Human InterestInjuriesNeurologySports Medicine Info

DEMENTIA PUGILISTICA

After I published the recent blog correlating football-related concussions with cognitive decline in old age, one loyal reader asked if similar statistics existed for boxers and mixed-martial arts fighters. They get their brains beat out, too, and more often! The overall answer is “yes,” but boxing has known about Chronic Traumatic Encephalopathy (CTE) for decades. They called it being “punch drunk,” instead. Later, it gained dignity with a complicated name, Dementia Pugilistica, and accepted it as a consequence of years of repeated blows to the head. It did not command the same attention or respect as CTE because most boxers fight in relative obscurity. The public was much more familiar with football players because we watch our favorites every Sunday for years. When after retirement they became paranoid, demented, depressed, or committed suicide later in life, it drew a lot of attention, but boxers and MMA fighters became “punch drunk” without much fanfare or concern. 

The classic case of Dementia Pugilistica should be Muhammad Ali, but he boasted he was never hit often enough or hard enough to be subject to it. Instead, neurologists who cared for him directly provided evidence he really had Parkinson’s Disease. However, Floyd Patterson, Sugar Ray Robinson, and Joe Louis, did have it. People with Dementia Pugilistica have memory loss, behavioral and personality changes, speech and gait (walking) abnormalities, tremor, paranoia, and physical characteristics of Parkinson’s Disease. They usually don’t live more than five years after diagnosis. 

Statistics of this subject abound. Here are some: Forty-four boxers sustained 192 head injuries. One-hundred-thirty-three of these were bad enough to interrupt training or competition. These 44 boxers averaged 3 head injuries per year or 12.8 head injuries per 100 hours of training. 

Five-hundred-forty-five boxers had 907 bouts. Over a period of 8.5 years they sustained an average of 214 injuries or 23.6 injuries per 100 fights. Interestingly, knockout rates in MMA are much less than those seen in boxing. 

Two-hundred-twenty MMA fighters were involved in 171 matches. Seventy-eight fighters had 96 head injuries. Of the 171 matches fought, 69 (40.3%) ended with one fighter injured. The overall rate was 12.5 injuries per 100 competitive rounds. 

Amateur boxers sustain one injury every 2.5 hours of competition and one every 714 hours of training. These head injuries often rise to the level of concussion and are symptomatic with dizziness, nausea, decreased attention span, amnesia, and headache. They usually improve “in about a week.”

Six studies on MMA fighters found that the losers of a match had three times as many head injuries as winners, and in another study of 503 bouts, the loser of the match was much more likely to have a head injury.

Severe concussions can be associated with loss of consciousness, coma, and many other symptoms. Boxing and mixed martial arts fighters are every bit as prone to serious head injury as football players. What I didn’t find was cognitive evaluations of fighters many years after head injury like has been done so extensively for football players. Fighters don’t tend to get the media and public attention experienced by NFL players. Being a punch drunk unknown middleweight on the Friday night card at the armory doesn’t draw the attention of the All-American linebacker who was a first round draft pick and Pro-Bowler. The fall of the famous linebacker into a world of dementia and paranoia is much more interesting and sympathy-capturing than the decline of “what’s-his-name” you saw at the Coliseum twenty years ago. 

A head injury is a head injury regardless how you get it. Dementia Pugilistica is a type of Chronic Traumatic Encephalopathy, CTE.  Undoubtedly, fighters have the same cognitive deficits as football players, but their stories are far less interesting and haven’t received the blessing of the media.

References: Zazryn TR, et al. Injury rates and risk factors in competitive professional boxing. Clin J Sport Med 2009 Jan;19(1):20-25. 

Ross AJ, Ross BJ, et al. Injury Profile of Mixed Martial Arts Competitions in the United States. Orthopedic J Sport Med 2021 March 24;9(3):2325967121991560.

Jayarao M, Chin LS, Cantu RC Boxing-related Head Injuries Phys Sportsmed 2010 Oct;38(3):18-26.

Siewe J, et al. Injuries in Competitive Boxing: A prospective study. Int J Sports Med 2015 Mar;36(3):249-253.

Alevras AJ, Fuller ST, et al. Epidemiology of injuries in amateur boxing: A systematic review and meta-analysis. J Sci Med Sport 2022 Dec;25(12):995-1001. 

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