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Possible Causes

Chronic Alcoholism

Standardized MRI evidence suggest chronic alcohol intoxication (like in alcohol use disorder) is associated with widespread cortical atrophy and major brain changes. In contrast to healthy controls, macrostructural findings indicate alcoholic brains are smaller in mass and volume1. Neuroimaging studies also show that cortical shrinkage in “uncomplicated alcoholism” is most severe in the frontal lobe in comparison to the other divisions of the cerebral cortex2. In addition, neurological diseases that co-occur with excessive alcohol consumption - such as Wernicke-Korsakoff syndrome (WKS) - are characterized by substantial volume deficits of the diencephalon structures2. In comparison to unaffected, non-alcoholic participants, tissue degeneration in WKS patients is found in specific white matter structures including the corpus callosum, the hippocampus, the subcortical basal ganglia (hypothalamus, thalamus, putamen), and the mammillary bodies3.

Treatments

Reversibility of Cerebral Atrophy

The pronounced shrinkage in the frontal lobes and cerebellum of alcoholics correlates with serious impairments in executive and psychomotor functions. However, longitudinal studies suggest that some of these brain damages are partially reversible with abstinence3. In response to drinking cessation, bodies of gray and white matter including the cerebral cortex, the limbic system (amygdala, hippocampus, thalamus), the cerebellum, and the brain stem all showed a general increase in brain volume2. Similarly, ventricular enlargement—which reflects atrophy of surrounding brain regions—is also reduced in abstinent alcoholics. Following extended sobriety, the volume of the lateral and third ventricles was decreased, and abstainers showed an improvement in working memory and balance3. Finally, evidence for the recovery of brain volume with continued sobriety is supported by the improvement in neuropsychological performance. Compared to the control participants, abstinent alcoholic patients scored significantly better on tests measuring cognitive, sensory, and motor functions including abstract reasoning, memory, visuospatial ability, and gait and balance3. That being said, while short-term abstinence suffices to produce structural and functional recovery, some alcohol-induced brain changes may persist even after long-term sobriety3.

References:


 * 1. Meyer, J. S., & Quenzer, L. F. (2013). Psychopharmacology: Drugs, the brain, and behavior (2nd ed.). Sinauer Associates.
 * 2. Zahr, Natalie M., & Pfefferbaum, Adolf. (2017). Alcohol's Effects on the train: Neuroimaging Results in Humans and Animal Models. Alcohol Research & Health., 38(2), 183–206. PMID 28988573
 * 3. Rosenbloom, M. J., & Pfefferbaum, A. (2008). Magnetic Resonance Imaging of the Living Brain Evidence for Brain Degeneration Among Alcoholics and Recovery With Abstinence. Alcohol Research & Health, 31(4), 362–376. PMID 23584010

Lead section:

Some degree of cerebral shrinkage occurs naturally with the dynamic process of aging1.

The human brain completes growth and attains its full maturity at 25 years of age2. Structural changes continue during adulthood as brain shrinkage commences after age 35 at a rate of 0.2% per year. The rate of decline is accelerated when individuals reach 70 years old https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596698/. By the age of 90, the peak brain weight has experienced a total loss of 15%3.Other than brain atrophy, aging has also been associated with white matter disease (add wikilink) and cerebral microbleeds1.

References:


 * 1)  Sungura, R., Onyambu, C., Mpolya, E., Sauli, E., & Vianney, J.-M. (2021). The extended scope of neuroimaging and prospects in brain atrophy mitigation: A systematic review. Interdisciplinary Neurosurgery : Advanced Techniques and Case Management, 23, 100875. https://doi.org/10.1016/j.inat.2020.100875
 * 2) Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease and Treatment, 9, 449–461. https://doi.org/10.2147/NDT.S39776

3.     https://www.sciencedirect.com/topics/immunology-and-microbiology/brain-weigh