Dementia pugilistica Flashcards
Dementia pugilistica (aka ‘punch drunk syndrome’) is a form of dementia usually seen in people who experience repeated head injuries, such as boxers.
Symptoms may appear immediately after a single traumatic brain injury, but are typically described following the cessation of exposure to chronic brain injury.
Symptoms of may include:
gait ataxia slurred speech impaired hearing tremors disequilibrium neurobehavioural disturbances progressive cognitive decline.
Most cases of present with early onset cognitive deficits. Behavioural signs exhibited by patients include:
aggression suspiciousness paranoia childishness hypersexuality depression restlessness
The progression leads to more prominent behavioural symptoms such as difficulty with impulse control, irritability, inappropriateness, and explosive outbursts of aggression.
Neuropathological examination have revealed neurofibrillary tangles, neuritic plaques, cerebral infarcts, fenestrated septum pellucidae, atrophic and gliotic mammillary bodies, pale substantia nigrae and locus ceruleae, thalamic gliosis, loss of Purkinje cells in the cerebellum, cerebral and cerebellar atrophy and lesions, and fornix degeneration and degradation.
Damage to the superior cerebellar peduncle and red nucleus is believed to contribute to slurring dysarthria and tremors.
Substantia nigral degeneration and neuronal loss in the lentiform nucleus is believed to contribute to Parkinsonian symptoms.
Cortical atrophy, specifically in the temporal lobe, is likely responsible for patients exhibiting hypersexual behavior such as exhibited in Kluver-Bucy syndrome.
Damage to the septum pellucidum may be the cause for feelings of depression in boxers with dementia pugilistica.
Damage to the mamillary bodies and the fornices suggest a cause for inappropriate emotions and abrupt mood changes, and is consistent with the symptoms of Wernicke-Korsakoff syndrome.
Neurofibrillary tangle (NFT) development in the cerebral cortex is the most prevalent pathological abnormality. NFTs may occur as a normal part of aging, but are located mainly in the hippocampus and temporal lobe and are uncommon in the neocortex of otherwise healthy individuals.
