Dementia pugilistica

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Dementia pugilistica, also called chronic traumatic encephalopathy, pugilistic Parkinson's syndrome, boxer's dementia, and punch-drunk syndrome, is a neurological disorder which affects some career boxers and others who receive multiple dazing blows to the head. The condition develops over a period of years, with the average time of onset being about 16 years after the start of a career in boxing.

The condition, which occurs in people who have suffered multiple concussions, commonly manifests as dementia, or declining mental ability, and parkinsonism, or tremors and lack of coordination. It can also cause unsteady gait, inappropriate behavior, and speech problems.

It is not well understood why this syndrome occurs (Drake and Cifu, 2004). 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, which may be etiologically related to Alzheimer's disease (Graham and Gennareli, 2000).

Famous sufferers include Joe Louis, Beau Jack and, more recently, Muhammad Ali, Jerry Quarry, Mike Quarry, Wilfredo Benitez, Emile Griffith, Willie Pep and Freddie Roach.

H. S. Martland documented a neurological syndrome that was prevalent among boxers of his time (Martland 1928). With no previously assigned name for the syndrome, he borrowed the term "punch drunk" used by boxing managers and fans to describe the imbalance and "slight flopping of one foot or leg in walking" of boxers. Some boxers display other neuropsychological symptoms such as short-memory, short attention span, slow muscular movement, and difficulty in processing information. The symptoms are so similar to that of alcohol intoxication that a referee during Martland's time dismissed a fight due to his suspicion that one of the boxers was drunk. A minority of boxers further developed speech difficulty, muscular movements like involuntary nodding of the head, hand tremors, and leg dragging. In severe cases, symptoms of memory loss, shuffling gait, dizziness and mental deterioration were observed, similar to that of Parkinson's Disease. It was not until later that these symptoms were collectively called chronic traumatic encephalopathy, or CTE, and the progressive state, dementia pugilistica (DP). The progressive effects of CTE are divided into three stages. The first stage reveal the psychotic symptoms and affective disturbances within the individual (Richards 1995). Boxers observed for these studies are often found this in early state, about %7 of them in fact (Mendez 1995). In this stage, the development of motor problems become evident in the tremors and the boxer's mild incoordination, especially his non-dominant hand (Mendez 1995). Psychiatric studies also revealed that boxers at this level become more irritable, withdrawn, and depressed. Euphoric and hypomanic attacks are also reported, and more interestingly, boxers at this stage exhibit childish behavior and talkativeness (Mendez 1995). A smaller number of boxers, those with a longer history of professional boxing, oftentimes experience a more progressive stage of CTE. There is a worsening of the previously detailed conditions, highlighted by additional symptoms similar, but not quite identical, to Parkinson's Disease (Richards 1995). The development of "parkinsonism," which includes the rigidity of facial features and an alteration of speech patterns (Mendez 1995) distinguishes this stage from that of the earlier kind. Boxers also display greater memory loss, a decreased control of impulses, and paranoia at this stage. Dementia pugilistica, is the last stage of CTE. The name is derived from the Latin pugil, which means "a fighter with a cestus [a hand covering]", in honor of the most common cause of the syndrome. Some boxers undergo the third stage of CTE, which features the severe deterioration of cognitive functions, leading to the dementia (Mendez 1995). The earlier symptoms of violent behavior and paranoia are still present, accompanied by worsened parkinsonism and incoordination.

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[edit] References

Drake D and Cifu D. 2004. "Repetitive Head Injury Syndrome." Emedicine.com.
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.
NCERx. 2005. Brain Trauma, Subdural Hematoma and Dementia Pugilistica. About-dementia.com.