Why Do Some Boxers Develop Dementia and Some Don’t?

Largest study of its kind expands to new site to find clues

Why Do Some Boxers Develop Dementia and Some Don’t?

The boxing community has known for decades that repeated blows to a fighter’s head can result in permanent brain damage, resulting in dementia or Parkinson’s disease-like movement changes.

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The boxing community even has a name for it: punch-drunk. But while many notable fighters have developed these problems – along with depression and other neurological symptoms – many have not.

A four-year-old study that is looking for answers as to why punch drunk happens — and why sometimes it doesn’t – is coming to Cleveland.

The largest study of its kind, the project began in April 2011 at Cleveland Clinic’s Lou Ruvo Center for Brain Health in Las Vegas, the world’s boxing capital.

There, researchers led by Charles Bernick, MD, MPH, have been working with nearly every professional boxing promoter and training center in Nevada, including the Nevada Athletic Commission, Golden Boy Promotions, Top Rank Boxing, the Ultimate Fighting Championship and Bellator Mixed Martial Arts.

The Cleveland extension site of the Las Vegas study will be modeled in virtually the same way, but will allow researchers to tap into the East Coast pool of fighters.

Early detection

The study focuses on developing methods to detect the earliest and most subtle signs of brain injury in active and retired professional boxers and mixed martial arts fighters. The project also aims to pinpoint at what point these changes result in impairment in thinking and brain function.

Researchers hope this may lead to being able to identify who is more likely to develop chronic neurological disorders. Ultimately the study could lead to improved safety in the sport of boxing and the medical field of traumatic brain injury.

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The results also may be useful to understanding other causes of traumatic brain injury in military or civilian populations.

The study is still in its early stages. But some preliminary results have been the subject of presentations, national scientific meetings and published articles.

Tracking brain changes

For example, researchers, using magnetic resonance imaging (MRI), detected changes in the volume of specific brain regions and in the connections between certain areas of the brain in some individuals as soon as one year after a fighter experienced a violent blow to the head. This, researchers say, suggests that MRI measurement may be useful to track brain changes over time in those exposed to head trauma.

“The study has made tremendous strides in better understanding of long-term brain injury resulting from head trauma,” says Dr. Bernick, who is Associate Medical Director at the Lou Ruvo Center for Brain Health. “We know now that MRI imaging has proven to show changes in the brain over time in some, but not all, fighters exposed to repetitive head trauma.”

A group of the participants in the Cleveland arm of the study will have MRIs with the 7-Tesla, one of the world’s most powerful MRI machines. The 7-Tesla is one of a handful in the country and the only one in Northeast Ohio. Its 80,000-pound magnet allows researchers to see the brain in far greater detail than with MRIs used for clinical purposes.

“With this advanced imaging capability, we can turn up the resolution and clearly visualize brain areas as small as one-tenth of a millimeter, bringing us much closer to having a microscope for the living brain,” says Michael Phillips, MD, Vice-Chair for Research and Academics, Diagnostic Radiology at Cleveland Clinic.

“This imaging allows us to accurately see structures we have never been able to see before, and allows much more accurate imaging and assessment of brain function,” Dr. Phillips says.

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Better prevention

When fighters demonstrate a relationship between MRI findings and physical symptoms of brain decline, researchers hope to determine what factors could play a role, such as genetics, lifestyle characteristics or the amount or type of head trauma.

“Our hope is by the end of the study, we will be able to use this information to better prevent permanent brain injury,” says Jay Alberts, PhD, Director of the Concussion Center at Cleveland Clinic and leader of the Cleveland-based arm of the study.

“The research completed in this study could have the potential to lead to better development of protective equipment across sports,” Dr. Alberts says.

To date, the study has enrolled nearly 500 active and retired fighters with the goal of evaluating 625 by its completion. Another 50 individuals who have not been exposed to head trauma comprise a control group.

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