Pugilistic Dementia, Boxer’s Syndrome

Pugilistic dementia is a neurodegenerative disorder that has taken on special relevance due to its associated characteristics. Its other name ” boxer syndrome” gives us a clue as to its etiology. The Latin root word pugil refers to boxing which, on many occasions, is the cause of the disease due to the repeated blows received.

Imagining receiving the number of blows to the head that a boxer or a person who practices contact sports receives throughout their career is not easy at all. Even so, it is not so difficult to think about the repercussions that the blows can have on the brain of the affected people.

Thus, pugilistic dementia is a disease caused by various multiple trauma and concussions that lead to cortical atrophy of the brain. Let’s go deeper.

General characteristics of the disease

This type of dementia was first described clinically in 1928 by pathologist and forensic physician Harrison Martland.

At present, it is considered a variant of chronic traumatic encephalopathy, although at first it did not differentiate between one or the other. The distinction between the two became evident when the researchers realized that the symptoms of pugilistic dementia occurred in other populations.

A disease that used to be silent

The popularity of boxing at the beginning of the 20th century caused many professionals and amateurs to turn to the sport. At first, the results were not obvious, but as the years passed, the cases of people affected increased in some way.

The main symptoms were apathy, psychotic features, loss of coordination and marked global intellectual deterioration. The scientists were clear about it, these changes were associated with repeated micro-injuries to the brain, the result of concussions.

Development of pugilistic dementia

The atrophy of the cerebral cortex results in a general reduction in the weight of the brain and its metabolism. In general, all brain structures end up being affected, damaging the general functionality of the brain.

However, this disease occurs in phases progressively, varying the symptoms:

• Early phase.  First symptoms of cognitive deterioration as a result of the blows. Although a clear onset has not been established, the disease is usually latent in the early years.

• Advanced phase. It is speculated that between 12 to 16 years from when the sport began to be practiced. The symptoms already appear clearly, although it cannot yet be classified as dementia.
• Dementia. The symptoms are already installed and affect the functionality of the subject in every way. The loss of mental faculties, such as memory and reason, are evident and there is a great impact on behavior.

Main symptoms

The symptoms of pugilistic dementia are very varied and often overlap with those of other neurodegenerative diseases. Even so, we find a group of features that are very present in the affected people that are accentuated as the disease progresses.

• Generalized apathy : lack of expressiveness and emotional interest, accentuated by impaired communication skills.

• Aggression : physical and verbal, highlighting impulsiveness and great irritability.
• Depression : the progressiveness in which the symptoms are manifested usually leads to loss of spirit, isolation and hopelessness.
• Memory : it is mainly affected in day-to-day tasks. The alteration of this function is correlated with difficulties in maintaining attention.
• Motor problems : at the beginning they are small failures or clumsiness, which little by little evolve into slowness, stiffness and coordination problems.

Main risk factors

The main risk factor for boxing dementia is the practice of a contact sport. Thus, the deterioration resulting from the various injuries does not only occur in boxing, there are other sports with a high incidence of the disease:

• Football.

• Kick boxing.
• High contact sports.
• Motorized racing sports.

On the other hand, other risk factors can be :

• Begin with the practice of a contact sport from a very young age.
• Do not use the recommended protection.
• A long-term sports career.
• Do not use prevention strategies.

Diagnosis

Pugilistic dementia is not associated with a particular lesion or a specific area of ​​the brain. For this reason, its diagnosis is very complicated and not very specific.

Behavioral and motor symptoms are usually explored and evaluated by a neurologist and a neuropsychologist. Likewise, neuroimaging tools, such as tomography, are used to detect the depth of brain damage.

Treatment

The main treatment is to avoid risk factors. In the event that a sport with the aforementioned characteristics is carried out, it must be carried out with the greatest care and protection.

In the event that the symptoms are already presenting, there are two general approaches:

• Medicalization : treatment with drugs that act on specific symptoms.
• Rehabilitation : it must be early and take advantage of brain plasticity. It focuses on giving the patient tools to compensate for motor losses and thus not lose their functionality.

Some considerations

Pugilistic dementia is a very illustrative example of the effects of not taking care of our brain. The alterations occur in the medium and long term, but the causes are very early.

Although there is usually no real awareness of the damage due to the little immediate impact, any corrosive activity for our nervous system generates great damage in the future. Taking care of the diet as well as the consumption habits is a very important prevention factor for any type of dementia.

Finally, it is convenient to bear in mind that some popular practices are not entirely healthy, especially if the necessary precautionary measures are not carried out. A large percentage of former football players suffer traumatic brain injuries that condition them for life.

Thanks to the progress of studies and the general awareness of these risks, measures such as the compensation paid by the American federation to former players and investment in research are possible.