Neuropsychological Consequences of Boxing and Recommendations to Improve Safety: A National Academy of Neuropsychology Education Paper

Abstract

Boxing has held appeal for many athletes and audiences for centuries, and injuries have been part of boxing since its inception. Although permanent and irreversible neurologic dysfunction does not occur in the majority of participants, an association has been reported between the number of bouts fought and the development of neurologic, psychiatric, or histopathological signs and symptoms of encephalopathy in boxers. The purpose of this paper is to (i) provide clinical neuropsychologists, other health-care professionals, and the general public with information about the potential neuropsychological consequences of boxing, and (ii) provide recommendations to improve safety standards for those who participate in the sport.

Therapeutic Intervention in a Case of Ataxic Dysarthria Associated With a History of Amateur Boxing

“…During the course of his boxing career, he experienced seven reported knockouts, including five technical knockouts. A technical knockout does not involve a loss of consciousness but signals the end of a match based on a referee's opinion that the boxer can no longer safely continue to fight (Heilbronner et al, 2009).…”

What boxing tells us about repetitive head trauma and the brain

“…However, whether these signs and symptoms develop in predictable stages is debated [4,5,16]. There does appear to be agreement that behavioral changes, ranging from affective disorders to paranoia, irritability, and aggression, occur frequently as an early symptom [4,5,9,17-19]. Progressively, cognitive dysfunction becomes noticeable with additional motor features such as dysarthria, parkinsonism, and gait disorder.…”

“…In regard to the specific neuropsychological domains effected in CTE, psychometric testing of former and active professional boxers has most frequently demonstrated deficits in memory, information-processing speed, finger-tapping speed, complex attentional tasks, and frontal-executive functions [5,9]. In contrast to professional fighting, amateur fighting has rarely been shown to result in any long-term changes in cognitive function [21]; longitudinal studies did not show any effect of boxing on psychometric results in amateurs even up to 9 years [22].…”

Long-term functional alterations in sports concussion

“…69 Along those lines, a recent consensus statement regarding the neuropsychological aspects of boxing strongly cautions against the potential neuropsychological sequelae of extended exposure to the sport. 29 To this day, the exact nature of the cumulative effects of multiple concussions on neuropsychological function remains a subject of debate. What seems apparent is that there is a subgroup of athletes who are more vulnerable than others and that certain deficits are more conspicuous than others.…”