Dementia pugilistica is the medical term for a traumatic encephalopathy with symptoms similar to Parkinson’s disease. The condition is most common among boxers and others who frequently endure blows to the head. No causative therapy exists at this time.
What is dementia pugilistica?
Dementia pugilistica is also known as chronic traumatic encephalopathy, pugilistic Parkinson’s syndrome, or boxer’s syndrome. This neurological disorder primarily affects people who often endure blows or jolts to the head area. The disease is therefore particularly common among boxers, football players and other professional athletes. However, drug addicts or alcoholics are also increasingly affected, as they fall more frequently and thus often hit their heads regularly. Among boxers, Jack Dempsey is one of the best-known patients of dementia pugilistica. In the NFL, names such as Chris Henry are again associated with the condition. The disease usually builds up over several years and often has its onset when the patient is only 16 years old. To date, the disease and its causes and progression have not been conclusively researched.
Causes
To date, the exact causes of dementia pugilistica have not been conclusively determined. Since the phenomenon occurs more frequently in boxers, medical science assumes that the causative factor is hard blows to the head area. The loss of brain cells apparently plays just as important a role in the clinical picture as traumatic damage to the cerebellum and scarring on the brain mass. Scar tissue in the central nervous system makes stimulus transmission difficult, among other things. Eventually, all scarred brain areas lose their original function. As long as the affected areas correspond to limited areas, the loss of function of the cells is compensated by the surrounding tissue. In larger scarred areas, such compensation is no longer possible. Why not all boxers suffer from dementia pugilistica is as yet largely unclear to medical science. Also a definite connection with boxing has not been proven so far. It is undoubtedly proven that dementia pugilistica is an acquired disease.
Symptoms, complaints, and signs
Purely externally, dementia pugilistica is reminiscent of Parkinson’s disease with its symptoms. Tremor is one of the leading symptoms of this disease. The severity of the tremor varies from case to case. In most cases, gait unsteadiness is also present. These symptoms often lead to difficulties in coordination. In most cases, the coordination ability decreases visibly in the course of the disease. These symptoms are sometimes accompanied by the classic symptoms of dementia, such as a slow deterioration of memory and personality. Normally, this is accompanied by changes in behavior in everyday life. Patients often react to everyday situations with actions or emotions that are difficult to understand. Psychological symptoms also occur. For example, those affected often suffer from persistent depressive moods. Apart from this, the ability to speak may be impaired. Severe speech problems are often even described as a leading symptom.
Diagnosis
For the diagnosis of dementia pugilistica, the medical history plays a crucial role. If the history suggests increased blows to the head with the leading symptoms described, the neurologist will probably have an initial suspicion. Diseases such as dementia and especially Parkinson’s disease should be considered for differential diagnosis. An MRI of the skull will show increased scarring, which may be another clue to the clinical picture. In boxers, the first symptoms usually present about 20 years after the causative head trauma. The course of the disease is to some extent individual and may even be influenced by the patient’s psychological constitution.
Complications
In most cases, dementia pugilistica causes tremor and thus the so-called tremor. This can extremely reduce the patient’s quality of life and also make everyday life more difficult for the patient. Ordinary activities are no longer possible, so that the patient can also suffer from mental illness and depression due to the restrictions.Likewise, insecurities occur during walking, which are accompanied by coordination disorders. Patients can no longer correctly assess distances and paths. Similarly, the ability to speak can also be restricted, which is reflected above all in a word-finding disorder. Not infrequently, the patient is then dependent on the help of other people in everyday life. Dementia pugilistica can also place a heavy burden on family members. Unfortunately, a causal treatment of dementia pugilistica is not possible. Therefore, only the symptoms can be limited somewhat in order to make everyday life bearable for the patient. Therapies and logopedic care are the main methods used. Often, depression can be limited by talking to a psychologist or with the help of medication. Life expectancy decreases due to the disease.
When should you see a doctor?
Unfortunately, dementia pugilistica cannot be completely cured or limited. However, early diagnosis can help improve symptoms, so medical treatment is definitely needed for this condition. A doctor must be consulted if the affected person suffers from tremor. In this case, gait unsteadiness can also indicate the disease and must be examined. Especially coordination disorders occur frequently in dementia pugilistica and are a common symptom. Furthermore, dementia must also be diagnosed and treated by a medical professional. This can make the daily life of the affected person and his relatives much easier. Sudden mood swings or depression can also be an indication of this disease. In this case, too, a doctor should be consulted. The diagnosis of this disease can usually be made by the general practitioner. Further treatment is carried out by various specialists and usually also depends on the patient’s condition. Unfortunately, a complete cure cannot yet be achieved.
Treatment and therapy
Damage to the central nervous system cannot be reversed according to the current state of medicine. Therefore, treatment of the causes is not possible in dementia pugilistica. Thus, the disease is an incurable late consequence of nervous system traumas. Despite the incurability and the unstoppability of the course of the disease, at least some symptoms of the disease can be treated. As with all incurable diseases, the goal of supportive therapy is primarily to improve quality of life. When nerve tissue dies, the surrounding nerve cells may, through training, learn to take over the tasks of the defective cells. This phenomenon is known not least from the therapy of stroke patients and may also play a role in the treatment of dementia pugilistica. In the case of gait disorders, for example, physiotherapeutic treatments can serve to compensate and thus improve the patient’s quality of life. The same applies to occupational therapy treatments, which ideally reduce tremor. Speech disorders, in turn, can improve with logopedic care. To learn to cope with the disease and improve one’s emotional state, physiotherapy sessions are often recommended. A stable psyche can probably have a positive influence on the course of the disease. However, drug therapies may also be considered against particularly severe depression.
Outlook and prognosis
The prognosis of dementia pugilistica is unfavorable overall. Although there are influencing factors that have a positive effect on the course of the disease, there is no cure. Dementia pugilistica progresses slowly over many years and decades. The symptoms develop gradually and are associated with dementia pugilistica only at a late stage. During this time, no treatment normally takes place due to a lack of diagnosis. If the affected person avoids the practice of martial arts and other blows to the head, the progress of the disease can be influenced. In addition, logopedic therapies help to achieve an improvement in speech. Nevertheless, permanent scars have formed in the brain, which can lead to further deterioration of the health condition at any time. Since the causes of dementia pugilistica have not been conclusively clarified to date, there is no single therapeutic option. What is certain is that the absence of blows to the head has a positive effect on health.If psychological problems occur in addition to dementia pugilistica, the prospect of relief deteriorates considerably. The quality of life is severely limited and the length of life is usually shortened. Gradually, gait insecurities appear. As the disease progresses, the patient requires daily care and support to cope with everyday life.
Prevention
Because dementia pugilistica is an acquired condition, its occurrence can be prevented to the greatest extent possible. Those who avoid blows and bumps to the head and have head trauma treated promptly are unlikely to develop the phenomenon.
Here’s what you can do yourself
To deal humanely with the disease dementica pugilistica, an assessment of the degree of the disease should first be made. This will help determine what treatment options are appropriate. If possible, the person with the disease should talk about it with those around him or her. Decisions can be made better together, and relatives or acquaintances may already have had good experiences with doctors or therapies. Speech therapy, for example, stabilizes and expands speech. With the help of physiotherapy, patients can train their motor skills again. Sufferers can also ask the city or municipality, or on the Internet, whether there are self-help groups near where they live. There should be people there who can share certain experiences with each other and thus get advice, experiences and places to go with the help of social workers and guided conversations. The person with the disease should also consciously describe objects, take them in hand, look at the peculiarities from all sides, feel the surface, think about what the object can be used for, and if possible also speak out loud these impressions, better yet, write them down. With the help of a dictionary or even with acquaintances or relatives, the vocabulary can be expanded, and the emotions connect with the right objects. Rooms, plants, animals, time, daily events, everything should be recognized and named as consciously as possible. The objects should then be returned to the place from which they were taken, if possible.
