Brain (Cerebral) Atrophy Guide
Starting at age 40, people's brains slowly shrink, losing about 5% of their size every ten years.
Brain atrophy has affected relationships and daily life in 60% of patients.
27% to 42% of people treated for alcoholism might have cerebellum degeneration, a type of brain shrinkage.
Diabetes can shrink memory areas in the brain 3-7 times more than if blood sugar levels are kept low and normal.
Some info about the brain
Our brain and 10 000 000 000 000 neurons make us who we are. It controls our actions, thoughts, feelings, and personality. All our memories and experiences happen in our brains.
Critical brain functions
- Memory: The hippocampus is a particular part of the brain that helps us make and keep memories. It's essential for remembering things that just happened and learning new things.
- Moving: The motor cortex and the cerebellum help us move and coordinate our actions. It means doing everything from walking and running to small hand movements like writing.
- Talking and understanding: Broca's and Wernicke's brain areas help us articulate and understand language. They allow us to speak and help us understand what people are saying or what we're reading.
- Feelings and behavior: The frontal lobe of our brain helps us make decisions, control our actions, and handle our emotions. We can plan things, think clearly, and manage our feelings.
- Thinking skills: Several parts of our brains help us solve problems, make plans, organize our thoughts, and do complicated tasks.
- Senses: Different parts of our brains help us process what we see, hear, feel, taste, and smell. They take signals from our eyes, ears, and other sensory organs and make sense of them.
These brain parts work together to help us interact with the world. It lets us learn from the past, think about the future, and understand the world. If something changes in our brains, it can change who we are. Brain atrophy significantly affects our quality of life.
What is brain atrophy?
Brain atrophy is when the brain starts to lose its cells, neurons, and the connections between them. It's like the brain is shrinking, so its size is reduced. Not all parts of the brain shrink at the same rate, with the front part of the brain shrinking more.
How our brains work changes with age to make up for these changes. For example, older brains use both sides equally, which could be a way to adjust to these changes.
One of the theories why these changes might happen is decreasing in brain chemicals like dopamine and serotonin. They have been connected to changes in thinking and movement skills. Changes in hormones, especially in women around menopause, can also affect thinking.
Types of the brain atrophy
Brain atrophy is associated with diseases that affect the brain. Various types of brain atrophy exist, each related to different conditions:
- Cerebral atrophy happens in the case of the whole brain atrophy (generalized form) and can happen because of Alzheimer's or dementia. They affect memory, thinking skills, and movement.
- Cortical brain atrophy is when the brain’s outer layer shrinks, which helps us with higher-level skills like language and memory. Alzheimer's disease is a common reason for such a condition.
- Multisystem atrophy (MSA) is a rare brain atrophy where many of its parts shrink. This can cause symptoms like those seen in Parkinson's disease.
- Frontotemporal dementia (FTD) is a process of atrophy of brain tissue where the front and sides of it are reduced. It causes changes in a person's personality and behavior, making it hard for them to use language.
- Spinocerebellar ataxia is a group of diseases passed down through families where the back part of the brain shrinks. It can make it hard to coordinate their movements and balance.
- Primary progressive aphasia (PPA) makes it hard to use language because certain brain areas responsible for speaking are shrinking.
- Posterior cortical atrophy (PCA): is a rare form of brain atrophy where the back of the brain parts shrinks. It usually starts with vision issues.
All these conditions mean the brain is losing volume or mass and not working as well as it used to. Each condition affects people differently and can be caused by different things.
Causes of brain atrophy and disease prevention
Here’re some numbers and facts we’ve found concerning causes and risk factors for brain atrophy:
Primary risk factors
- Age: Almost all people experience some degree of brain atrophy as they age. For example, research reports that the human brain decreases volume by around 5% per decade after age 40. The brain tends to shrink faster as we age if certain risk factors are present. Age-related atrophy brain is accelerated when health issues like high blood pressure, heart issues, or diabetes exist. Glycated hemoglobin A (HbA1c) is one notable factor among these.
- Neurodegenerative diseases: Some studies show that about 15% of people with Alzheimer's have posterior cortical atrophy, and around 80% of those with Parkinson's may have dementia. Most of them have brain atrophy.
- Stroke: In the United States, approximately 795,000 people have a stroke each year, with many experiencing some degree of brain atrophy.
- Traumatic brain injury is a significant risk factor. Due to the study, 52-year-old with severe brain injuries have a similar brain size to 71-year-olds with dementia.
- Infections: HIV, which can cause brain atrophy in later stages, affected about 38 million people globally as of 2019.
- Drugs: Some medicines, such as those used for mental health issues or seizures, can lead to brain shrinkage. This brain atrophy has been linked to how many drugs a person takes. Certain medications for cancer can also cause the brain to shrink, which can happen in children too. Chemotherapy, a cancer treatment, can harm brain cells and cause shrinkage and severe memory or thinking problems. High-dose treatments for aggressive tumors can also cause the brain to shrink.
- Radiation, primarily from medical sources, can cause brain atrophy when the brain is exposed to high-energy beams. This process begins with DNA damage and ends with a neurodegenerative disorder. The damage depends on the radiation dose; even minimal doses can cause significant tissue damage.
- Hydrocephalus, or fluid accumulation in the brain, can cause brain atrophy if not treated.
- Birth injuries, leading to low oxygen levels, can cause brain atrophy. These damages may not be immediately apparent but can manifest later in life, often with delayed motor development or cerebral palsy.
- Autoimmune diseases: Multiple sclerosis (MS), which can lead to brain atrophy, is estimated to affect about 1 million people in the United States. Brain atrophy in these patients occurs 3-5 times faster.
- Alcohol abuse: A recent study suggests that one drink (a pint of beer or glass of wine) daily can make the brain smaller. It gets worse the more you drink. For example, 50-year-olds who drink two units of alcohol daily have brains that look two years older than those who drink less. Those who drink three units daily have brains that look 3.5 years older. Drinking four units daily can make a person's brain look over 10 years older.
- Malnutrition: Severe nutrition issues, which can contribute to brain atrophy, affected an estimated 149 million children under five globally in 2019.
- Genetic or metabolic disorders: Hormones and nutrients impact how the brain grows and changes. Certain metabolic diseases can cause brain atrophy. Chronic diseases like diabetes can lead to a smaller brain. Hormonal disorders like Cushing's can cause brain atrophy too.
Brain shrinkage can happen because of various causes and risk factors. Aging, for instance, is a universal factor.
How to prevent brain atrophy?
Brain atrophy can happen for many reasons. There are ways how to slow it down and keep your brain healthy.
- Keeping your blood pressure healthy can help you prevent brain atrophy. High blood pressure often leads to strokes, which can cause brain atrophy, so avoiding strokes is key to maintaining good brain health.
- Eat healthy foods: Include many fruits, vegetables, lean proteins, and healthy fats. Exclude red and processed meat. In a study, people who ate a Green Mediterranean diet had less shrinking in a part of the brain important for memory than others not on a diet.
- Exercise regularly: Physical activity helps keep the brain healthy. A study showed that adults who don't exercise much are almost two times more likely to have their brain functions decline than those who are active. Adults with long-term health problems should try to do 150 to 300 minutes of medium-level exercise or 75 to 150 minutes of high-level exercise weekly, or a mix of both.
- Keep your mind active: Do things like puzzles, reading, or learning new skills to keep your mind sharp and prevent brain atrophy. For example, researchers found that patients who speak two languages developed dementia 4.5 years later compared to those who only speak one language.
- Get good sleep: Get plenty of quality sleep every night.
- Get regular check-ups: Timely doctor visits can catch health problems like brain atrophy at their early stages.
- Avoid harmful substances: Limit alcohol and tobacco, and drugs. To stop using it completely is the best for your brain. Studies show that stopping can help your brain and make you live longer.
- Socialize: Spend time with friends and engage in group activities. In a study, participants were involved in the exercise, team activities, mentoring, problem-solving, and social events. These activities are believed to boost brain health and counter the usual brain atrophy from aging.
- Manage stress: Activities like yoga or meditation can help reduce stress.
Can brain atrophy be reversed or prevented? Cerebral atrophy can't be reversed once it has happened. However, stopping brain damage, like avoiding high blood pressure leading to a stroke, or preventing alcoholic brain atrophy by limiting its use, could slow the shrinkage over time. Some scientists think a healthy lifestyle might reduce the normal shrinkage of aging.
Symptoms of brain atrophy
Brain atrophy symptoms can indeed differ between generalized and localized types.
Signs of generalized form
Generalized brain atrophy happens all over the brain. It can lead to:
- Forgetting things and memory loss,
- Trouble making decisions or solving problems,
- Hard time with body movements,
- Changes in behavior, like being more impulsive or uninterested,
- Difficulty speaking or understanding words.
Symptoms of the localized form
Localized brain atrophy happens in specific parts of the brain. Its symptoms depend on which area is affected:
- Frontal lobe: Personality changes, speech problems, and movement difficulties.
- Temporal lobe: Memory issues, trouble understanding words, and recognizing things or faces.
- Parietal lobe: Issues understanding space, reading, writing, or math.
- Occipital lobe: Trouble seeing colors, objects, or movement.
Other signs of localized or focal brain atrophy can include:
- Problems with maintaining balance while standing;
- The trouble with coordination;
- Some loss of muscle control or movement.
Sometimes, symptoms of an atrophied brain are mild, but in some cases, they can get severe and need immediate medical help. These can include passing out, seeing or hearing things that aren't there, severe muscle spasms, pain in the eyes, acting violently, or having thoughts of hurting oneself.
Diagnostic tests and staging
Several methods exist for diagnosing brain atrophy, including imaging studies, cognitive and psychiatric evaluations, laboratory tests, and electrophysiological tests.
Imaging studies
- MRI and CT scans provide detailed brain images to help doctors spot any shrinkage or changes with high diagnostic accuracy (87% for MRI and comparable for CT).
- PET scans use a special dye with radioactive tracers that highlight active areas of the brain.
- SPECT scan gives information about blood flow in the brain, which helps diagnose certain types of brain atrophy.
- Functional MRI (fMRI) measures brain activity by identifying changes in blood flow.
- Quantitative MRI gives a more precise measurement of the volume of specific brain structures and shows brain atrophy.
Cognitive and psychiatric tests
- Neuropsychological tests assess memory, problem-solving skills, attention span, and language abilities to gauge the extent of cognitive issues.
- Psychiatric evaluation helps identify cognitive symptoms, mood, and mental health conditions related to brain atrophy.
Laboratory tests
- Blood tests can identify nutritional deficiencies, infections, or other conditions that might contribute to brain atrophy.
- Lumbar puncture collects cerebrospinal fluid for examination to detect infections or diseases.
- Genetic testing can confirm the diagnosis if a hereditary condition is suspected.
- Biopsy: In rare cases, a small sample of brain tissue might be examined under a microscope to detect specific conditions, like a brain tumor.
Electrophysiological test
- Electroencephalogram (EEG) measures the brain's electrical activity to detect disorders.
Brain atrophy can cause various health problems, but numerous diagnostic tools can help detect it early. These methods include examining images of the brain, assessing cognitive abilities, testing bodily fluids, and measuring brain activity. Understanding these tests can make the diagnosis process less daunting and more accessible.
Stages of cerebral atrophy
Brain atrophy, like other neurodegenerative conditions, can progress in different stages depending on the underlying cause. The stages can vary significantly, but a general outline might look something like this:
- Mild stage: Symptoms may not be noticeable, or they may be very mild. Even though there are no apparent outward symptoms, changes in mild atrophy brain might be detectable through imaging scans like MRIs or CT scans.
- Moderate stage: As atrophy progresses, symptoms start becoming more noticeable. This could include difficulty with memory, issues with concentration or decision-making, or physical problems like clumsiness or poor balance. At this stage, brain atrophy could be pretty clear in imaging studies.
- Severe stage: The symptoms become more prominent and disruptive. Cognitive abilities might be impaired, affecting the ability to live independently. Physical symptoms may also become more severe. In severe atrophy, brain volume loss is typically visible in imaging studies.
- Advanced stage: In the final stage, individuals might require full-time care due to profound cognitive and physical impairment. The brain's structure would show substantial volume loss and deformation in advanced cerebral atrophy.
That this is a general overview, the progression of brain atrophy can vary based on factors like the underlying cause, the individual's overall health, and the treatments they're receiving. The rate of progression can also differ significantly from person to person.
Where to treat brain atrophy?
Conventional brain atrophy treatment
There is no specific treatment for cerebral atrophy. However, doctors can reduce the symptoms. The success of these treatments can vary widely based on personal circumstances:
Medications
Alzheimer's meds like Donepezil (success rate varies in 40-58%), Rivastigmine, and Memantine can help improve memory and thinking in Alzheimer's, a condition often linked with brain atrophy. Parkinson's meds like Levodopa and Carbidopa can help control tremors and movement issues in people with brain atrophy due to Parkinson's disease. Anti-epileptic medications like Levetiracetam, Lamotrigine, and Gabapentin can help control seizures in conditions that cause brain atrophy, like epilepsy.
The VITACOG trial, where people took high doses of three B vitamins (B6, B9, and B12) for two years, showed that this could slow down the speed of brain shrinkage by up to 53% each year. These medicines work differently for everyone and should be part of a treatment plan.
Rehabilitation and lifestyle change
Physical therapy
It helps with movement problems and helps people stay active. How successful it is depends on each person, but it can be beneficial for managing specific symptoms and is widely used in brain atrophy rehabilitation.
Speech therapy
This therapy helps with language and swallowing problems. It usually helps people improve, but how much it helps can change much based on why the brain atrophy happened.
Cognitive Therapy
Training the brain with special exercises might slow down problems with thinking or memory. In one study, about 74 out of 100 people saw their memory and thinking abilities improve.
Healthy lifestyle
Exercise, a good diet, enough sleep, and brain activities might slow down brain atrophy. It's hard to say precisely how helpful these things are because it's different for everyone, but they're generally good for the brain.
Social activities
Spending time with others can improve quality of life and slow down memory or thinking problems. It's hard to say how much it helps because it's different for everyone.
Regular doctor visits
Going to check-ups often is essential to manage symptoms and watch for any changes. Regular visits help find problems early, which might slow down brain atrophy.
How well these treatments for brain atrophy work can change a lot based on why the brain atrophy happened and the person's overall health.
Best centers for brain atrophy treatment
New treatment options for cerebral shrink
However, as these are still under research, their availability and effectiveness can change.
New medications
New promising drugs like monoclonal antibodies were found in some cases of brain atrophy, like those because of multiple sclerosis. The drug Ocrelizumab reduced brain volume loss by 17.5% in patients with a type of multiple sclerosis called PPMS. Meanwhile, the research found that Cladribine led to a 20% reduction in brain atrophy in MS patients.
Stem cell therapy
Stem cell treatment for brain atrophy is still under research. They are being conducted to see if introducing stem cells into the brain could help regenerate lost or damaged cells and brain tissues. There is promising brain atrophy therapy, for example, after stroke. However, treatment for brain atrophy with stem cell is in the early stages of studies, and much more studies are needed to understand their effectiveness and safety.
Genetic treatment
Gene therapy attempts to treat diseases at the genetic level by introducing, removing, or changing genetic material within a person’s cells. It's hoped that such treatments could potentially slow or stop the progress of brain atrophy by targeting the disease's genetic causes. For example, it is studied for Alzheimer’s.
Neurotrophic factors
Neurotrophic factors (NTFs)are proteins that help neurons grow and survive. Research is ongoing to see if treatments involving neurotrophic factors could help slow down or stop brain atrophy.
Disease-Modifying Therapies
For diseases like Alzheimer's, which are known to cause brain atrophy, researchers are actively working on disease-modifying therapies. These treatments aim to target the disease's underlying causes, potentially slowing or stopping the progression of brain atrophy.
Also, multiple sclerosis research shows that certain medications can slow down the atrophy process of the brain in patients with a condition called a clinically isolated syndrome. The effect is more substantial after the first year of treatment. However, more research is needed because early changes in brain scans might not reflect actual brain shrinkage.
Surgical options
Surgery is not typically used to treat brain atrophy, but certain conditions that can lead to brain atrophy may be treatable with the operation. For example, a condition such as normal pressure hydrocephalus, which can cause symptoms similar to brain atrophy, can be treated surgically by removing excess fluid from the brain.
Deep brain stimulation
DBS is a treatment that includes implanting a device. It sends electrical signals to specific areas in the brain. While it's primarily used for movement disorders like Parkinson's (success rate is up to 90%), researchers are studying its potential benefits for other brain atrophy conditions.
All these treatments aim to slow or stop brain shrinkage, but their effectiveness still needs more validation.
Who treats brain atrophy?
Statistics and cerebral atrophy prognosis
Brain atrophy, which 1 in every 6 adults can face, still is irreversible. But, it can be managed to mitigate symptoms and improve quality of life.
Impact of the disease on the chart
A National Institutes of Health study revealed the disease's broad impact:
- 75% of patients experienced mobility issues like walking and balance problems;
- 80% reported chronic fatigue; 55% faced cognitive issues;
- 44% endured mood swings;
- 60% had their relationships and daily life affected.
Brain health dramatically influences overall well-being.
Prognosis
Cerebral atrophy prognosis depends on its cause and the person's overall health. Conditions like Alzheimer's have a poor outlook as they worsen over time. Early treatment can improve the outlook if the prognosis of brain atrophy is more favorable due to a treatable condition, such as alcohol-induced brain damage or hydrocephalus.
In common, symptoms can be managed, and progression can sometimes be slowed, but the damage can't be reversed.
The AiroMedical team provides personalized treatment and long-term support for patients with brain atrophy. An easy online consultation can also provide a tailored strategy for managing it.
References:
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- Cacabelos R. Donepezil in Alzheimer’s disease: From conventional trials to pharmacogenetics. Neuropsychiatr Dis Treat. 2007 Jun;3(3):303–333. PMID: 19300564; PMCID: PMC2654795.
- Tsivgoulis G, Katsanos AH, Grigoriadis N, Hadjigeorgiou GM, Heliopoulos I, Papathanasopoulos P, Dardiotis E, Kilidireas C, Voumvourakis K; on behalf of HELANI (Hellenic Academy of Neuroimmunology). The effect of disease-modifying therapies on brain atrophy in patients with clinically isolated syndrome: a systematic review and meta-analysis. Ther Adv Neurol Disord. 2015 Sep;8(5):193-202. doi 10.1177/1756285615600381. PMID: 26557896; PMCID: PMC4622115.
- Smith AD, Smith SM, de Jager CA, Whitbread P, Johnston C, Agacinski G, Oulhaj A, Bradley KM, Jacoby R, Refsum H. Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial. PLoS One. 2010;5(9):e12244. Published 2010 Sep 8. doi: 10.1371/journal.pone.0012244. PMID: 20838622; PMCID: PMC293589
- Smith, P. A., Schmid, C., Zurbruegg, S., Theil, D., Dubost, V., & Beckmann, N. (2018). Fingolimod inhibits brain atrophy and promotes brain-derived neurotrophic factors in an animal model of multiple sclerosis. Journal of Neuroimmunology, 318, 103-113. https://doi.org/10.1016/j.jneuroim.2018.02.016
- Author manuscript. (2021). Gene-based therapies for Neurodegenerative Diseases. Nature Neuroscience, 24(3), 297–311. Published in final edited form as: https://doi.org/10.1038/s41593-020-00778-1
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