Repeated head trauma
by Alexander Kurz
There are two lines of evidence linking traumatic brain injury with dementia. Firstly, chronic traumatic brain injury is associated with boxing. Although many boxers will develop mild neurocognitive deficits, it is not yet known how many of these mild presentations progress to diagnosable dementia pugilistica.
Secondly, remote head trauma has been identified in some studies as a risk factor for of Alzheimer’s disease, particularly if associated with the loss of consciousness.
Dementia pugilistica, punch-drunk syndrome.
Symptoms and course
The clinical symptoms of dementia pugilistica are different from those seen in Alzheimer’s disease. They include movement disorder, ataxia, cognitive changes, and personality change. Patients perform poorly on neuropsychological tests, are frequently aggressive, and undergo a progressive social decline.
Causes and risk factors
Risk factors associated with dementia pugilistica include increased exposure (duration of career, age of retirement, total number of bouts) and in individuals carrying the apolipoprotein E e4 allele. Initially it was believed that the brains of patients with dementia pugilistica show numerous neurofibrillary tangles in the absence of plaques, more recent studies have demonstrated that all cases with substantial tangle formation showed evidence of extensive diffuse beta amyloid protein immunoreactive deposits. It is therefore assumed that repeated head injury can trigger similar neurodegenerative mechanisms as in Alzheimer’s disease. The increased risk of boxers carrying the apolipoprotein E e4 allele is explained by the finding that deposition of amyloid beta protein occurs after head injury particularly in individuals who carry the apolipoprotein E e4.
Chronic traumatic brain injury associated with boxing occurs in approximately 20 % of professional boxers.
The diagnosis of dementia pugilistica is dependent upon documenting a progressive neuropsychiatric condition which is consistent with the clinical symptomatology of chronic traumatic brain injury attributable to brain trauma and unexplainable by an alternative process.
Care and treatment
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Last Updated: Friday 09 October 2009