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What Is Cortical Atrophy?

By Samantha Bangayan
Updated Mar 03, 2024
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Cortical atrophy is a medical diagnosis indicating a degeneration of brain cells, which is why it’s sometimes called “brain atrophy.” The word “cortical” refers to the cortex, the outermost part of the brain, which consists of six folded layers of connected neurons. The word “atrophy” refers to the action of wasting away or decreasing in volume. Diseases like posterior cortical atrophy can cause this problem. The patient will show very different symptoms, depending on where atrophy is happening in the cortex.

Posterior cortical atrophy is a progressive degenerative disease, which means that the brain cells increasingly waste away over time. In this disease, atrophy occurs in the posterior cortex at the back of the brain, which is the part that houses the neurons that handle visual processing. As a result, patients have problems with their vision, including difficulty recognizing faces, reading, and seeing in the dark. Vision decline is inevitable with this disease as more cells die in that area of the brain.

People with this condition eventually will begin to have difficulty with coordinated movements and literacy skills. These symptoms are expressed through a difficulty using tools, putting on clothes, sitting on a chair, writing letters of the alphabet, and spelling words. At a certain point during the course of the disease, atrophy can extend to other areas of the brain and turn into full-blown dementia. These patients display further degeneration of memory, language, and cognitive capacity.

Posterior cortical atrophy treatment involves prescription medication to slow down degeneration or help surviving brain cells function more effectively. Medical professionals often recommend that patients also supplement their medication with occupational therapy. Occupational therapists assist the patient in adapting to daily life and living as independently as possible, even with faltering visual, motor, and cognitive ability. Some patients can become depressed or irritable while dealing with the rapid loss of independence and can also benefit from antidepressant medication. These approaches treat the symptoms of the disease, but there is no cure.

Possible risk factors for the development of brain atrophy include tobacco use, alcohol use, head injury, and a genetic predisposition. When brain cells begin wasting away, patients have lower life expectancy. Other diseases that involve atrophy include Alzheimer’s disease and other types of dementia. Brain atrophy occurs in all humans as they grow older, but typically not to a clinical extent.

Posterior Cortical Atrophy Stages

The symptoms and stages of cortical atrophy depend on the cause of the damage to brain cells. For example, when atrophy is the result of a traumatic brain injury from a car accident, tissues may heal over time and the patient may improve motor skills and speech abilities.

On the other hand, posterior cortical atrophy caused by a condition such as Alzheimer’s disease generally gets progressively worse over time. There are six main posterior cortical atrophy stages.

Stage 1: No Apparent Decline in Brain Function

At this stage, the individual who has PCA doesn’t notice any real change in concentration, memory or eyesight. Friends and family often don’t notice any symptoms either. How can brain atrophy be detected this early?

Sometimes, health professionals pick up on it after checking patients who have a family history of brain atrophy, Alzheimer’s disease or Huntington’s disease. Other times, people go to the hospital because of head trauma caused by an accident and MRI or CT scans reveal the cortical atrophy.

Stage 2: Very Mild Decline in Brain Function

The changes in brain function at this stage are primarily visual. Someone who has PCA may start to have trouble judging distances properly. They may bump into objects accidentally or get into minor fender benders. Family members may start to notice that the person feels more uncomfortable driving or drives more slowly than before.

Stage 3: Mild Decline in Brain Function

When PCA enters this stage, other areas of cognitive function can start to be subtly affected. Cortical atrophy can begin to make it hard for a person to locate objects as well as cause some memory problems.

The individual may get lost in the store or have trouble finding the way back home. Problems with spatial awareness are common as well, such as tripping over furniture or having to pause before going up the stairs to judge distances correctly. Sometimes, communicating becomes more difficult as the person struggles to remember certain words or numbers.

Stage three is commonly when friends and family members begin to notice mild changes, though they generally chalk it up to ordinary forgetfulness. When ability changes or personality changes are starkly different from the way a person normally behaves, such as someone normally great with directions getting lost frequently, it’s a warning sign that PCA may be the issue.

Stage 4: Moderate Decline in Brain Function

With moderate cognitive decline, a person who has cortical atrophy will find it hard to perform common tasks during the day. For example, the individual may have a hard time remembering where the bathroom is or may experience difficulty walking there safely. Both familiar and unfamiliar places become frightening as the person’s vision gets worse and recognizing surroundings is a challenge.

At this point, most people who have PCA require some level of help with everyday activities. For example, they may need a family member to help them put on shoes or take a bath without losing their balance. Preparing food often becomes difficult because of trouble holding or using cooking utensils safely.

Stage 5: Moderate-to-Severe Decline in Brain Function

Vision changes get much worse at this stage. Many people who have PCA are declared legally blind at this stage due to vision degradation. The person may require help with most or all everyday tasks, including walking, eating, bathing and dressing. Hearing problems, balance issues, some involuntary movements (such as trembling hands), and headaches are also common.

The problem isn’t always related to the person not remembering how to perform these abilities. Instead, the brain’s movement centers and visual areas can make executing the required movements next to impossible for the individual. This sense of helplessness and frustration is one reason that depression or other emotional health issues can appear.

Stage 6: Severe Decline in Brain Function

When cortical atrophy reaches a severe stage, the cognitive decline becomes very pronounced. The patient may be diagnosed with dementia. Trouble remembering previously familiar people, places and objects are common. Other signs of advanced brain atrophy include bladder control issues, trouble forming complete sentences or carrying on coherent conversations, and major changes in sleep patterns.

Strategies for Improving Quality of Life With PCA

Aside from medications and physical therapies prescribed by your doctor, patients may be able to feel more comfortable by adapting to PCA symptoms. Here are some ideas:

  • Use voice-activated aids such as home assistants and talking clocks
  • Have groceries or prepared meals delivered to the home
  • Take advantage of sensors and other modern devices designed for people who have vision problems
  • Get rid of rugs and other slipping dangers
  • Leave the lights on at night
  • Paint light switches and doorframes a bright color that stands out from the walls
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Discussion Comments
By anon955319 — On Jun 06, 2014

Is there any cure for minimal cortical atrophy and chronic micro vascular ischemic changes?

By anon228940 — On Nov 11, 2011

From what I have read about PCA, it is a rare disease, so I am wondering if it is genetic? My mother was diagnosed at 71 after years of doctor visits and tests. We do not have a family history of dementia.

By SkyWhisperer — On Aug 24, 2011

@Charred - I agree. In my opinion there is no greater inspiration in this regard than Stephen Hawking.

He suffers from a paralyzing muscle atrophy that forces him to use a machine to talk. I don’t know how much of his disease has impaired his brain function, but you certainly couldn’t tell if it had.

Hawking is one of the most brilliant scientists of the modern era, and is an example of what you can do when you keep exercising your brain, regardless of your physical condition.

By Charred — On Aug 23, 2011

The article points out that all brain cells atrophy to some extent as we grow older. I’ve heard that too, with atrophy symptoms such as increased forgetfulness happening as people age; the brain simply gets smaller and smaller.

However, there is good news. There is a way to reduce atrophy, at least from what scientists tell us. The way to do that is to exercise the brain; in other words, keep it active, learn a new language, skill or activity. Do crossword puzzles (although this is probably on the low end of mental exercises).

In short, keep doing things that keep your brain alert and sharp and you can minimize the atrophy. That’s what I plan to do, well into my nineties! Perhaps I’ll be speaking multiple languages or reciting Shakespeare or something, but I don’t intend to wither and die.

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