atrophy essentially means that neurons and their connections to each other have undergone necrosis (cell death). The affected areas cannot function as they should. Where this occurs determines what symptoms you experience.

Atrophy in the brain can be focal or generalized:

  • Focal brain atrophy affects one or more specific regions.
  • Generalized cerebral atrophy affects the whole brain about equally throughout all regions.

Usually, with cerebral atrophy, there are still some functioning neurons among those that have undergone necrosis, so the symptoms may be partial rather than complete.

Progressive atrophy typically occurs during adulthood, manifesting with a loss of skills. It tends to be generalized, although there may be areas of the brain that are more affected than others. The symptoms tend to slowly worsen over the course of months or even years.

Symptoms of progressive brain atrophy include:

Acute focal brain atrophy, that which occurs weeks after the sudden symptoms of a stroke, head trauma, or infection, can produce:

  • Weakness of the face, arm and/or leg
  • Numbness
  • Vision changes
  • Problems with balance

Congenital brain atrophy tends to affect certain areas of the brain, rather than the whole brain equally. Symptoms may be noticeable during infancy or early childhood and can include:

  • Seizures
  • Trouble walking
  • Delayed speech
  • Learning difficulties

Diagnosis

Typically, cerebral atrophy is identified with brain imaging tests. These tests can include computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), or single-photon emission computerized tomography (SPECT) scans.

Your medical team might request that you have a brain CT or MRI if you develop symptoms such as weakness, numbness, vision, loss, or personality changes.

In general, PET and SPECT are often done for research purposes rather than in the clinical setting. These tests may identify generalized cerebral atrophy or areas of focal cerebral atrophy.

Sometimes when regions of atrophy are noted on a brain imaging examination, it can help in diagnosing the medical condition. For example:

  • Alzheimer's disease: The hippocampus, which helps form new memories, and the temporo-parietal lobes are affected by atrophy in most patients with Alzheimer's disease.
  • Fronto-temporal dementia: The frontal and temporal lobes are the most severely affected by atrophy.
  • Lewy body dementia: The midbrain, hypothalamus, and substantia innominata are the areas with the most atrophy in this condition.
  • Parkinson's disease: The substantia nigra and midbrain may appear smaller at late stages.
  • Stroke: Areas of the brain that have been damaged by bleeding or loss of blood supply may undergo atrophy, producing small "holes" in the brain.

Some other types of atrophy—such as vascular dementia, CTE, MS, and atrophy due to encephalitis or AIDS—may result in cerebral atrophy in different regions of the brain.

Treatment

It is not possible to reverse brain atrophy after it has already occurred. However, preventing brain damage, especially by preventing a stroke, may reduce the amount of atrophy that you develop over time.

Some researchers suggest that healthy lifestyle strategies could minimize the atrophy that is normally associated with aging.

Medications

Prescription medications used for the prevention of strokes such as blood thinners, cholesterol-lowering agents, and antihypertensive medications may help prevent atrophy. These medications are not for everyone, but they can be beneficial if you have certain risk factors.

There are also medications used to treat Alzheimer's disease, including Aricept (donepezil) and Namenda (memantine). They may help slow down atrophy, but the effect is believed to be small, if any.

Lifestyle Strategies

Maintaining a lifestyle that includes physical exercise, a low-cholesterol diet, blood sugar control, and a healthy weight may prevent or reduce the speed of cerebral atrophy by reducing the effects of inflammation on the brain.

Certain fats, specifically trans fats, have a harmful effect on the body and can increase the risk of strokes, therefore, avoiding trans fats can help prevent strokes and consequently cerebral atrophy.

Stress management may also reduce brain atrophy because emotional stress is associated with conditions such as hypertension, heart disease, and stroke—all of which lead to vascular dementia. Furthermore, researchers are starting to see evidence that stress may contribute to dementia as well.

A Word From Verywell

The thought of your brain shrinking is something that certainly would stop anyone in their tracks. However, it's important to know that a very slow and steady rate of brain atrophy may not cause any effects at all. If you have been diagnosed and your case is more substantial and producing symptoms, be sure to follow up with your doctor and to use medications and/or lifestyle strategies to reduce the impact and progression of your condition.

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