Dementia Pugilistica: Difference between revisions
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== | == Introduction == | ||
Dementia Pugilistica (DP) is a form of Chronic Traumatic Encephalopathy (CTE), it is predominant among athletes and sportspeople who suffers 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 [[Overview of Traumatic Brain Injury|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.<ref>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. <nowiki>PMID 10949160</nowiki>.</ref> 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.<ref>1. Martland HS (1928). "Punch Drunk". Journal of the American Medical Association 91 (15): 1103–1107. doi:10.1001/jama.1928.02700150029009</ref> | |||
== Mechanism of Injury / Pathological Process<br> == | == Mechanism of Injury / Pathological Process<br> == | ||
It is not explicitly understood how DP occurs, however, Loss of neurons, scarring of [[Brain Anatomy|brain]] tissue, collection of proteinaceous, senile plaques, [[hydrocephalus]], attenuation of the corpus callosum, diffuse [[Axons|axonal]] injury, neurofibrillary tangles, and damage to the [[cerebellum]] are implicated in this condition and may be related to Alzheimer’s disease aetiologically.<ref>1. Cifu D & Drake D (2006-08-17). "Repetitive Head Injury syndrome". eMedicine.com. Retrieved 2007-12-19. Others would argue that the mechanism is well understood indeed. It arrives with a crashing blow to the head from boxing glove many times over, contact with astroturf even fewer times. In war or in sport, an injury to the head is treated the same. However, while an athlete loses his career, a soldier with a head injury may lose his career, his limbs, his hearing or sight.</ref><ref>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.</ref> 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.<ref>1. Jordan, B. D. (2009). Brain injury in boxing. Clinics in Sports Medicine, 28(4), 561-78, vi.</ref> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
These include;<ref>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. <nowiki>PMID 8567192</nowiki></ref> | |||
* 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 | == Management / Interventions == | ||
There is no known cure yet, but individuals with this condition may be managed as patients with [[Parkinson's - Anatomy, Pathology, Prognosis and Diagnosis|parkinsonism]] and [[Alzheimer's Disease|Alzheimer’s disease]].<ref>1. Jordan BD (2000). "Chronic traumatic brain injury associated with boxing". Seminars in Neurology 20 (2): 179–85. doi:10.1055/s-2000-9826. <nowiki>PMID 10946737</nowiki>.</ref> | |||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
* [[Concussion|Concussions]] in sport | |||
* [[Traumatic Brain Injury|Traumatic brain injury]] | |||
* Post-concussion syndrome | |||
* Proteopathy | |||
* [[Second Impact Syndrome|Second-impact syndrome]] | |||
* Chronic traumatic encephalopathy | |||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Neurology]] | |||
[[Category:Neurological - Conditions]] | |||
Revision as of 23:04, 25 July 2021
Original Editor - User Name
Top Contributors - Kehinde Fatola, Carina Therese Magtibay, Cindy John-Chu and Nupur Smit Shah
Top Contributors - Kehinde Fatola, Carina Therese Magtibay, Cindy John-Chu and Nupur Smit Shah
Introduction[edit | edit source]
Dementia Pugilistica (DP) is a form of Chronic Traumatic Encephalopathy (CTE), it is predominant among athletes and sportspeople who suffers 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
[edit | edit source]
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
[edit | edit source]
- Concussions in sport
- Traumatic brain injury
- Post-concussion syndrome
- Proteopathy
- Second-impact syndrome
- Chronic traumatic encephalopathy
References[edit | edit source]
- ↑ 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.
- ↑ 1. Martland HS (1928). "Punch Drunk". Journal of the American Medical Association 91 (15): 1103–1107. doi:10.1001/jama.1928.02700150029009
- ↑ 1. Cifu D & Drake D (2006-08-17). "Repetitive Head Injury syndrome". eMedicine.com. Retrieved 2007-12-19. Others would argue that the mechanism is well understood indeed. It arrives with a crashing blow to the head from boxing glove many times over, contact with astroturf even fewer times. In war or in sport, an injury to the head is treated the same. However, while an athlete loses his career, a soldier with a head injury may lose his career, his limbs, his hearing or sight.
- ↑ 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.
- ↑ 1. Jordan, B. D. (2009). Brain injury in boxing. Clinics in Sports Medicine, 28(4), 561-78, vi.
- ↑ 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
- ↑ 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.
