Download PDF
Semin Neurol 2000; 20(2): 179-186
DOI: 10.1055/s-2000-9826
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Chronic Traumatic Brain Injury Associated with Boxing

Barry D. Jordan
  • Brain Injury Program, Burke Rehabilitation Hospital, White Plains, New York and Department of Neurology, Cornell University Medical College, New York, New York
Further Information

Publication History

Publication Date:
31 December 2000 (online)

    Permissions and Reprints

ABSTRACT

Chronic traumatic brain injury (CTBI) associated with boxing occurs in approximately 20% of professional boxers. Risk factors associated with CTBI include increased exposure (i.e., duration of career, age of retirement, total number of bouts), poor performance, increased sparring, and apolipoprotein (APOE) genotype. Clinically, boxers exhibiting CTBI will present with varying degrees of motor, cognitive, and/or behavioral impairments. The severe form of CTBI is referred to as dementia pugilistica. The diagnosis of CTBI is dependent upon documenting a progressive neurological condition that is consistent with the clinical symptomatology of CTBI attributable to brain trauma and unexplainable by an alternative pathophysiological process. Pathologically, CTBI shares many characteristics with Alzheimer's disease (i.e., neurofibrillary triangles, diffuse amyloid plaques, acetylcholine deficiency, and/or tau immunoreactivity). The mainstay of treatment of CTBI is prevention, however medications used in the treatment of Alzheimer's disease and/or parkinsonism may be utilized.

KEYWORD

Chronic traumatic brain injury - Alzheimer's disease - apolipoprotein E - boxing - sports neurology - dementia

REFERENCES

  • 1 Martland H AS. Punch drunk.  JAMA . 1928;  91 1103-1107
    CrossrefPubMedSearch in Google Scholar
  • 2 Roberts A H. Brain Damage in Boxers.  London: Pitman Publishing; 1969
    Search in Google Scholar
  • 3 Critchley M. Medical aspects of boxing, particularly from a neurological standpoint.  Br Med J . 1957;  1 357-362
    PubMedSearch in Google Scholar
  • 4 Mendez M F. The neuropsychiatric aspects of boxing.  Int J Psychiatry . 1995;  25 249-262
    PubMedSearch in Google Scholar
  • 5 LaCava G. Boxer's encephalopathy.  J Sports Med Phys Fitness . 1963;  3 87-92
    PubMedSearch in Google Scholar
  • 6 Jordan B D, Matser E, Zimmerman R D. Sparring and cognitive function in professional boxers.  Physician Sports Med . 1996;  24 87-98
    PubMedSearch in Google Scholar
  • 7 Jordan B D, Jahre C, Hauser W A. CT of 338 active professional boxers.  Radiology . 1992;  2 181-185
    PubMedSearch in Google Scholar
  • 8 Jordan B D, Relkin N R, Ravdin L D. Apolipoprotein Ee4 associated with chronic traumatic brain injury in boxing.  JAMA . 1997;  278 136-140
    CrossrefPubMedSearch in Google Scholar
  • 9 Jordan B D. Epidemiology of brain injury in boxing. In: Jordan BD, ed. Medical Aspects of Boxing Boca Raton, FL: CRC Press 1993: 147-168
    Search in Google Scholar
  • 10 Davie C A, Pirtosek Z, Barker G J. Magnetic resonance spectroscopic study of parkinsonism related to boxing.  J Neurol Neurosurg Psychiatry . 1995;  58 688-691
    PubMedSearch in Google Scholar
  • 11 Jordan B D. Boxing. In: Jordan BD, Tsairis P, Warren RF, eds. Philadelphia: Lippincott-Williams; 1998: 351-366
    Search in Google Scholar
  • 12 Jordan B D, Zimmerman R D. Computed tomography, magnetic resonance imaging comparisons in boxers.  JAMA . 1990;  263 1670-1674
    CrossrefPubMedSearch in Google Scholar
  • 13 Casson I R, Siegel O, Sham R. Brain damage in modern boxers.  JAMA . 1984;  251 2663-2667
    CrossrefPubMedSearch in Google Scholar
  • 14 Ross R J, Casson J R, Siegel O. Boxing injuries: neurologic, radiologic and neuropsychologic evaluation.  Clin Sports Med . 1987;  6 41-51
    PubMedSearch in Google Scholar
  • 15 Casson I R, Sham R, Campbell E A. Neurological and CT evaluation of knocked-out boxers.  J Neurol Neurosurg Psychiatry . 1982;  45 170-174
    PubMedSearch in Google Scholar
  • 16 Sironi V A, Scotti G, Ravagnati L. CT scan and EEG findings in professional pugilists: early detection of cerebral atrophy in young boxers.  J Neurosurg Sci . 1982;  26 165-168
    PubMedSearch in Google Scholar
  • 17 Ross R J, Cole M, Thompson J S. Boxers-computed tomography, EEG and neurosurgical evaluation.  JAMA . 1983;  249 211-213
    CrossrefPubMedSearch in Google Scholar
  • 18 Bodensteiner J B, Schaefer G B. Dementia pugilistica and cavum septi pellucidi: born to box.  Sports Med . 1997;  24 361-365
    PubMedSearch in Google Scholar
  • 19 Bogdanoff B, Natter H M. Incidence of cavum septum pellucidum in adults: a sign of boxer's encephalopathy.  Neurology . 1989;  39 991-992
    CrossrefPubMedSearch in Google Scholar
  • 20 Jordan B D, Jahre C, Hauser W A. Serial computed tomography in professional boxers.  J Neuroimaging . 1992;  2 181-185
    PubMedSearch in Google Scholar
  • 21 Jordan B D, Dane S D, Rowen A J. SPECT scanning in professional boxers.  J Neuroimaging . 1999;  9 59-60
    PubMedSearch in Google Scholar
  • 22 Levin H S, Jordan B D. Neuropsychological assessment of brain injury in boxing. In: Jordan BD, ed. Medical Aspects of Boxing Boca Raton, FL: CRC Press 1993: 197-206
    Search in Google Scholar
  • 23 Thomassen A, Juul-Jensen P, Olivarius B. Neurological electroencephalographic and neuropsychological examination of 53 former amateur boxers.  Acta Neurol Scand . 1979;  60 352-362
    PubMedSearch in Google Scholar
  • 24 Matser J T, Kessels A GH, Jordan B D. Chronic traumatic brain injury in professional soccer players.  Neurology . 1998;  51 791-796
    CrossrefPubMedSearch in Google Scholar
  • 25 Matser J T, Kessels A G, Lezak M D. Neuropsychological impairment in amateur soccer players.  JAMA . 1999;  282 971-973
    CrossrefPubMedSearch in Google Scholar
  • 26 Brooks N, Krysshik G, Wilson L. A neuropsychological study of active amateur boxers.  J Neurol Neurosurg Psychiatry . 1987;  50 997-1000
    PubMedSearch in Google Scholar
  • 27 Kaste M, Vikki J, Sainio K. Is chronic brain damage in boxing a hazard of the past?.  Lancet . 1982;  2 1186-1188
    CrossrefPubMedSearch in Google Scholar
  • 28 Heilbronner R L, Henry G K, Carson-Brewer M. Neuropsychologic test performance in amateur boxers.  Am J Sports Med . 1991;  19 376-379
    PubMedSearch in Google Scholar
  • 29 Levin H S, Lippold S C, Goldman A. Neurobehavioral functioning and magnetic resonance imaging findings in young boxers.  J Neurosur . 1987;  67 657-667
    PubMedSearch in Google Scholar
  • 30 Drew R H, Templer D I, Schulyer B A. Neuropsychological deficits in active licensed professional boxers.  J Clin Psychol . 1986;  42 520-525
    PubMedSearch in Google Scholar
  • 31 Butler R J, Forsythe W I, Beverly D W. A prospective controlled investigation of the cognitive effects of amateur boxing.  J Neurol Neurosurg Psychiatry . 1993;  56 1055-1061
    PubMedSearch in Google Scholar
  • 32 Casson I R, Siegel O, Sham R. Brain damage in modern boxers.  JAMA . 1984;  251 2663-2667
    CrossrefPubMedSearch in Google Scholar
  • 33 McLatchie G, Brooks N, Gailbraith S. Clinical neurological examination, neuropsychology, electroencephalography, and computed tomographic head scanning in active amateur boxers.  J Neurol Neurosurg Psychiatry . 1987;  50 96-99
    CrossrefPubMedSearch in Google Scholar
  • 34 Stewart W F, Gordon B, Selnes O. Prospective study of central nervous system function in amateur boxers in the United States.  Am J Epidemiol . 1994;  139 573-599
    PubMedSearch in Google Scholar
  • 35 Johnson J. Organic psychosyndromes due to boxing.  Br J Psychiatry . 1969;  115 45-53
    CrossrefPubMedSearch in Google Scholar
  • 36 Murelius H, Haglund Y. Does Swedish amateur boxing lead to chronic brain damage?.  <~>A retrospective neuropsychological study. Acta Neurol Scand . 1991;  83 9-13
    PubMedSearch in Google Scholar
  • 37 Haglund Y, Eriksson E. Does amateur boxing lead to chronic brain damage?.  <~>A review of some recent investigations. Am J Sports Med . 1993;  21 97-109
    PubMedSearch in Google Scholar
  • 38 Butler R J. Neuropsychological investigation of amateur boxers.  Br J Sports Med . 1994;  28 187-190
    PubMedSearch in Google Scholar
  • 39 Corsellis J AN, Bruton C J, Freeman-Browne C. The aftermath of boxing.  Psychol Med . 1973;  3 270-303
    CrossrefPubMedSearch in Google Scholar
  • 40 Corsellis J AN. Posttraumatic dementia in Alzheimer's disease. In: Jatzman R, Terry RD, Bick K, eds. Senile Dementia and Related Disorders New York: Raven Press 1978: 125-133
    Search in Google Scholar
  • 41 Roberts G W, Allsop D, Bruton C. The occult aftermath of boxing.  J Neurol Neurosurg Psychiatry . 1990;  53 373-378
    CrossrefPubMedSearch in Google Scholar
  • 42 Tokuda T, Ikeda S, Yanugesa N. Re-examination of ex-boxer's brain using immunohistochemistry with antibodies to amyloid beta protein and tau protein.  Acta Neuropathol . 1991;  82 280-285
    CrossrefPubMedSearch in Google Scholar
  • 43 Dale G E, Leigh P N, Luthert P. Neurofibrillary tangles in dementia pugilistica are ubiquitinated.  J Neurol Neurosurg Psychiatry . 1991;  54 116-118
    PubMedSearch in Google Scholar
  • 44 Uhl G R, McKinney M, Hedreen J C. Dementia pugilistica: loss of basal forebrain cholinergic neurons and cortical cholinergic markers.  Ann Neurol . 1982;  12 99
    PubMedSearch in Google Scholar
  • 45 Hof P R, Bouras C, Buee L. Differential distribution of neurofibrillary tangles in the cerebral cortex of dementia pugilistica and Alzheimer's disease cases.  Acta Neuropathol . 1992;  85 23-30
    CrossrefPubMedSearch in Google Scholar
  • 46 Geddes J F, Vowles G H, Robinson S FD. Neurofibrillary tangles, but not Alzheimer-type pathology, in a young boxer.  Neuropathology Appl Neurobiol . 1996;  22 12-16
    PubMedSearch in Google Scholar
  • 47 Mortimer J A, French L R, Hutton J T. Head injury as a risk factor for Alzheimer's disease.  Neurology . 1985;  35 264-267
    PubMedSearch in Google Scholar
  • 48 Merz Brown. Is boxing a risk factor for Alzheimer's?.  JAMA . 1989;  261 2597-2598
    CrossrefPubMedSearch in Google Scholar
  • 49 Saija A, Hayes R L, Lyeth B G. The effects of concussive head injury on central cholinergic neurons.  Brain Res . 1988;  452 303-311
    PubMedSearch in Google Scholar
  • 50 Smith C M, Swash M. Possible biochemical basis of memory disorder in Alzheimer's disease.  Neurology . 1978;  3 471-473
    PubMedSearch in Google Scholar
  • 51 Nicoll J AR, Roberts G W, Graham D I. Apolipoprotein Ee4 allele is associated with deposition of amyloid beta protein following head injury.  Nat Med . 1995;  1 135-137
    PubMedSearch in Google Scholar
  • 52 Mayeaux R, Ottoman R, Maestre G. Synergistic effects of traumatic head injury and apoplipoprotein e4 in patients with Alzheimer's disease.  Neurology . 1995;  45 555-557
    CrossrefPubMedSearch in Google Scholar
  • 53 Katzman R, Galosko D R, Saitoh T. Apolipoprotein e4 and head trauma: synergistic or additive risks?.  Neurology . 1996;  46 889-892
    PubMedSearch in Google Scholar
  • 54 Jordan B D, Kanick A B, Horwich M S. Apolipoprotein e4 and fatal cerebral amyloid angiopathy associated with dementia puglistica.  Ann Neurol . 1995;  38 698-699
    CrossrefPubMedSearch in Google Scholar
  • 55 Case records. Massachusetts General Hospital.  N Engl J Med . 1999;  340 1269-1277
    CrossrefPubMedSearch in Google Scholar
  • 56 Teasdale G M, Nicoll J AR, Murray G. Association of apolipoprotein E polymorphism with outcome after head injury.  Lancet . 1997;  350 1069-1071
    CrossrefPubMedSearch in Google Scholar
  • 57 Seliger G, Lichtman S W, Polsky T. The effect of apolipoprotein E on short-term recovery from head injury.  Neurology . 1997;  48 A213
    PubMedSearch in Google Scholar
  • 58 Friedman G, Froom P, Sazbon L. Apolipoprotein E e4 genotype predicts a poor outcome in survivors of traumatic brain injury.  Neurology . 1999;  52 244-248
    PubMedSearch in Google Scholar
  • 59 Chen Y, Lomnitski L, Michaelson D M. Motor and cognitive deficits in apolipoprotein E deficient mice after closed head injury.  Neuroscience . 1997;  80 1255-1262
    CrossrefPubMedSearch in Google Scholar
  • 60 Colosimo C, Albanese A. Boxer disqualified for taking selegiline.  Lancet . 1995;  346 647
    PubMedSearch in Google Scholar
  • 61 Goldberg E, Gerstman L J, Mattis S. Effects of cholinergic treatment on posttraumatic anterograde amnesia.  Arch Neurol . 1982;  39 581
    PubMedSearch in Google Scholar
  • 62 Taverni J P, Seliger G, Lichtman S W. Donepezil medicated memory improvement in traumatic brain injury during post acute rehabilitation.  Brain Injury . 1998;  12 77-80
    CrossrefPubMedSearch in Google Scholar
  • 63 Professional Boxing Safety Act of 1996 (HR 4167). Public Law 104-272 104th Congress
  • 64 Jordan B D. Genetic susceptibility to brain injury in sports: a role for genetic testing in athletes.  Physician Sports Med . 1998;  26 25-26
    PubMedSearch in Google Scholar