Dementia in Sport: Causation, Management and Prevention

Abstract

Dementia in sport emerged as a problem at the beginning of the 20^th century, when "punch drunk syndrome" was diagnosed in boxers. This diagnosis was soon refined to dementia pugilistica and later to chronic traumatic encephalopathy. Since then dementia has appeared in other sports, particularly those involving violent collisions and/or head injuries. The problem continues in boxing, but during the 21^st century dementia has become a significant problem in American Football, football in the United Kingdom (soccer) and rugby. For example, a recent study from Boston found evidence of chronic traumatic encephalopathy in >90% of former American Football players, and a controlled study of >7,000 soccer players found that the former footballers were 3.5 times more likely to die from dementia or other neuro-degenerative diseases than the controls, the increased risk being related to playing position and length of playing career, thus establishing a dose-response relationship. The emerging consensus is that dementia in sport is caused by repetitive subconcussive head injuries occurring over a long-playing career.

The author asserts that the brain’s vulnerability to repeated minor blows to the head is due to its inherent fragility and evidence is provided to support this view. For effective prevention and management three steps are outlined. The first is recognition and acceptance of the brain’s vulnerability and fragility and mounting a public health initiative to educate the public and the sporting world. Second, all players at risk should have baseline cognitive tests which must be repeated regularly; if this show deterioration early retirement from the sport must be considered. The third recommendation is that all the sports regulatory bodies must explore with urgency how brain injuries in their specific field can be reduced and eliminated.