Dementia pugilistica

Dementia pugilistica
Classification and external resources
Boxers receive many blows involving rotational force, which is implicated in concussion. Repeat concussions can lead to dementia pugilistica.
DiseasesDB	11042
eMedicine	sports/113

Dementia pugilistica (DP) is a type of neurodegenerative disease or dementia, which may affect amateur or professional boxers as well as athletes in other sports who suffer concussions. It is also called chronic boxer’s encephalopathy, traumatic boxer’s encephalopathy, boxer's dementia, chronic traumatic brain injury associated with boxing (CTBI-B) and punch-drunk syndrome ('punchy'), and chronic traumatic encephalopathy (CTE). Symptoms and signs of DP develop progressively over a long latent period sometimes reaching decades, with the average time of onset being about 12–16 years after the start of a career in boxing. The condition is thought to affect around 15-20% of professional boxers.

The condition is caused by repeated concussive and sub-concussive blows (blows that are below the threshold of force necessary to cause concussion), or both.^[1] Because of the concern that boxing may cause DP, there is a movement among medical professionals to ban the sport.^[2] Medical professionals have called for such a ban since as early as the 1950s.^[3]

The word pugilistica comes from the Latin root pugil, for boxer.^[4]

Symptoms

The condition, which occurs in boxers who have suffered repeated blows to the head, manifests as dementia, or declining mental ability, problems with memory, and parkinsonism, or tremors and lack of coordination.^[2] It can also cause speech problems^[2] and an unsteady gait. Patients with DP may be prone to inappropriate or explosive behavior and may display pathological jealousy or paranoia.^[2] Individuals displaying these symptoms also can be characterized as "punchy", another term for a person suffering from DP.

Sufferers may be treated with drugs used for Alzheimer's disease and Parkinsonism.^[5]

Mechanism

It is not well understood why this syndrome occurs.^[6] Loss of neurons, scarring of brain tissue, collection of proteinaceous, senile plaques, hydrocephalus, attenuation of corpus callosum, diffuse axonal injury, neurofibrillary tangles and damage to the cerebellum are implicated in the syndrome.^[7] The condition may be etiologically related to Alzheimer's disease.^[7] Neurofibrillary tangles have been found in the brains of dementia pugilistica patients, but not in the same distribution as is usually found in Alzheimer's sufferers.^[8] One group examined slices of brain from patients who had had multiple mild traumatic brain injuries and found changes in the cells' cytoskeletons, which they suggested might be due to damage to cerebral blood vessels.^[9]

History

DP was first described in 1928 by a forensic pathologist, Dr. Harrison Stanford Martland, who was the chief medical examiner of Essex County in Newark, New Jersey in a Journal of the American Medical Association article, in which he noted the tremors, slowed movement, confusion, and speech problems typical of the condition.^[10] In 1973, a group led by J.A. Corsellis^[11] described the typical neuropathological findings of DP after post-mortem examinations of the brains of 15 former boxers.^[11]

Famous cases

Dementia pugilistica is relatively common among boxers who had long careers and received a great many blows to the head. It is perhaps under-reported because the symptoms often do not become overt until middle age or even later, and are often indistinguishable from Alzheimer's. On the other hand, dementia pugilistica has often been falsely reported. It has been rumored that Jack Dempsey suffered from it, when in fact he retained his mental vigor until his death at 87^{[citation needed]}. Joe Louis developed signs of paranoid schizophrenia that have been attributed to cocaine abuse but may also have a genetic element (his father was institutionalised for mental illness)^{[citation needed]}. Other ex-boxers have been said to have had dementia pugilistica when in fact they suffer from nothing worse than a working-class accent and a gruff demeanor, e.g. Rocky Graziano, Tony Zale.

However, Jimmy Ellis, Floyd Patterson (who resigned from the New York State Athletic Commission because of his deteriorating memory), Bobby Chacon, Jerry Quarry, Mike Quarry, Wilfred Benitez, Emile Griffith, Willie Pep, Freddie Roach, Sugar Ray Robinson, Billy Conn, Joe Frazier, Fritzie Zivic, and Meldrick Taylor appear to have been genuinely affected by the disorder^{[citation needed]}. Ingemar Johansson may be another victim. In addition, Muhammad Ali's Parkinson's disease was said to be caused by his boxing career, but Ali's own physician Fredie Pacheco MD states in his Book 'Fight Doctor' that Ali's condition is often misquoted and that Ali in fact has Parkinson's Syndrome which he advises is caused by physical trauma. However, some maintain this sort of dementia is precisely diagnosed only in autopsy, and claims of retired athletes not having DP are rarely accompanied by autopsy results^{[citation needed]}. On the other hand, diagnosis of Parkinson's disease on the basis of clinical observations is 75-80% accurate..^[12]

Notably, autopsies of eleven professional American football players by Dr. Ann McKee, of Boston University School of Medicine, found CTE in all cases.^[13] CTE has been diagnosed (also by the Boston University group^[14]) in one amateur football player, University of Pennsylvania lineman Owen Thomas, following his suicide.^[15]

Professional wrestler Chris Benoit was discovered to have suffered from CTE following his 2007 murders and subsequent suicide, as was his former colleague, Andrew Martin, following his 2009 overdose death.

See also

• Traumatic brain injury
• Concussion
• Post-concussion syndrome
• Proteopathy
• Second-impact syndrome

References

1. ^ Erlanger DM, Kutner KC, Barth JT, Barnes R (1999). "Neuropsychology of sports-related head injury: Dementia pugilistica to post concussion syndrome". The Clinical Neuropsychologist 13 (2): 193–209. doi:10.1076/clin.13.2.193.1963. PMID 10949160. 
2. ^ ^{a b c d} Mendez MF (1995). "The neuropsychiatric aspects of boxing". International Journal of Psychiatry in Medicine 25 (3): 249–262. doi:10.2190/CUMK-THT1-X98M-WB4C. PMID 8567192. 
3. ^ Corsellis JA (1989). "Boxing and the Brain". BMJ 298 (6666): 105–109. doi:10.1136/bmj.298.6666.105. PMC 1835400. PMID 2493277. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1835400. 
4. ^ NCERx. 2005. Brain Trauma, Subdural Hematoma and Dementia Pugilistica. About-dementia.com. Retrieved on 2007-12-19.
5. ^ Jordan BD (2000). "Chronic traumatic brain injury associated with boxing". Seminars in Neurology 20 (2): 179–85. doi:10.1055/s-2000-9826. PMID 10946737. 
6. ^ Cifu D and Drake D (2006-08-17). "Repetitive Head Injury syndrome". eMedicine.com. http://www.emedicine.com/sports/topic113.htm. Retrieved 2007-12-19. 
7. ^ ^{a b} Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" In, Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.
8. ^ Hof PR, Bouras C, Buée L, Delacourte A, Perl DP, Morrison JH (1992). "Differential Distribution of Neurofibrillary Tangles in the Cerebral Cortex of Dementia Pugilistica and Alzheimer's Disease Cases". Acta Neuropathologica 85 (1): 23–30. doi:10.1007/BF00304630. PMID 1285493. 
9. ^ Geddes JF, Vowles GH, Nicoll JA, Révész T (1999). "Neuronal Cytoskeletal Changes are an Early Consequence of Repetitive Head Injury". Acta Neuropathologica 98 (2): 171–178. doi:10.1007/s004010051066. PMID 10442557. 
10. ^ Martland HS (1928). "Punch Drunk". Journal of the American Medical Association 91 (15): 1103–1107. doi:10.1001/jama.1928.02700150029009. http://jama.ama-assn.org/content/91/15/1103.extract. 
11. ^ ^{a b} Corsellis JA, Bruton CJ, Freeman-Browne D (August 1973). "The aftermath of boxing". Psychological Medicine 3 (3): 270–303. doi:10.1017/S0033291700049588. PMID 4729191. 
12. ^ Jankovic J (April 2008). "Parkinson's disease: clinical features and diagnosis". J. Neurol. Neurosurg. Psychiatr. 79 (4): 368–76. doi:10.1136/jnnp.2007.131045. PMID 18344392. http://jnnp.bmj.com/content/79/4/368.full. 
13. ^ http://www.abc.net.au/worldtoday/content/2009/s2727506.htm
14. ^ http://www.bu.edu/cste/2010/09/13/penn-football-player-had-brain-trauma-autopsy-shows/
15. ^ "Suicide Reveals Signs of a Disease Seen in N.F.L.". New York Times. September 13, 2010. http://www.nytimes.com/2010/09/14/sports/14football.html. Retrieved 2010-11-01. "A brain autopsy of a University of Pennsylvania football player who killed himself in April has revealed the same trauma-induced disease found in more than 20 deceased National Football League players, raising questions of how young football players may be at risk for the disease." 

External links

• Chronic Traumatic Encephalopathy In The National Football League: Pages 223-225 (Courtesy of http://www.sportslegacy.org)
• Pugilistic Dementia; Something old, something new - from Boxingwriter.co.uk
• Offensive Play: How different are dogfighting and football?, Malcolm Gladwell, The New Yorker, October 19, 2009 – article on the serious dangers of suffering long-term chronic traumatic encephalopathy brain damage in American football
• Boston University Center for the Study of Traumatic Encephalopathy