My mri report says diffuse generalized neuroparenchymal atrophy and ex vacuo prominence of the sulci and ventricles. when i reviewed the scans with my neurologist, he said it's not clinically significant enough to be concerned. any thoughts?

The MRI is consistent with brain atrophy, but in the absence of seeing the films themselves, not feasible to judge if more than would be expected for age. The key significance would involve clinical correlation with cognitive compromise, if present (Is there Mild Cognitive Impairment?). Maybe if memory issues, a neuropsychological test should be considered.