The occult aftermath of boxing.
Open accessAbstract
The repeated head trauma experienced by boxers can lead to the development of dementia pugilistica (DP)--punch drunk syndrome. The neuropathology of DP in a classic report by Corsellis et al describes the presence of numerous neurofibrillary tangles in the absence of plaques, in contrast to the profusion of tangles and plaques seen in Alzheimer's disease (AD). The DP cases used in that report were re-investigated with immunocytochemical methods and an antibody raised to the beta-protein present in AD plaques. We found that all DP cases with substantial tangle formation showed evidence of extensive beta-protein immunoreactive deposits (plaques). These diffuse "plaques" were not visible with Congo-red or standard silver stains. The degree of beta-protein deposition was comparable to that seen in AD. Our data indicate that the present neuropathological description of DP (tangles but no plaques) should be altered to acknowledge the presence of substantial beta-protein deposition (plaques). The molecular markers present in the plaques and tangles of DP are the same as those in AD. Similarities in clinical symptoms, distribution of pathology and neurochemical deficits also exist. Epidemiological studies have shown that head injury is a risk factor in AD. It is probable that DP and AD share common pathogenic mechanisms leading to tangle and plaque formation.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the past, based on studies in boxers with extensive neurotrauma exposure, slurred and dysarthric speech, gait problems, Parkinsonism, cognitive impairment, and dementia were considered clinical features.
“In the past, based on studies in boxers with extensive neurotrauma exposure, slurred and dysarthric speech, gait problems, Parkinsonism, cognitive impairment, and dementia were considered clinical features [2, 48, 49].”
From The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features (2017) · cites this paper as [48]
Cites
The precursor of Alzheimer's disease amyloid A4 protein resembles a cell-surface receptor
Kang, J., Lemaire, H.-G., Unterbeck, A., Salbaum, J. M., Masters, C. L., Grzeschik, K.-H., Multhaup, G., Beyreuther, K., & Müller-Hill, B. (1987) · Nature · doi:10.1038/325733a0 · Cited by 4,619 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Alzheimer's disease: the amyloid cascade hypothesis
Hardy, J. A., & Higgins, G. A. (1992) · Science · doi:10.1126/science.1566067 · Cited by 7,484 · see citing works
Amyloid deposition as the central event in the aetiology of Alzheimer’s disease
Hardy, J., & Allsop, D. (1991) · Trends in Pharmacological Sciences · doi:10.1016/0165-6147(91)90609-v · Cited by 2,538 · see citing works
Self-citationChronic traumatic encephalopathy in athletes: Progressive tauopathy after repetitive head injury
McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., Santini, V. E., Lee, H.-S., Kubilus, C. A., & Stern, R. A. (2009) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e3181a9d503 · Cited by 2,295 · see citing works
Nelson, P. T., Alafuzoff, I., Bigio, E. H., Bouras, C., Braak, H., Cairns, N. J., Castellani, R. J., Crain, B. J., Davies, P., Tredici, K. D., et al. (2012) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e31825018f7 · Cited by 2,050 · see citing works
2018 Alzheimer's disease facts and figures
Alzheimer's Association (2018) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2018.02.001 · Cited by 1,912 · see citing works
Baumgart, M., Snyder, H. M., Carrillo, M. C., Fazio, S., Kim, H., & Johns, H. (2015) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2015.05.016 · Cited by 1,660 · see citing works
Axonal pathology in traumatic brain injury
Johnson, V. E., Stewart, W., & Smith, D. H. (2013) · Experimental Neurology · doi:10.1016/j.expneurol.2012.01.013 · Cited by 1,273 · see citing works
Guskiewicz, K. M., Marshall, S. W., Bailes, J., McCrea, M., Cantu, R. C., Randolph, C., & Jordan, B. D. (2005) · Neurosurgery · doi:10.1227/01.neu.0000175725.75780.dd · Cited by 1,197 · see citing works
the TBI/CTE group, McKee, A. C., Cairns, N. J., Dickson, D. W., Folkerth, R. D., Dirk Keene, C., Litvan, I., Perl, D. P., Stein, T. D., Vonsattel, J.-P., et al. (2016) · Acta Neuropathologica · doi:10.1007/s00401-015-1515-z · Cited by 885 · see citing works
Chronic Traumatic Encephalopathy in a National Football League Player
Omalu, B. I., DeKosky, S. T., Minster, R. L., Kamboh, M. I., Hamilton, R. L., & Wecht, C. H. (2005) · Neurosurgery · doi:10.1227/01.neu.0000163407.92769.ed · Cited by 894 · see citing works
Chronic neuropathologies of single and repetitive TBI: substrates of dementia?
Smith, D. H., Johnson, V. E., & Stewart, W. (2013) · Nature Reviews Neurology · doi:10.1038/nrneurol.2013.29 · Cited by 699 · see citing works
CHRONIC TRAUMATIC ENCEPHALOPATHY IN A NATIONAL FOOTBALL LEAGUE PLAYER: PART II
Omalu, B. I., DeKosky, S. T., Hamilton, R. L., Minster, R. L., Kamboh, M. I., Shakir, A. M., & Wecht, C. H. (2006) · Neurosurgery · doi:10.1227/01.neu.0000245601.69451.27 · Cited by 694 · see citing works
The Neuropathology and Neurobiology of Traumatic Brain Injury
Blennow, K., Hardy, J., & Zetterberg, H. (2012) · Neuron · doi:10.1016/j.neuron.2012.11.021 · Cited by 669 · see citing works
Arendt, T., Stieler, J. T., & Holzer, M. (2016) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2016.08.018 · Cited by 609 · see citing works
Identification of normal and pathological aging in prospectively studied nondemented elderly humans
Dickson, D. W., Crystal, H. A., Mattiace, L. A., Masur, D. M., Blau, A. D., Davies, P., Yen, S.-H., & Aronson, M. K. (1992) · Neurobiology of Aging · doi:10.1016/0197-4580(92)90027-u · Cited by 643 · see citing works
Neuropathology and Cognitive Impairment in Alzheimer Disease: A Complex but Coherent Relationship
Nelson, P. T., Braak, H., & Markesbery, W. R. (2009) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e3181919a48 · Cited by 643 · see citing works
Widespread tau and amyloid-beta pathology many years after a single traumatic brain injury in humans
Johnson, V. E., Stewart, W., & Smith, D. H. (2012) · Brain Pathology · doi:10.1111/j.1750-3639.2011.00513.x · Cited by 620 · see citing works
Traumatic brain injury and amyloid-β pathology: a link to Alzheimer's disease?
Johnson, V. E., Stewart, W., & Smith, D. H. (2010) · Nature Reviews Neuroscience · doi:10.1038/nrn2808 · Cited by 587 · see citing works
The Neuropathology of Chronic Traumatic Encephalopathy
McKee, A. C., Stein, T. D., Kiernan, P. T., & Alvarez, V. E. (2015) · Brain Pathology · doi:10.1111/bpa.12248 · Cited by 585 · see citing works
Roberts, G. W., Gentleman, S. M., Lynch, A., Murray, L., Landon, M., & Graham, D. I. (1994) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.57.4.419 · Cited by 569 · see citing works
Self-citationApolipoprotein E ε4 allele is associated with deposition of amyloid β-protein following head injury
Nicoll, J. A. R., Roberts, G. W., & Graham, D. I. (1995) · Nature Medicine · doi:10.1038/nm0295-135 · Cited by 486 · see citing works
Self-citationExperimental models of traumatic brain injury: do we really need to build a better mousetrap?
Morales, D. M., Marklund, N., Lebold, D., Thompson, H. J., Pitkanen, A., Maxwell, W. L., Longhi, L., Laurer, H., Maegele, M., Neugebauer, E., et al. (2005) · Neuroscience · doi:10.1016/j.neuroscience.2005.08.030 · Cited by 339 · see citing works
Recent advances in neurotrauma
Graham, D. I., McIntosh, T. K., Maxwell, W. L., & Nicoll, J. A. R. (2000) · Journal of Neuropathology & Experimental Neurology · doi:10.1093/jnen/59.8.641 · Cited by 328 · see citing works
Neuronal cytoskeletal changes are an early consequence of repetitive head injury
Geddes, J. F., Vowles, G. H., Nicoll, J. A. R., & Révész, T. (1999) · Acta Neuropathologica · doi:10.1007/s004010051066 · Cited by 323 · see citing works
Mild head injury increasing the brain's vulnerability to a second concussive impact
Laurer, H. L., Bareyre, F. M., Lee, V. M. Y. C., Trojanowski, J. Q., Longhi, L., Hoover, R., Saatman, K. E., Raghupathi, R., Hoshino, S., Grady, M. S., et al. (2001) · Journal of Neurosurgery · doi:10.3171/jns.2001.95.5.0859 · Cited by 313 · see citing works
The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters
Galetta, K. M., Barrett, J., Allen, M., Madda, F., Delicata, D., Tennant, A. T., Branas, C. C., Maguire, M. G., Messner, L. V., Devick, S., et al. (2011) · Neurology · doi:10.1212/wnl.0b013e31821184c9 · Cited by 302 · see citing works
Long-term intracerebral inflammatory response after traumatic brain injury
Gentleman, S. M., Leclercq, P. D., Moyes, L., Graham, D. I., Smith, C., Griffin, W. S. T., & Nicoll, J. A. R. (2004) · Forensic Science International · doi:10.1016/j.forsciint.2004.06.027 · Cited by 272 · see citing works
Chronic traumatic brain injury associated with boxing
Jordan, B. D. (2000) · Seminars in Neurology · doi:10.1055/s-2000-9826 · Cited by 262 · see citing works
The cause of neuronal degeneration in Alzheimer’s disease
Vickers, J. (2000) · Progress in Neurobiology · doi:10.1016/s0301-0082(99)00023-4 · Cited by 254 · see citing works
Griffin, W. S. T., & Mrak, R. E. (2002) · Journal of Leukocyte Biology · doi:10.1189/jlb.72.2.233 · Cited by 248 · see citing works
McKee, A. C., Stein, T. D., Huber, B. R., Crary, J. F., Bieniek, K., Dickson, D., Alvarez, V. E., Cherry, J. D., Farrell, K., Butler, M., et al. (2023) · Acta Neuropathologica · doi:10.1007/s00401-023-02540-w · Cited by 244 · see citing works
Schmidt, M., Zhukareva, V., Newell, K., Lee, V., & Trojanowski, J. (2001) · Acta Neuropathologica · doi:10.1007/s004010000330 · Cited by 230 · see citing works
Hof, P. R., Bouras, C., Bu�e, L., Delacourte, A., Perl, D. P., & Morrison, J. H. (1992) · Acta Neuropathologica · doi:10.1007/bf00304630 · Cited by 213 · see citing works
Gong, J.-S., Kobayashi, M., Hayashi, H., Zou, K., Sawamura, N., Fujita, S. C., Yanagisawa, K., & Michikawa, M. (2002) · Journal of Biological Chemistry · doi:10.1074/jbc.m203934200 · Cited by 214 · see citing works
Concussion in chronic traumatic encephalopathy
Stein, T. D., Alvarez, V. E., & McKee, A. C. (2015) · Current Pain and Headache Reports · doi:10.1007/s11916-015-0522-z · Cited by 177 · see citing works
Maroon, J. C., Winkelman, R., Bost, J., Amos, A., Mathyssek, C., & Miele, V. (2015) · PLoS ONE · doi:10.1371/journal.pone.0117338 · Cited by 175 · see citing works
Chronic traumatic encephalopathy - confusion and controversies
Smith, D. H., Johnson, V. E., Trojanowski, J. Q., & Stewart, W. (2019) · Nature Reviews Neurology · doi:10.1038/s41582-018-0114-8 · Cited by 166 · see citing works
Lee, E. B., Kinch, K., Johnson, V. E., Trojanowski, J. Q., Smith, D. H., & Stewart, W. (2019) · Acta Neuropathologica · doi:10.1007/s00401-019-02030-y · Cited by 157 · see citing works
Neuropathological observations in a case of autism presenting with self-injury behavior
Hof, P. R., Knabe, R., Bovier, P., & Bouras, C. (1991) · Acta Neuropathologica · doi:10.1007/bf00308819 · Cited by 151 · see citing works
Smith, D. H., Nakamura, M., McIntosh, T. K., Wang, J., Rodríguez, A., Chen, X.-H., Raghupathi, R., Saatman, K. E., Clemens, J., Schmidt, M. L., et al. (1998) · The American Journal of Pathology · doi:10.1016/s0002-9440(10)65643-x · Cited by 143 · see citing works
“Previously, postmortem histopathological analysis of brains from boxers with dementia pugilistica (punch-drunk syndrome) revealed neurofibrillary tangles and diffuse plaques composed of b-amyloid peptides (Abs) similar to AD lesions.(1,2) Indeed, a single incident of brain trauma may result in a widespread deposition…”
BackgroundResearch Gaps and Controversies in Chronic Traumatic Encephalopathy: A Review
Asken, B. M., Sullan, M. J., DeKosky, S. T., Jaffee, M. S., & Bauer, R. M. (2017) · JAMA Neurology · doi:10.1001/jamaneurol.2017.2396 · Cited by 135 · see citing works
Rubenstein, R., Chang, B., Davies, P., Wagner, A. K., Robertson, C. S., & Wang, K. K. W. (2015) · Journal of Neurotrauma · doi:10.1089/neu.2014.3548 · Cited by 116 · see citing works
Neurofibrillary tangles, but not Alzheimer‐type pathology, in a young boxer
Geddes, J. F., Vowles, G. H., Robinson, S. F. D., & Sutcliffe, J. C. (1996) · Neuropathology and Applied Neurobiology · doi:10.1111/j.1365-2990.1996.tb00840.x · Cited by 116 · see citing works
Tau biology, tauopathy, traumatic brain injury, and diagnostic challenges
Castellani, R. J., & Perry, G. (2019) · Journal of Alzheimer’s Disease · doi:10.3233/jad-180721 · Cited by 110 · see citing works
A critical review of chronic traumatic encephalopathy
Iverson, G. L., Gardner, A. J., McCrory, P., Zafonte, R., & Castellani, R. J. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.05.008 · Cited by 103 · see citing works
Randolph, C., Karantzoulis, S., & Guskiewicz, K. (2013) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617713000805 · Cited by 103 · see citing works
Current understanding of chronic traumatic encephalopathy
Baugh, C. M., Robbins, C. A., Stern, R. A., & McKee, A. C. (2014) · Current Treatment Options in Neurology · doi:10.1007/s11940-014-0306-5 · Cited by 94 · see citing works
Traumatic encephalopathy: Review and provisional research diagnostic criteria
Victoroff, J. (2013) · Neurorehabilitation · doi:10.3233/nre-130839 · Cited by 91 · see citing works
Johnson, V. E., Stewart, W., Trojanowski, J. Q., & Smith, D. H. (2011) · Acta Neuropathologica · doi:10.1007/s00401-011-0909-9 · Cited by 87 · see citing works
The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features
Iverson, G. L., Keene, C. D., Perry, G., & Castellani, R. J. (2017) · Journal of Alzheimer's Disease · doi:10.3233/jad-170654 · Cited by 72 · see citing works
“In the past, based on studies in boxers with extensive neurotrauma exposure, slurred and dysarthric speech, gait problems, Parkinsonism, cognitive impairment, and dementia were considered clinical features [2, 48, 49].”
BackgroundPost–traumatic Alzheimer's disease: preponderance of a single plaque type
CLINTON, J., AMBLER, M. W., & ROBERTS, G. W. (1991) · Neuropathology and Applied Neurobiology · doi:10.1111/j.1365-2990.1991.tb00695.x · Cited by 70 · see citing works
Self-citationBennett, R. E., & Brody, D. L. (2014) · Journal of Neurotrauma · doi:10.1089/neu.2013.3320 · Cited by 64 · see citing works
Apolipoprotein E ϵ4 and fatal cerebral amyloid angiopathy associated with dementia pugilistica
Jordan, B. D., Kanik, A. B., Horwich, M. S., Sweeney, D., Relkin, N. R., Petito, C. K., & Gandy, S. (1995) · Annals of Neurology · doi:10.1002/ana.410380429 · Cited by 55 · see citing works
Shively, S. B., Edgerton, S. L., Iacono, D., Purohit, D. P., Qu, B.-X., Haroutunian, V., Davis, K. L., Diaz-Arrastia, R., & Perl, D. P. (2017) · Acta Neuropathologica · doi:10.1007/s00401-016-1649-7 · Cited by 52 · see citing works
Davis, G. A., Castellani, R. J., & McCrory, P. (2015) · Neurosurgery · doi:10.1227/neu.0000000000000722 · Cited by 47 · see citing works
Chronic Effects of Mild Neurotrauma: Putting the Cart Before the Horse?
Castellani, R. J., Perry, G., & Iverson, G. L. (2015) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0000000000000193 · Cited by 40 · see citing works
Schwab, N., & Hazrati, L.-N. (2018) · Journal of Alzheimer’s Disease · doi:10.3233/jad-180373 · Cited by 18 · see citing works
- Authors
- Roberts, G. W., Allsop, D., & Bruton, C.
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 1990-05-01
- Volume
- 53
- Issue
- 5
- Pages
- 373-378
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC488051
- OpenAlex
- W2123546024
- Cited by
- 518
- References
- 1
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 10 · 2022: 7 · 2021: 7 · 2020: 26 · 2019: 21 · 2018: 14 · 2017: 18 · 2016: 23 · 2015: 30 · 2014: 21 · 2013: 23 · 2012: 15
- FWCI
- 11.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- chronic traumatic encephalopathy, boxing, head trauma, neurofibrillary tangles, Alzheimer's disease, neuropathology, immunocytochemistry, common pathogenic mechanisms
- MeSH terms
- Adult, Aged, Aged, 80 and over, Alzheimer Disease, Amyloid, Boxing, Brain, Brain Concussion, Brain Damage, Chronic, Dementia, Follow-Up Studies, Humans, Immunoenzyme Techniques, Male, Middle Aged, Neurofibrils, Amyloid beta-Peptides
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
