Dementia Pugilistica

Original Editor - Kehinde Fatola
Top Contributors - Kehinde Fatola and Cindy John-Chu

Introduction[edit | edit source]

Dementia Pugilistica (DP) is a form of Chronic Traumatic Encephalopathy (CTE). It is predominant among athletes and sportspeople who suffer concussion, e.g, wrestlers, boxers, etc, and present essentially with characteristics of dementia. It is also referred to as chronic boxer's encephalopathy, traumatic boxer’s encephalopathy, boxer's dementia, chronic traumatic brain injury associated with boxing (CTBI-B), and punch-drunk syndrome. Dementia Pugilistica was once considered as CTE but is now reckoned as a subtype of CTE.

It is caused by concussive, sub-concussive blows or both.[1] Symptoms progressively develop over a latent period sometimes up to a decade. It was first described by a forensic pathologist, Dr. Martland in 1928 when he noted tremors, slowed movement, confusion, and speech problems as characteristics of the condition.[2]

Mechanism of Injury / Pathological Process
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It is not explicitly understood how DP occurs, however, loss of neurons, scarring of brain tissue, collection of proteinaceous, senile plaques, hydrocephalus, attenuation of the corpus callosum, diffuse axonal injury, neurofibrillary tangles, and damage to the cerebellum are implicated in this condition and may be related to Alzheimer’s disease aetiologically.[3][4] Persistent and prolonged exposure to concussions and sub-concussive blows is noted as the most important risk factor, which can depend on the total number of fight bouts, number of knockout losses, career duration, fight frequency, age of retirement, and style of fighting.[5]

Clinical Presentation[edit | edit source]

These include;[6]

  • Declining mental ability (dementia)
  • Problems with memory
  • Dizzy spells
  • Lack of balance and/or Parkinsonism
  • Tremors and lack of coordination
  • Speech impairment
  • Unsteady gait
  • Paranoia

Management / Interventions[edit | edit source]

There is no known cure yet, but individuals with this condition may be managed as patients with parkinsonism and Alzheimer’s disease.[7]

Differential Diagnosis
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References[edit | edit source]

  1. 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. 1.      Martland HS (1928). "Punch Drunk". Journal of the American Medical Association 91 (15): 1103–1107. doi:10.1001/jama.1928.02700150029009
  3. 1.      Cifu D & Drake D (2006-08-17). "Repetitive Head Injury syndrome". eMedicine.com. Retrieved 2007-12-19.
  4. 1.      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.
  5. 1.      Jordan, B. D. (2009). Brain injury in boxing. Clinics in Sports Medicine, 28(4), 561-78, vi.
  6. 1.      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
  7. 1.      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.