brain atrophy

Question

Hello Dr.-in 1996 I had a brain scan performed and I was 37 at the time. I was told that I had mild diffused atrophy of the frontal lobe. How common is this in people with aids? Does this mean that my brain is inpaired and that I will never be able to function normally? I take dexadrine-which helps me focus and peps me up. I assume my lackluster brain function is due to the brain atrophy-Can you explain to me the significance of having this problem?Thankyou

Answer

First, you should know that there is a wide range of normal when it comes to interpreting brain scans. "Mild diffuse atrophy of the frontal lobes" does not necessarily indicate any brain disease or impairment of the ability to perform intellectual tasks. We know that some people may have evidence of mild atrophy but no evidence of significant impairment on tests of cognitive function. So, the answer to your question is: No, this does not mean that your brain is impaired or that you will never be able to function normally. The fact that you had this finding on a brain scan 8 years ago and that today you are writing an intelligent and thoughtful question on the internet indicates to me that your intellectual functioning is certainly not seriously impaired.

As for the brain findings in people with AIDS, evidence of cerebral atrophy (widened sulci and dilated ventricles) and cognitive impairment are more common among people with advanced AIDS, ie. with high viral loads and low CD4 counts. However, antiretroviral treatment has greatly improved the prognosis for people with AIDS-associated cognitive impairment. Even people with HIV-associated dementia can improve in their cognitive abilities and functional level if they have a good response to HAART.

Symptoms like decreased attention, slowed thinking and fatigue associated with AIDS often do respond to stimulants such as dextro-amphetamine (Dexedrine) or methylphenidate (Ritalin). That seems to be the case for you, and the fact that these symptoms responded to medication indicates that they are not fixed or static, but still responsive to treatment.