Dementia Pugilistica: Causes and Symptoms of Punch-Drunk Syndrome

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Dementia PugilisticaA far too common head injury among athletes of contact sports can lead to dementia pugilistica. This form of dementia is known as punch-drunk syndrome, as it occurs after a prolonged period of concussions.

It can go unnoticed for many years before signs of mental deterioration arise. This condition does not happen with a few direct blows to the head. The effects of dementia pugilistica can extend into physical aspects as well.

Let’s now learn more about this degenerative brain disease. To understand the dementia pugilistica definition, we will look at the causes, symptoms, and possible treatment to slow down the progression of this disease.

What Is Dementia Pugilistica?

As a chronic brain injury, dementia pugilistica causes damage to the nerve cells over time. It is frequently seen with boxers due to the constant blows to the head they receive time and time again. In some circuits, it is referred to as boxer’s syndrome, as it is more prevalent with these athletes.

Football players are also at a high risk despite having a helmet for protection. Some cases may also be seen with military personnel who have been exposed to detonations of explosive material.

Causes of Dementia Pugilistica

There are two main categories of punch-drunk syndrome causes—the injury itself and the aftereffects of the trauma.

1. Initial Injury

Direct, repetitive blows to the head can lead to punch-drunk syndrome. It can happen with consecutive hits or repeated concussions over time.

Athletes in contact sports are closely monitored for signs and symptoms. When it comes to military personnel, they can be affected by the development of dementia pugilistica without having repeated concussions.

2. Injury Effects

With the damage to the afflicted sections of the brain, there can be significant changes in the nerve cells and fibers. Dementia pugilistica can cause the brain to waste away in the condition of atrophy.

Trauma affects the nerve cell axons which transmit electrical impulses and communication, and the presence of proteins changes the interface of the brain matter.  The lasting effects are similar to those found in other neurogenerative diseases such as Alzheimer’s disease, Parkinson’s disease, and any motor neuron diseases.

Dementia Pugilistica Symptoms

Punch-drunk syndrome symptoms mimic other brain disorders such as amyotrophic lateral sclerosis (ALS), Parkinson’s disease, frontotemporal dementia, and Alzheimer’s disease. With dementia pugilistica, the behavioral and cognitive issues usually present eight to 10 years after the initial injury.

These are the first signs that appear with any physical aspects showing later in the disease:

  • Cognitive troubles
  • Depression
  • Lack of interest
  • Impulsiveness
  • Short-term memory loss
  • Feeling overemotional
  • Executive function difficulty
  • Suicidal thoughts
  • Substance abuse

As time passes, memory loss and executive functioning may become worse. Other symptoms that can also develop over time include:

  • Aggressiveness
  • Irritability
  • Speech difficulty
  • Difficulty swallowing
  • Vision issues
  • Reduced smelling ability
  • Dementia
  • Loss of motor skills function

The symptoms of dementia pugilistica gradually become worse and have a bigger effect on the person’s life over time. It begins with behavioral and mood changes while showing a significant change in cognitive thinking with older adults.

There are four stages of progression of this disease.

Stage One: Headaches, loss of concentration, and lack of attention.

Stage Two: Depression, memory loss, and irritability.

Stage Three: Executive function problems and cognitive difficulties.

Stage Four: Dementia, aggressiveness, and inability to form words.

Dementia Pugilistica Risk Factors

The risk factors expand beyond the repetitive head trauma with punch-drunk syndrome. The progression of behavioral, cognitive, and emotional difficulties may have a link to other medical conditions and factors.

Genetic research on the existing presence of the apolipoprotein E gene is a current focus since this does not appear to be a risk factor for dementia pugilistica as it is for Alzheimer’s disease.

A person’s age, stress levels, and the use of alcohol and recreational drugs are also factors that contribute to the progression of dementia pugilistica.

As of now, a dementia pugilistica diagnosis can only be confirmed after a patient’s death. The visible changes to the brain are apparent during an autopsy. There is extensive, ongoing research to discover ways to be able to diagnose the condition while the patient is living.

Dementia Pugilistica Treatments

With a diagnosis not being able to be confirmed until it is too late, treatment or a cure is out of reach at this time. Prevention is the only precaution available with close monitoring of possible symptoms, if applicable.

Dementia pugilistica develops with an initial concussion, and it is important to recognize any changes that indicate symptoms. If present, there are several actions to take:

  • Limit activities
  • Rest
  • Avoid prolonged periods staring at computer screen
  • Get adequate sleep
  • Slowly return to physical activities
  • Follow medical advice
  • Avoid the use of alcohol with prescribed medications
  • Seek advice with decisions
  • Take heed with the risk of a second concussion

Long-term support with signs of punch-drunk syndrome requires attention similar to those patients with a diagnosis of other dementia conditions. These may include the following lifestyle changes and tasks.

  • Staying in a calm environment as much as possible, as the symptoms of dementia pugilistica can become overwhelming and heightened with distraction and negative surroundings.
  • Receiving patience from loved ones and caretakers is key to a healthy lifestyle for sufferers.
  • Responding to questions and directions from a sufferer in a calm and straightforward manner.
  • Maintain a routine and schedule each day and night.
  • Exercise regularly to promote a healthy heart, body, and mind.

Dementia pugilistica is a frightening condition for both the sufferer and the family as this disease progressively takes over one’s mind and body. It appears to occur in those involved in high-risk contact sports such as boxing and football. Repetitive trauma to the head can affect the entire brain in various ways.

The symptoms are important to recognize as a diagnosis is only available once it is too late. Also known as punch-drunk syndrome, this condition can only be treated through the individual symptoms as there is no cure.

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“Punch Drunk Syndrome or Dementia Pugilistica,” ePain Assist, May 2, 2017;, last accessed June 14, 2017.
“Dementia Pugilistica,” Dementia, July 2, 2015;, last accessed June 14, 2017.