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Dementia pugilistica
Classification and external resources

Boxers receive many blows involving rotational force, which is implicated in concussion. Repeat concussions can lead to dementia pugilistica.
DiseasesDB 11042
eMedicine sports/113

Dementia pugilistica (DP) is a a type of neurodegenerative disease or dementia, which may affect amateur or professional boxers. 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'), as well as a variant form, Chronic traumatic encephalopathy. 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.[1] Due to the concern that boxing may cause DP, there is a movement among medical professionals to ban the sport.[2] Medical professionals have called for such a ban since as early as the 1950s.[3]

The word pugilistica comes from the Latin root pugil, for boxer.[4]



The condition, which occurs in boxers who have suffered repeated blows to the head manifests as dementia, or declining mental ability, problems with memory, and parkinsonism, or tremors and lack of coordination.[2] It can also cause speech problems[2] and an unsteady gait. Patients with DP may be prone to inappropriate or explosive behavior and may display pathological jealousy or paranoia.[2] Individuals displaying these symptoms also can be characterized as "punchy," another term for a person suffering from DP.

The brains of DP patients atrophy and lose neurons, for example in the cerebellum.[1] The corticospinal or pyramidal tract generally dysfunctions.[1]

Sufferers may be treated with drugs used for Alzheimer's disease and parkinsonism.[5]


It is not well understood why this syndrome occurs.[6] 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.[7] The condition may be etiologically related to Alzheimer's disease.[7] 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.[8] 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.[9]


DP was first described in 1928 by a forensic pathologist, Dr. Harrison Stanford Martland, 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.[10] In 1973, a group led by J.A. Corsellis[citation needed] described the typical neuropathological findings of DP after post-mortem examinations of the brains of 15 former boxers.[10]

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 don't 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 Dempsey suffered from it, when in fact he retained his mental vigor until his death at 87[citation needed]. Joe Louis suffered from dementia that was probably genetic in origin and was controlled with medication[citation needed]. Other ex-boxers have been accused of having dementia pugilistica when in fact they suffer from nothing worse than a working-class accent and a bluff demeanor, e.g. Rocky Graziano, Tony Zale, and Teddy Atlas[citation needed]. 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, Fritzie Zivic, and Meldrick Taylor appear to have been genuinely affected by the disorder[citation needed]. In addition, Muhammad Ali's Parkinson's disease was said to be caused by his boxing career.

In 2002, Dr. Bennet Omalu, another forensic pathologist and neuropathologist in Allegheny County, Pittsburgh, Pennsylvania described a new variant of DP in football players, which he named Chronic Traumatic Encephalopathy (CTE). Dr. Omalu examined the brains of Mike Webster, Terry Long, Andre Waters, Justin Strzelczyk and Tom McHale. Repeated concussions and sub-concussions incurred during the play of football over a long period can result in CTE. The brain changes in CTE and DP are similar and are delayed sequelae of repeated concussions and sub-concussions of the brain.

In 2007, the same forensic pathologist, Dr. Bennet Omalu, examined the brain of Chris Benoit, a professional wrestler with the WWE, and identified pathognomonic brain tissue changes of CTE. Chris Benoit had killed his wife and son before committing suicide by hanging at age 40. In 2009, Dr. Omalu discovered the same condition in recently retired wrestler Andrew "Test" Martin, who died aged 33 from a drug overdose.[11]

Neuropathologists at Boston University disclosed that Reg Fleming was the first hockey player known to have been tested for the disease. This discovery was announced in December 2009, six months after Fleming's death.[12]

See also


  1. ^ a b c 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. PMID 10949160. 
  2. ^ a b c d 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. 
  3. ^ Corsellis JA (1989). "Boxing and the Brain". BMJ 298 (6666): 105–109. PMID 2493277. 
  4. ^ NCERx. 2005. Brain Trauma, Subdural Hematoma and Dementia Pugilistica. Retrieved on 2007-12-19.
  5. ^ 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. 
  6. ^ Cifu D and Drake D (2006-08-17). "Repetitive Head Injury syndrome". Retrieved 2007-12-19. 
  7. ^ a b 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.
  8. ^ Hof PR, Bouras C, Buée L, Delacourte A, Perl DP, Morrison JH (1992). "Differential Distribution of Neurofibrillary Tangles in the Cerebral Cortex of Dementia Pugilistica and Alzheimer's Disease Cases". Acta Neuropathologica 85 (1): 23–30. doi:10.1007/BF00304630. PMID 1285493. 
  9. ^ 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.
  10. ^ a b Cantu RC (2007). "Chronic Traumatic Encephalopathy in the National Football League". Neurosurgery 61 (2): 223–225. doi:10.1227/01.NEU.0000255514.73967.90. PMID 17762733. 
  11. ^ Greg Garber (2009-12-08). "Andrew "Test" Martin suffered from postconcussion brain damage, researchers say - ESPN". Retrieved 2009-12-09. 
  12. ^ Schwarz, Alan & Klein, Jeff Z. "Brain Damage Found in Hockey Player," The New York Times, Friday, December 18, 2009.

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