Dementia pugilistica
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2008-06-23T22:04:18Z
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{{Infobox_Disease
| Name = Dementia pugilistica
| Image = Boxing.png
| Width = 250px
| Caption = Boxers receive many blows involving rotational force, which is implicated in [[concussion]]. Repeat concussions can lead to dementia pugilistica.
| DiseasesDB = 11042
| ICD10 =
| ICD9 =
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj = sports
| eMedicineTopic = 113
| MeshID =
}}
'''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 [[boxing|boxer]]s and [[wrestling|wrestler]]s who receive multiple dazing blows to the head. Dementia pugilistica, the severe form of [[chronic traumatic brain injury]],<ref name="pmid10946737">
{{
cite journal |author=Jordan BD |title=Chronic Traumatic Brain Injury Associated with Boxing |journal=Seminars in Neurology |volume=20 |issue=2 |pages=179–85 |year=2000 |pmid=10946737 |doi=10.1055/s-2000-9826
}}
</ref> 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.<ref name="bernhardt">
{{
cite web | url=http://www.emedicine.com/sports/topic27.htm | title=Concussion | author=Bernhardt DT | date=2007-12-18 | publisher=eMedicine.com | accessdate=2008-01-14
}}
</ref> The condition may be caused by repeat [[concussion]]s or repeat subconcussive blows, blows that are below the threshold of force necessary to cause concussion, or both.<ref name="Erlanger99"/> Due to the concern that boxing causes CTE, there is a movement among medical professionals to ban the sport.<ref name="Mendez"/> Medical professionals have called for such a ban since as early as the 1950s.<ref name="Corsellis89">
{{
cite journal |author=Corsellis JA |title=Boxing and the Brain |journal=BMJ |volume=298 |issue=6666 |pages=105–109 |year=1989 |pmid=2493277 |doi= |url=http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1835400
}}
</ref>
The word ''pugilistica'' comes from the [[Latin]] root ''pugil'', for boxer.<ref>NCERx. 2005. [http://www.about-dementia.com/dementia/brain-trauma.php Brain Trauma, Subdural Hematoma and Dementia Pugilistica]. About-dementia.com. Retrieved on [[2007-12-19]].</ref>
==Symptoms==
The condition, which occurs in people who have suffered multiple [[concussion]]s, commonly manifests as [[dementia]], or declining mental ability, problems with memory, and [[parkinsonism]], or tremors and lack of coordination.<ref name="Mendez"/> It can also cause [[dysarthria|speech problems]]<ref name="Mendez"/> and an unsteady gait. Patients with CTE may be prone to inappropriate or explosive behavior and may display pathological [[jealousy]] or [[paranoia]].<ref name="Mendez">
{{
cite journal |author=Mendez MF |title=The neuropsychiatric aspects of boxing |journal=International Journal of Psychiatry in Medicine |volume=25 |issue=3 |pages=249–262 |year=1995 |pmid=8567192 |doi=10.2190/CUMK-THT1-X98M-WB4C
}}
</ref> Individuals displaying these symptoms also can be characterized as "punchy," another term for a person suffering from dementia pugilistica.
The [[human brain|brain]]s of dementia pugilistica patients [[atrophy]] and lose [[neuron]]s, for example in the [[cerebellum]].<ref name="Erlanger99">
{{
cite journal |author=Erlanger DM, Kutner KC, Barth JT, Barnes R |title=Neuropsychology of sports-related head injury: Dementia pugilistica to post concussion syndrome |journal=The Clinical Neuropsychologist |volume=13 |issue=2 |pages=193–209 |year=1999 |pmid=10949160 |doi=10.1076/clin.13.2.193.1963
}}
</ref> The [[pyramidal tract]] dysfunctions.<ref name="Erlanger99"/>
Sufferers may be treated with drugs used for Alzheimer's and parkinsonism.<ref name="pmid10946737"/>
==Mechanism==
It is not well understood why this syndrome occurs.<ref name="drake">
{{
cite web | url=http://www.emedicine.com/sports/topic113.htm | title=Repetitive Head Injury syndrome | author=Cifu D and Drake D | date=2006-08-17 | publisher=eMedicine.com|accessdate=2007-12-19
}}
</ref> Loss of [[neuron]]s, scarring of [[human brain|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.<ref name="Graham">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> The condition may be [[etiology|etiologically]] related to [[Alzheimer's disease]].<ref name="Graham"/> 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.<ref name="Hof">
{{
cite journal |author=Hof PR, Bouras C, Buée L, Delacourte A, Perl DP, Morrison JH |title=Differential Distribution of Neurofibrillary Tangles in the Cerebral Cortex of Dementia Pugilistica and Alzheimer's Disease Cases |journal=Acta Neuropathologica |volume=85 |issue=1 |pages=23–30 |year=1992 |pmid=1285493 |doi=10.1007/BF00304630
}}
</ref> 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]].<ref>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.</ref>
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.<ref name="McCroryRetire">
{{
cite journal |author=McCrory P |title=When to retire after concussion? (requires free registration) |url=http://bjsm.bmj.com/cgi/content/full/35/6/380 |journal=British Journal of Sports Medicine |volume=35 |issue=6 |pages=380–382 |year=2001 |pmid=11726470 |doi=
}}
</ref> Boxers with the [[apolipoprotein E|apolipoprotein Eε-4 gene]] may be at higher risk for CTE.<ref name="McCroryRetire"/>
==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.<ref name="cantuCTE">
{{
cite journal |author=Cantu RC |title=Chronic Traumatic Encephalopathy in the National Football League |journal=Neurosurgery |volume=61 |issue=2 |pages=223–225 |year=2007 |pmid=17762733 |doi=10.1227/01.NEU.0000255514.73967.90
}}
</ref> 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.<ref name="cantuCTE"/>
==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 [[National Football League|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 (football player)|Terry Long]] were diagnosed with the disorder after committing suicide. [[Pro Football Hall of Fame]]r [[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.<ref>[http://sports.espn.go.com/nfl/news/story?id=2905142&campaign=rss&source=ESPNHeadlines "Report: Signs of damage linked to dementia in Strzelczyk's brain"] ESPN.com. Accessed 15 June 2007</ref>
More recently, an analysis of brain tissue of [[professional wrestling|professional wrestler]] [[Chris Benoit]], who [[Chris Benoit double murder and suicide|murdered]] [[Nancy Benoit|his wife]] and son before [[suicide|killing himself]] on the weekend of [[June 25]] [[2007]], showed that he was suffering from serious brain damage consistent with CTE.<ref>{{cite web|url=http://sports.espn.go.com/espn/news/story?id=3005520 |title=Study suggests brain damage may have affected Benoit |author=Associated Press |publisher=ESPN.com |date=[[2007-09-05]] |accessdate=2007-09-05}}</ref>
[[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]].<ref name=vitapro>{{cite web| url=http://www.vitapro.com/Indonesia/ali1.htm | title =The World's Champion | author=William Plumber |date=1997-01-07| |publisher=www.people.com| accessmonthday =June 24 | accessyear =2006}}</ref><ref>Schwartz, L. [http://espn.go.com/sportscentury/features/00014063.html "He is simply ... The Greatest"] ESPN.com </ref><ref>Muhammad Ali Parkinson Centre. [http://www.maprc.com/home/info/alicare.aspx "Ali Care."]</ref><ref>Babb, A. [http://www.aan.com/press/index.cfm?fuseaction=release.view&release=390 "Rasheda Ali-Walsh Partners with American Academy of Neurology on Parkinson Disease Guidelines Public Service Campaign".] American Academy of Neurology.</ref>
== See also ==
* [[Traumatic brain injury]]
* [[Concussion]]
* [[Post-concussion syndrome]]
* [[Second-impact syndrome]]
== References ==
<references/>
{{Neurotrauma}}
[[Category:Neurotrauma]]
[[Category:Boxing]]
[[Category:Parkinson's disease]]
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