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Repeated head trauma

Traumatic diseases

by Alexander Kurz

General outline

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.

Diagnostic procedures

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

The mainstay of treatment of dementia pugilistica is prevention, however medications used in the treatment of Alzheimer’s disease and / or Parkinson’s disease may be utilised.

Available services

Alzheimer Europe

145 Route de Thionville

L- 2611 Luxembourg

Tel: +352 / 29.79.70

Fax: +352 / 29.79.72

Alzheimer's Disease International

45-46 Lower Marsh

London SE1 7RG

United Kingdom

Tel: +44 -(0)20- 7620 3011

Fax: +44 -(0)20- 7401 7351


  • Guo Z, Cupples LA, Kurz A, Auerbach SH, Volicer L, Chui H, et al. Head injury and the risk of AD in the MIRAGE study. Neurology 2000;54:1316-1323.
  • Jordan BD. Chronic traumatic brain injury associated with boxing. Semin Neurol 2000;20:179-185.
  • Roberts GW, Allsop D, Bruton C. The occult aftermath of boxing. J Neurol Neurosurg Psychiatry 1990;53:373-378.
  • Graham DI, Gentleman SM, Nicoll JA, Royston MC, McKenzie JE, WRoberts G, et al. Altered beta-APP metabolism after head injury and its relationship to the aetiology of Alzheimer's disease. Acta Neurochir 1996;66(Supplement):96-102.
  • Nicoll JAR, Roberts GW, Graham DI. Apolipoprotein E e4 allele is associated with deposition of amyloid beta-protein following head injury. Nature med 1995;1(2):135-137.



Last Updated: Friday 09 October 2009


  • Acknowledgements

    This information was gathered in the framework of the European Commission financed project "Rare forms of dementia". Neither the European Commission nor any person acting on its behalf is responsible for any use that might be made of the following information.
  • European Union