Dementia pugilistica
Encyclopedia
Dementia pugilistica 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. Because of the concern that boxing may cause DP, there is a movement among medical professionals to ban the sport. Medical professionals have called for such a ban since as early as the 1950s.
The word pugilistica comes from the Latin
root pugil, for boxer.
, or declining mental ability, problems with memory, and parkinsonism
, or tremors and lack of coordination. It can also cause speech problems
and an unsteady gait. Patients with DP may be prone to inappropriate or explosive behavior and may display pathological jealousy
or paranoia
. 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.
s, scarring of brain
tissue, collection of protein
aceous, senile plaques, hydrocephalus
, attenuation of corpus callosum
, diffuse axonal injury
, neurofibrillary tangle
s and damage to the cerebellum
are implicated in the syndrome. The condition may be etiologically
related to Alzheimer's disease
. 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. One group examined slices of brain from patients who had had multiple mild traumatic brain injuries and found changes in the cells' cytoskeleton
s, which they suggested might be due to damage to cerebral blood vessels.
, 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. In 1973, a group led by J.A. Corsellis described the typical neuropathological findings of DP after post-mortem examinations of the brains of 15 former boxers.
suffered from it, when in fact he retained his mental vigor until his death at 87 . 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). 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 . 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. On the other hand, diagnosis of Parkinson's disease on the basis of clinical observations is 75-80% accurate..
Notably, autopsies of eleven professional American football players by Dr. Ann McKee, of Boston University School of Medicine, found CTE in all cases. CTE has been diagnosed (also by the Boston University group) in one amateur football player, University of Pennsylvania lineman Owen Thomas, following his suicide.
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.
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
, which may affect amateur or professional boxers
Boxing
Boxing, also called pugilism, is a combat sport in which two people fight each other using their fists. Boxing is supervised by a referee over a series of between one to three minute intervals called rounds...
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
Chronic traumatic encephalopathy
Chronic traumatic encephalopathy is a progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury. A variant of the condition, dementia pugilistica, is primarily associated with boxing...
(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. Because of the concern that boxing may cause DP, there is a movement among medical professionals to ban the sport. Medical professionals have called for such a ban since as early as the 1950s.
The word pugilistica comes from the Latin
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
root pugil, for boxer.
Symptoms
The condition, which occurs in boxers who have suffered repeated blows to the head, manifests as dementiaDementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
, or declining mental ability, problems with memory, and parkinsonism
Parkinsonism
Parkinsonism is a neurological syndrome characterized by tremor, hypokinesia, rigidity, and postural instability. The underlying causes of parkinsonism are numerous, and diagnosis can be complex...
, or tremors and lack of coordination. It can also cause speech problems
Dysarthria
Dysarthria is a motor speech disorder resulting from neurological injury of the motor component of the motor-speech system and is characterized by poor articulation of phonemes...
and an unsteady gait. Patients with DP may be prone to inappropriate or explosive behavior and may display pathological jealousy
Jealousy
Jealousy is a second emotion and typically refers to the negative thoughts and feelings of insecurity, fear, and anxiety over an anticipated loss of something that the person values, particularly in reference to a human connection. Jealousy often consists of a combination of presenting emotions...
or paranoia
Paranoia
Paranoia [] is a thought process believed to be heavily influenced by anxiety or fear, often to the point of irrationality and delusion. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy concerning a perceived threat towards oneself...
. 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.
Mechanism
It is not well understood why this syndrome occurs. Loss of neuronNeuron
A neuron is an electrically excitable cell that processes and transmits information by electrical and chemical signaling. Chemical signaling occurs via synapses, specialized connections with other cells. Neurons connect to each other to form networks. Neurons are the core components of the nervous...
s, scarring of brain
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...
tissue, collection of protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
aceous, senile plaques, hydrocephalus
Hydrocephalus
Hydrocephalus , also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head,...
, attenuation of corpus callosum
Corpus callosum
The corpus callosum , also known as the colossal commissure, is a wide, flat bundle of neural fibers beneath the cortex in the eutherian brain at the longitudinal fissure. It connects the left and right cerebral hemispheres and facilitates interhemispheric communication...
, diffuse axonal injury
Diffuse axonal injury
Diffuse axonal injury is one of the most common and devastating types of traumatic brain injury, meaning that damage occurs over a more widespread area than in focal brain injury. DAI, which refers to extensive lesions in white matter tracts, is one of the major causes of unconsciousness and...
, neurofibrillary tangle
Neurofibrillary tangle
Neurofibrillary Tangles are aggregates of hyperphosphorylated tau protein that are most commonly known as a primary marker of Alzheimer's Disease. Their presence is also found in numerous other diseases known as Tauopathies...
s and damage to the cerebellum
Cerebellum
The cerebellum is a region of the brain that plays an important role in motor control. It may also be involved in some cognitive functions such as attention and language, and in regulating fear and pleasure responses, but its movement-related functions are the most solidly established...
are implicated in the syndrome. The condition may be etiologically
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
related to Alzheimer's disease
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...
. 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. One group examined slices of brain from patients who had had multiple mild traumatic brain injuries and found changes in the cells' cytoskeleton
Cytoskeleton
The cytoskeleton is a cellular "scaffolding" or "skeleton" contained within a cell's cytoplasm and is made out of protein. The cytoskeleton is present in all cells; it was once thought to be unique to eukaryotes, but recent research has identified the prokaryotic cytoskeleton...
s, which they suggested might be due to damage to cerebral blood vessels.
History
DP was first described in 1928 by a forensic pathologist, Dr. Harrison Stanford MartlandHarrison Stanford Martland
Harrison Stanford Martland was an American pathologist who coined the term punch drunk.Martland was born in Newark, New Jersey. In 1901 he received a BS degree from Western Maryland College and in 1905 he received his MD degree from Columbia University College of Physicians and Surgeons.Dr...
, who was the chief medical examiner of Essex County
Essex County, New Jersey
Essex County is a county located in the northeastern part of the U.S. state of New Jersey. As of the United States 2010 Census, the population was 783,969, ranking it third in the state after Bergen County and Middlesex County; Essex County's population has declined from 786,147 as of the bureau's...
in Newark, New Jersey
Newark, New Jersey
Newark is the largest city in the American state of New Jersey, and the seat of Essex County. As of the 2010 United States Census, Newark had a population of 277,140, maintaining its status as the largest municipality in New Jersey. It is the 68th largest city in the U.S...
in a Journal of the American Medical Association
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...
article, in which he noted the tremors, slowed movement, confusion, and speech problems typical of the condition. In 1973, a group led by J.A. Corsellis described the typical neuropathological findings of DP after post-mortem examinations of the brains of 15 former boxers.
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 DempseyJack Dempsey
William Harrison "Jack" Dempsey was an American boxer who held the world heavyweight title from 1919 to 1926. Dempsey's aggressive style and exceptional punching power made him one of the most popular boxers in history. Many of his fights set financial and attendance records, including the first...
suffered from it, when in fact he retained his mental vigor until his death at 87 . Joe Louis
Joe Louis
Joseph Louis Barrow , better known as Joe Louis, was the world heavyweight boxing champion from 1937 to 1949. He is considered to be one of the greatest heavyweights of all time...
developed signs of paranoid schizophrenia that have been attributed to cocaine
Cocaine
Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
abuse but may also have a genetic element (his father was institutionalised for mental illness). 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
Rocky Graziano
Rocky Graziano, born Thomas Rocco Barbella in New York City , was an Italian American boxer. Graziano was considered one of the greatest knockout artists in boxing history, often displaying the capacity to take his opponent out with a single punch...
, Tony Zale
Tony Zale
Anthony Florian Zaleski was an American boxer. Zale was born and raised in Gary, Indiana, a steel town, which gave him his nickname, "Man of Steel." In addition, he had the reputation of being able to take fearsome punishment and still rally to win, reinforcing that nickname...
.
However, Jimmy Ellis
Jimmy Ellis
James Albert "Jimmy" Ellis is a retired boxer from Louisville, Kentucky. He fought in what some consider to be the greatest heavyweight era of all-time, which included Muhammad Ali, Joe Frazier, George Foreman, Jerry Quarry, Floyd Patterson, Oscar Bonavena, Earnie Shavers and George Chuvalo among...
, Floyd Patterson
Floyd Patterson
Floyd Patterson was an American heavyweight boxer and former undisputed heavyweight champion. At 21, Patterson became the youngest man to win the world heavyweight title. He was also the first heavyweight boxer to regain the title. He had a record of 55 wins 8 losses and 1 draw, with 40 wins by...
(who resigned from the New York State Athletic Commission because of his deteriorating memory), Bobby Chacon
Bobby Chacon
Bobby Chacon is an American former, two-time, world boxing champion.-Career:Chacon turned professional in 1972 and won his first 19 fights, including a win against former champion Jesus Castillo...
, Jerry Quarry
Jerry Quarry
Jerry Quarry , nicknamed "Irish" or “The Bellflower Bomber,” was an Irish-American heavyweight boxer. Quarry was rated by Ring Magazine as the most popular fighter in the sport, 1968–1971, and was one of the biggest stars of arguably the greatest era in the history of the heavyweight division.-...
, Mike Quarry
Mike Quarry
Mike Quarry born in Bakersfield, California, was a light heavyweight boxer. He had a record of 63-13-6 including 17 knockouts during his career, which began in 1969 and ended in 1982....
, Wilfred Benitez
Wilfred Benitez
Wilfred Benítez , is a Puerto Rican boxer. He is remembered best as a skilled and aggressive fighter with exceptional defensive abilities who won world championships in three separate weight divisions, and was the youngest world champion in boxing history at the age of 17...
, Emile Griffith
Emile Griffith
Emile Alphonse Griffith is a former boxer who was the first fighter from the U.S. Virgin Islands ever to become a world champion. He is perhaps best known for his controversial third fight with Benny Paret in 1962 for the welterweight world championship...
, Willie Pep
Willie Pep
Guglielmo Papaleo was an American boxer who was better known as Willie Pep. Pep boxed a total of 1956 rounds in the 241 bouts during his 26 year career, a considerable number of rounds and fights even for a fighter of his era. His final record was 229-11-1 with 65 knockouts...
, Freddie Roach, Sugar Ray Robinson
Sugar Ray Robinson
Sugar Ray Robinson was an African-American professional boxer. Frequently cited as the greatest boxer of all time, Robinson's performances in the welterweight and middleweight divisions prompted sportswriters to create "pound for pound" rankings, where they compared fighters regardless of weight...
, Billy Conn
Billy Conn
William David Conn , better known as Billy Conn, was an American Light-Heavyweight boxing champion famed for his fights with Joe Louis. He had a professional boxing record of 63 wins, 11 losses and 1 draw, with 14 wins by knockout...
, Joe Frazier
Joe Frazier
Joseph William "Joe" Frazier , also known as Smokin' Joe, was an Olympic and Undisputed World Heavyweight boxing champion, whose professional career lasted from 1965 to 1976, with a one-fight comeback in 1981....
, Fritzie Zivic
Fritzie Zivic
Fritzie Zivic , born as Ferdinand Henry John Zivcich , was an American boxer.-Biography:...
, and Meldrick Taylor
Meldrick Taylor
Meldrick Taylor is a former Olympic gold medalist and world boxing champion in two weight classes.-Amateur career:...
appear to have been genuinely affected by the disorder . Ingemar Johansson
Ingemar Johansson
Jens Ingemar Johansson was a Swedish boxer and former heavyweight champion of the world. Johansson was the fifth heavyweight champion born outside the United States. In 1959 he defeated Floyd Patterson by TKO in the third round, after flooring Patterson seven times in that round, to win the World...
may be another victim. In addition, Muhammad Ali
Muhammad Ali
Muhammad Ali is an American former professional boxer, philanthropist and social activist...
's Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
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. On the other hand, diagnosis of Parkinson's disease on the basis of clinical observations is 75-80% accurate..
Notably, autopsies of eleven professional American football players by Dr. Ann McKee, of Boston University School of Medicine, found CTE in all cases. CTE has been diagnosed (also by the Boston University group) in one amateur football player, University of Pennsylvania lineman Owen Thomas, following his suicide.
Professional wrestler Chris Benoit
Chris Benoit
Christopher Michael "Chris" Benoit was a Canadian professional wrestler whose career and life ended in a murder–suicide...
was discovered to have suffered from CTE following his 2007 murders and subsequent suicide
Chris Benoit double murder and suicide
The Chris Benoit double murder suicide occurred over a three-day period ending on June 24, 2007. World Wrestling Entertainment professional wrestler Chris Benoit killed his wife, Nancy Benoit, strangled his seven-year-old son, Daniel, and subsequently committed suicide by hanging. Autopsy results...
, as was his former colleague, Andrew Martin, following his 2009 overdose death.
See also
- Traumatic brain injuryTraumatic brain injuryTraumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...
- Concussion
- Post-concussion syndromePost-concussion syndromePost-concussion syndrome, also known as postconcussive syndrome or PCS, and historically called shell shock, is a set of symptoms that a person may experience for weeks, months, or occasionally up to a year or more after a concussion – a mild form of traumatic brain injury . PCS may also...
- ProteopathyProteopathyIn medicine, proteopathy refers to a class of diseases in which certain proteins become structurally abnormal, and thereby disrupt the function of cells, tissues and organs of the body...
- Second-impact syndromeSecond-impact syndromeSecond-impact syndrome is a condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided. This deadly second blow may occur days, weeks or minutes after an initial concussion, and even the mildest...
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 GladwellMalcolm GladwellMalcolm Gladwell, CM is a Canadian journalist, bestselling author, and speaker. He is currently based in New York City and has been a staff writer for The New Yorker since 1996...
, The New YorkerThe New YorkerThe New Yorker is an American magazine of reportage, commentary, criticism, essays, fiction, satire, cartoons and poetry published by Condé Nast...
, 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