Dementia pugilistica
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| Dementia pugilistica | |
| Classification and external resources | |
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| 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), also called chronic traumatic encephalopathy (CTE), chronic boxer’s encephalopathy, traumatic boxer’s encephalopathy, boxer's dementia, and punch-drunk syndrome ('punchy'), is a neurological disorder which may affect career boxers, wrestlers, mixed martial artists, and football players[1] who receive multiple dazing blows to the head. Dementia pugilistica, the severe form of chronic traumatic brain injury,[2] commonly manifests as declining mental and physical abilities such as dementia and parkinsonism.
The encephalopathy develops over a period of years, 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% of professional boxers, but it rarely affects other types of athletes.[3] The condition may be caused by repeat concussions, or repeat subconcussive blows (blows that are below the threshold of force necessary to cause concussion), or both.[4] Due to the concern that boxing may cause CTE, there is a movement among medical professionals to ban the sport.[5] Medical professionals have called for such a ban since as early as the 1950s.[6]
The word pugilistica comes from the Latin root pugil, for boxer.[7]
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[edit] Symptoms
The condition, which occurs in people who have suffered multiple concussions, commonly manifests as dementia, or declining mental ability, problems with memory, and parkinsonism, or tremors and lack of coordination.[5] It can also cause speech problems[5] and an unsteady gait. Patients with CTE may be prone to inappropriate or explosive behavior and may display pathological jealousy or paranoia.[5] Individuals displaying these symptoms also can be characterized as "punchy," another term for a person suffering from dementia pugilistica.
The brains of dementia pugilistica patients atrophy and lose neurons, for example in the cerebellum.[4] The pyramidal tract dysfunctions.[4]
Sufferers may be treated with drugs used for Alzheimer's disease and parkinsonism.[2]
[edit] Mechanism
It is not well understood why this syndrome occurs.[8] 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.[9] The condition may be etiologically related to Alzheimer's disease.[9] 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.[10] 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.[11]
It has not been conclusively shown that repeat concussions necessarily lead to cumulative brain damage, and some scientists argue that boxers who get chronic traumatic encephalopathy are genetically predisposed.[12] Boxers with the apolipoprotein Eε-4 gene may be at higher risk for CTE.[12]
[edit] History
Dementia pugilistica was first described in 1928 by Harrison Stanford Martland 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.[13] In 1973, a group led by J.A. Corsellis[citation needed] described the typical neuropathological findings of CTE after post-mortem examinations of the brains of 15 former boxers.[13]
[edit] 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 don't become overt until middle age or even later, and are often indistinguishable from Alzheimer's. However, 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 suffered from dementia that was probably genetic in origin and was controlled with medication[citation needed]. Other ex-boxers have been accused of having dementia pugilistica when in fact they suffer from nothing worse than a working-class accent and a bluff demeanor, e.g. Rocky Graziano, Tony Zale, and Teddy Atlas[citation needed]. 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, Fritzie Zivic, and Meldrick Taylor appear to have been genuinely affected by the disorder[citation needed].
Recently, several former NFL players have been posthumously diagnosed with CTE. Justin Strzelczyk died in 2004 during a high-speed chase with police after apparently suffering a nervous breakdown. Andre Waters and Terry Long were diagnosed with the disorder after committing suicide. Pro Football Hall of Famer Mike Webster suffered from dementia before his death due to heart failure, and was also diagnosed with CTE. Houston Oilers Pro Bowl linebacker John Grimsley was diagnosed with CTE after his untimely death, as was Tampa Bay Buccaneer offensive guard Tom McHale. It is believed that numerous concussions and other brain injuries incurred during their careers are responsible for the development of CTE.[14]
More recently, an analysis of brain tissue of professional wrestler Chris Benoit, who murdered his wife and son before killing himself on the weekend of June 25, 2007, showed that he was suffering from serious brain damage consistent with CTE.[15]
[edit] See also
[edit] References
- ^ Stephanie Smith. "Dead athletes' brains show damage from concussions," CNN
- ^ a b Jordan BD (2000). "Chronic traumatic brain injury associated with boxing". Seminars in Neurology 20 (2): 179–85. doi:. PMID 10946737.
- ^ Bernhardt DT (2007-12-18). "Concussion". eMedicine.com. http://www.emedicine.com/sports/topic27.htm. Retrieved on 2008-01-14.
- ^ a b c 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:. PMID 10949160.
- ^ a b c d Mendez MF (1995). "The neuropsychiatric aspects of boxing". International Journal of Psychiatry in Medicine 25 (3): 249–262. doi:. PMID 8567192.
- ^ Corsellis JA (1989). "Boxing and the Brain". BMJ 298 (6666): 105–109. PMID 2493277. http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1835400.
- ^ NCERx. 2005. Brain Trauma, Subdural Hematoma and Dementia Pugilistica. About-dementia.com. Retrieved on 2007-12-19.
- ^ Cifu D and Drake D (2006-08-17). "Repetitive Head Injury syndrome". eMedicine.com. http://www.emedicine.com/sports/topic113.htm. Retrieved on 2007-12-19.
- ^ 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.
- ^ 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:. PMID 1285493.
- ^ Geddes JF, Vowles GH, Nicoll JA, Révész T (1999). Neuronal Cytoskeletal Changes are an Early Consequence of Repetitive Head Injury. Acta Neuropathologica. Volume 98, Issue 2, Pages 171-178. PMID 10442557.
- ^ a b McCrory P (2001). "When to retire after concussion? (requires free registration)". British Journal of Sports Medicine 35 (6): 380–382. PMID 11726470. http://bjsm.bmj.com/cgi/content/full/35/6/380.
- ^ a b Cantu RC (2007). "Chronic Traumatic Encephalopathy in the National Football League". Neurosurgery 61 (2): 223–225. doi:. PMID 17762733.
- ^ "Report: Signs of damage linked to dementia in Strzelczyk's brain" ESPN.com. Accessed 15 June 2007
- ^ Associated Press (2007-09-05). "Study suggests brain damage may have affected Benoit". ESPN.com. http://sports.espn.go.com/espn/news/story?id=3005520. Retrieved on 2007-09-05.
