title: Boxing-acute complications and late sequelae: from concussion to dementia.
abstract: BACKGROUND
  Boxing has received increased public attention and acceptance in recent years. However, this development has not been accompanied by a critical discussion of the early and late health complications.
  
  
  METHODS
  We selectively review recent studies on the acute, subacute, and chronic neuropsychiatric consequences of boxing.
  
  
  RESULTS
  Cerebral concussions ("knock-outs") are the most relevant acute consequence of boxing. The number of reported cases of death in the ring seems to have mildly decreased. Subacute neuropsychological deficits appear to last longer than subjective symptoms. The associated molecular changes demonstrate neuronal and glial injury correlated with the number and severity of blows to the head (altered total tau, beta-amyloid, neurofilament light protein, glial fibrillary acidic protein, and neuron-specific enolase). The risk of a punch-drunk syndrome (boxer's dementia, dementia pugilistica) as a late effect of chronic traumatic brain injury is associated with the duration of a boxer's career and with his earlier stamina. There are similarities (e.g. increased risk with ApoE4-polymorphism, beta-amyloid pathology) and differences (more tau pathology in boxers) compared with Alzheimer's disease.
  
  
  CONCLUSIONS
  Protective gear has led to a remarkable reduction of risks in amateur boxing. Similar measures can also be used in professional boxing, but may decrease the thrill, which does appeal to many supporters.
authors.affiliation: Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München, Ismaningerstr. 22, 81675 München, Germany. hans.foerstl@lrz.tu-muenchen.de
authors.forename: Hans
authors.initials: H
authors.lastname: Förstl
authors.forename: Christian
authors.initials: C
authors.lastname: Haass
authors.forename: Bernhard
authors.initials: B
authors.lastname: Hemmer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.forename: Martin
authors.initials: M
authors.lastname: Halle
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D001914:Boxing / Q000293:injuries*; D001921:Brain / Q000473:pathology; D001924:Brain Concussion / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D002423:Cause of Death; D003704:Dementia / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012307:Risk Factors; D055815:Young Adult