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Dementia pugilistica

Dementia pugilistica (DP), also called chronic traumatic encephalopathy (CTE), chronic boxer’s encephalopathy, traumatic boxer’s encephalopathy, boxer's dementia, and punch-drunk syndrome, is a neurological disorder which may affect career boxers and wrestlers who receive multiple dazing blows to the head. Dementia pugilistica, the severe form of chronic traumatic brain injury, 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. 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. Due to the concern that boxing causes CTE, 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.

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. It can also cause speech problems and an unsteady gait. Patients with CTE 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 dementia pugilistica.

The brains of dementia pugilistica patients atrophy and lose neurons, for example in the cerebellum. The pyramidal tract dysfunctions.

Sufferers may be treated with drugs used for Alzheimer's and parkinsonism.

Mechanism

It is not well understood why this syndrome occurs. 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. 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' cytoskeletons, which they suggested might be due to damage to cerebral blood vessels.

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. Boxers with the apolipoprotein Eε-4 gene may be at higher risk for CTE.

History

Dementia pugilistica was first described in 1928 by Harrison S. 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. In 1973, a group led by J.A. Corsellis described the typical neuropathological findings of CTE after post-mortem examinations of the brains of 15 former boxers.

Famous cases

Famous sufferers are thought to include Jack Dempsey, Joe Louis, Beau Jack and, more recently, Jimmy Ellis, Floyd Patterson (who resigned from the New York State Athletic Commission because of his deteriorating memory), Bobby Chacon, Jerry Quarry, Mike Quarry, Wilfredo Benitez, Emile Griffith, Willie Pep, Freddie Roach, Sugar Ray Robinson, and Meldrick Taylor.

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. It is believed that numerous concussions and other brain injuries incurred during their careers are responsible for the development of CTE.

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.

Muhammad Ali is often mistaken as a sufferer of dementia pugilistica, when in fact the main cause of his condition is diagnosed as Parkinson's disease.