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2017 ; 60
(4
): 1209-1221
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Dementia Pugilistica Revisited
#MMPMID29036831
Castellani RJ
; Perry G
J Alzheimers Dis
2017[]; 60
(4
): 1209-1221
PMID29036831
show ga
Extensive exposure of boxers to neurotrauma in the early 20th century led to the
so-called punch drunk syndrome, which was formally recognized in the medical
literature in 1928. "Punch drunk" terminology was replaced by the less derisive
'dementia pugilistica' in 1937. In the early case material, the diagnosis of
dementia pugilistica required neurological deficits, including slurring
dysarthria, ataxia, pyramidal signs, extrapyramidal signs, memory impairment, and
personality changes, although the specific clinical substrate has assumed lesser
importance in recent years with a shift in focus on molecular pathogenesis. The
postmortem neuropathology of dementia pugilistica has also evolved substantially
over the past 90 years, from suspected concussion-related hemorrhages to diverse
structural and neurofibrillary changes to geographic tauopathy. Progressive
neurodegenerative tauopathy is among the prevailing theories for disease
pathogenesis currently, although this may be overly simplistic. Careful
examination of historical cases reveals both misdiagnoses and a likelihood that
dementia pugilistica at that time was caused by cumulative structural brain
injury. More recent neuropathological studies indicate subclinical and possibly
static tauopathy in some athletes and non-athletes. Indeed, it is unclear from
the literature whether retired boxers reach the inflection point that tends
toward progressive neurodegeneration in the manner of Alzheimer's disease due to
boxing. Even among historical cases with extreme levels of exposure, progressive
disease was exceptional.
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