A brain injury that is mild but traumatic (Concussion) of the head, resulting from several blows, is what causes a punch drunk syndrome (PDS) or dementia pugilistica (DP). Difficulties caused by punch drunk syndrome (PDS) or dementia pugilistica (DP) take many years to be noticed. The ability to think (cognition), emotions and behaviors those are not easily noticeable. Physical problems can occur due to punch drunk syndrome or dementia pugilistica as well. One or two concussions do not necessarily give rise to it.

Punch Drunk Syndrome

Punch drunk syndrome or dementia pugilistica is a neurodegenerative disease which means that it damages the nervous cells progressively. Visible changes results in the brain owing to this damages. Imaging of the brain can be used to observe these changes that occur, but as per now the situation can only be diagnosed during an autopsy (after the patient's death).

Researchers are striving to get the correct the correct diagnosis for punch drunk syndrome (PDS) or dementia pugilistica (DP) so as to combat it while the patient is still alive.

Boxers are those who demonstrated punch drunk syndrome (PDS) or dementia pugilistica (DP) for the first time. Punch drunk syndrome or dementia pugilistica vulnerability spans in areas like football due to its involvement in repeated blows in the sport. Risks extend to military personnel who have had injuries from blasts. The causes and prevalence of punch drunk syndrome or dementia pugilistica is not yet known by researchers. Punch drunk syndrome (PDS) or dementia pugilistica has no cure at the moment.

Causes of Punch Drunk Syndrome or Dementia Pugilistica

Initial Bruise or Injury

Repetitive trauma to the head is the main cause of punch drunk syndrome (PDS) or dementia pugilistica (DP). Punch drunk syndrome or dementia pugilistica studies are conducted majorly in football players. Those who are prone to be exposed to high rate of concussing are other sports athletes like soccer players, rugby, ice hockey, wrestling, boxing, lacrosse, filed hockey and basketball.

Punch drunk syndrome (PDS) or dementia pugilistica (DP) development in individuals is that, not everyone who has had repeated concussions will be affected by it, for example military personnel.

Effect of Injury

Atrophy (the wasting away) of various brain sections is the effect of punch drunk syndrome or dementia pugilistica. The axons (parts that conduct electrical impulses) of the nerve cells is where it is mainly affected. Cell-to-cell communication is interfered due to the injuries in this section. The part of the brain composed of nerve fibers (white matter) will be changed and TDP-43 and tau proteins deposit are some of the changes that occurs. Beta-amyloid, which is another protein common in Alzheimer's syndrome, is not common.

Neurodegenerative diseases like front temporal lobar degeneration, Parkinson's disease, motor neuron disease or Alzheimer's disease have 1/3 of signs that punch drunk syndrome (PDS) or dementia pugilistica (DP) patients elaborate.

Symptoms of Punch Drunk Syndrome or Dementia Pugilistica

Symptoms of punch drunk syndrome (PDS) or dementia pugilistica (DP) are similar to other degenerative diseases (condition involving progressive loss of structure and function of the nerve cells) are:

  • Alzheimer's disease
  • Parkinson's disease
  • Frontotemporal dementia
  • Amyotrophic lateral sclerosis (ALS)

Behavior, mood and cognition (thinking) are the problems that people with punch drunk syndrome (PDS) or dementia pugilistica (DP) have in overall. Physical problems can be developed later. Post traumatic disorder can accrue to military personnel who have experienced injury to the brain that is traumatic.
8-10 years after the mild traumatic injury to the brain is the duration that punch drunk syndrome (PDS) or dementia pugilistica (DP) signs and symptoms can take in order to occur. These include:

  • Cognitive impairment (difficulty thinking)
  • Impulsive behavior
  • Apathy or depression
  • Memory loss that is short-term
  • Unstable emotion
  • Substance abuse
  • Suicidal behavior or thought
  • Task planning and performing difficulty (executive function)

Executive functions and memory might worsen overtime in punch drunk syndrome or dementia pugilistica and also development of other signs and symptoms which include:

  • Irritability
  • Being aggressive
  • Difficult to speak language
  • Dysphasia (swallowing problem)
  • Focusing and vision problems
  • Olfactory abnormalities (sense of smell trouble)
  • Dementia
  • Rigidity, weakness, muscle immobility, tremor or walking difficulty (motor impairment)

Punch drunk syndrome or dementia pugilistica symptoms progression is described through the following stages by researchers:

Stage I: Loss of concentration and attention and headache

Stage II: Memory loss for a short term, explosivity, depression

Stage III: Cognitive impairment, executive (decision making) dysfunction

Stage IV: Aggression, dementia, difficulty in finding words.

Brain tissue damage has been described through the creation of four stages too. The pathological changes caused by punch drunk syndrome (PDS) or dementia pugilistica (DP) are ongoing once they are started and last for decades following a traumatic injury to the brain or even after retirement from a sport. The progress of the symptoms will be for the entire life of the individual.

The progress of punch drunk syndrome or dementia pugilistica is in two patterns, beginning with mood and behavioral changes, while in older patients, it can start with cognitive problems that progresses and might lead to dementia. It is not known if there are two distinguished processes of the disease or whether the changes of the disease are occurring overtime.

Risk Factors for Punch Drunk Syndrome or Dementia Pugilistica

Punch drunk syndrome or dementia pugilistica development is believed by researchers to be due to mild traumatic injury to the brain that is repetitive. However, development of behavioral, emotional, cognitive (thinking) problems later in life need not be due to repetitive head injury. Thus there is need for other factors. Other medical factors can also be included and factors like; injury state, severity and other health factors.

Genetic risk factors have been the major focus of research, particularly specific apolipoprotein E (APOE) genotypes presence, which have been determined as the risk factor causing Alzheimer's disease. APOE has not been found to be the risk factor for punch drunk syndrome (PDS) or dementia pugilistica (DP) development.

Punch drunk syndrome or dementia pugilistica development can also be linked to stress, sex, abuse of substance and alcohol and age.

Tests to Diagnose Punch Drunk Syndrome or Dementia Pugilistica

While the patient is alive no test can define the condition currently. Brain tissue degeneration, tau and other protein deposits are what are needed for a diagnosis. After-death inspection (autopsy) is the only way that these proteins are visible. Still researchers are deeply engrossed on how punch drunk syndrome (PDS) or dementia pugilistica (DP) cane diagnosed while patient is still alive. Brains of patients who might have succumbed to punch drunk syndrome or dementia pugilisticaare also being studied, example soccer players.

Hopefully, the diagnosis of punch drunk syndrome (PDS) or dementia pugilistica (DP) is eventually going to be the use of a range neuropsychological examinations biomarkers and brain imaging. Diagnosis will be enhanced through the imaging of tau and amyloids protein-types.

Neurological Test for Punch Drunk Syndrome or Dementia Pugilistica

Your neurological health will be tested by the doctor for punch drunk syndrome (PDS) or dementia pugilistica (DP) through examining:

  • Cognition, speech and language, long and short term memory too.
  • The strength of your muscles tone
  • Reflexes
  • Ability of standing up from a chair and walking across the room
  • Sense of hearing and sight
  • Balance
  • Coordination.

Brain-Imaging Test for Punch Drunk Syndrome or Dementia Pugilistica

Mild traumatic injury to the head is treated with the use of brain-imaging technology currently. Punch drunk syndrome (PDS) or dementia pugilistica (DP) diagnosis can be realized through the use of the following technologies in the future:

  1. MRI: (Magnetic Resonance Imaging) Detailed images of your brain are shown by the use of strong magnetic field during an MRI. Researchers are hopeful that punch drunk syndrome or dementia pugilistica diagnosis can be achieved through the help of the following MRI test which have evolved over time.

    • SWI (Susceptibility-Weighted Imaging) is an MRI type sensitive to micro hemorrhages occurring after a physical trauma affecting the central nervous system.
    • DTI (diffusion tensor imaging) is an MRI type revealing disruption of the fibers of the white matter and tracks. Precision and accuracy technological enhancement can promise the detection of punch drunk syndrome or dementia pugilistica.
    • MRS (Magnetic Resonance Spectroscopy) is the same as MRI but additional information regarding neurological damage is obtained.
  2. PET (Positron Emission Tomography) for Punch Drunk Syndrome or Dementia Pugilistica: Use of low-level radioactive tracer injected via a vein is what is done in PET scan. The tracer's flow in the brain is tracked by the scanner. Researchers are on the verge of developing PET that detects abnormalities in tau attributed to neurodegenerative disorder. The aim is developing a maker the pathology of tau in patients with PDS while they are still alive. Tau evidence was recently traced by an injection given to athletes with the substance FDDNP and scanned through a PET. The levels of FDDNP were higher in athletes as compared to the controls associated to tau deposits produced after trauma.

  3. ERPs Event-related potentials and (quantitative) EGG for Punch Drunk Syndrome or Dementia Pugilistica: Brain waves are analyzed by the doctor by placing a mesh cap covered with electrodes (electroencephalography (EGG)) on the head of a person when conducting this noninvasive test. Neurophysiologic changes resulting from numerous TBIs can also be detected.

  4. SPECT: (single photon emission computerized tomography) Dementia types are differentiated through the use of SPECT. Further studies are required to discern if SPECT can distinguish between PDS and Alzheimer's disease or any other degenerative disorder.

Other Tests for Detecting Punch Drunk Syndrome or Dementia Pugilistica

Cerebral spinal fluid plasma or blood has received little research so far whereas the process could yield long-term solution in punch drunk syndrome (PDS) or dementia pugilistica (DP) diagnosis. The similarities of punch drunk syndrome or dementia pugilistica and Alzheimer's condition are a leeway on using biomarkers used in the research on Alzheimer's.

Treatment for Punch Drunk Syndrome or Dementia Pugilistica

No treatment has been found for punch drunk syndromeor dementia pugilistica as it is a progressive, degenerative brain disorder. Avoiding head injury to the head and staying informed of the current recommendations for detecting and managing mild traumatic injury to the brain.

Punch drunk syndrome (PDS) or dementia pugilistica (DP) could not have developed if you recently had a concussion. You have to prevent further injury by taking care of yourself most certainly. If the symptoms recur at any point:

  • Reduce activities
  • Rest plentifully
  • Minimize physical activities
  • Reduce your computer time
  • Sleep enough
  • Gradually return to activities with your doctor's guidance
  • Take medical prescription and no alcohol consumption
  • Limit tasks by writing them down as required
  • Resume work with ease
  • Prior to making decision, consult others

Second impact syndrome (second concussion) should be avoided before the preceding injury heals is very important. Death or permanent damage to the brain can result with second concussion.

Care and Precautions for Punch Drunk Syndrome or Dementia Pugilistica

The supportive care that should be given to someone who has exhibited symptoms that are associated with punch drunk syndrome (PDS) or dementia pugilistica (DP) should be like those administered in patients with other types of dementia.

  • Calming environment. Functioning and focusing of someone with dementia is easier when clutter and noise that distracts is reduced. Frustration and confusion can also be reduced.
  • Reassuring response. Response to a behavior like agitation can be worse coming from a caregiver. Quizzing and correcting a person with dementia should be best avoided. Many situations can be diffused through the validation and reassurance for a dementia patient.
  • Modified task. Success and not failure should be the aim after dividing a task into easy steps. Confusion is reduced in dementia patients through routine and structure.
  • Regular exercise. Maintenance of the heart, joint and muscle health and mood elevation can be attained through daily activities like 30-minute walk on a daily basis. Calming effect can be created, motor skills retained, depression symptoms lessened, constipation prevented and restful; sleep promoted through it. Stationery bike can be used by patients who cannot walk or chair exercise participation can be helpful.

Prevention of Punch Drunk Syndrome or Dementia Pugilistica

Punch drunk syndrome (PDS) or dementia pugilistica (DP) and any other neurodegenerative disease have no cure. Prevention of punch drunk syndrome (PDS) or dementia pugilistica (DP) is achievable because it occurs due to recurrent concussion. The likelihood of having a second injury is probable in most individuals who have had the first concussion.

Preventing further concussion and reducing mild traumatic injuries to the brain is the key of PDS prevention. Head injury can be reduced with the use of the following equipments:

  • Specific sports-helmet. Injuries have reduced by helmets in snowboarding, alpine skiing, rugby, ice hockey and baseball. The possibility of those wearing a helmet is that the risks they take are fewer. Soccer players have not been saved by helmets. Concussio9ns cannot be eradicated by helmets.
  • Motorcycle and bicycle helmets. Head injury is reduced in accident scenarios.

Players and coaches should familiarize themselves with the guidelines on injuries relating to sports. Concussion when playing is hard to be evaluated and players and coaches should lean on caution by keeping athletes who are injured outside the game. Coaches or athletes can be able to visualize concussion's symptoms of punch drunk syndrome (PDS) or dementia pugilistica (DP) through the following:

Signals of danger:

  • Loss of consciousness, even for a brief moment.
  • One pupil will be larger
  • Drowsiness or not easily awaken
  • Worsening headache
  • Decreased coordination numbness and weakness
  • Nausea or repeated vomiting
  • Slurring speech
  • Seizures or convulsion
  • Inability to recognize places or people
  • Confusion, restlessness, agitation and other behaviors those are unusual.

Signs that a third party can observe for punch drunk syndrome (PDS) or dementia pugilistica (DP):

  • Appearing stunned or dazed
  • Confused about position or assignment
  • Forgetting instructions
  • Unsure of a game, opponent or score
  • Moving clumsily
  • Slow to answer questions
  • Losing consciousness, even for a brief moment
  • Personal, behavioral or mood changes
  • Memory loses before the event or after the fall or hit.

Symptoms that one can notice by themselves for punch drunk syndrome (PDS) or dementia pugilistica (DP):

  • Pressure in the head or headache
  • Vomiting or nausea
  • Dizziness or balance problems
  • Burry or double vision
  • Light sensitivity
  • Noise sensitivity
  • Feeling hazy, groggy, sluggish or foggy
  • Memory problems or concentration
  • Confusion.

Four-step action plan should be followed if concussion is suspected by you or someone:

  • The athlete should be removed from playing that day.
  • The athlete should be evaluated by a professional.
  • The significant other or a guardian of the athlete should be informed.
  • Keep the athlete off the field until the healthcare professional gives an ok to return.

Gradual five-step should be followed to return to playing:

  • No weightlifting only light aerobics
  • Moderate exercise
  • Heavy and non-contact exercises
  • Controlled full contact and practice
  • Competition

Former NFL Players who had Punch Drunk Syndrome or Dementia Pugilistica

  1. Mike Webster
  2. Andre waters
  3. Justin Strzelczyk
  4. Junior Seau
  5. Tom McHale
  6. Ollie Matson
  7. John Mackey
  8. Terry Long
  9. Chris Henry
  10. John Grimsley
  11. Cookie Gilchrist
  12. Ray Easterling
  13. Dave Duerson
  14. Shane Dronett
  15. Lou Creekmur
  16. Lew carpenter
  17. Forrest Blue
  18. Jovan Belcher.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: November 7, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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