Is CTE (Chronic Traumatic Encephalopathy) irreversible? As far as we know, it is not, but the severity of the disease typically varies depending on TBI, and mTBI events (Traumatic Brain Injury, the m is for mild).
Do all boxers develop CTE, no, however, the risk becomes greater when a boxer has a larger number of fights and especially more regularly, as the process of neurogenesis, and other repair mechanisms can become disrupted.
An Amateur boxer with approximately 50 fights, is more likely to develop stage 1-2 CTE later in life, compared to someone more experienced, and especially a pro fighter with a 100 fights or more (amateur and pro fights combined), is at greater risk of developing stage 3-4 CTE.
It has also been noted that other variables associated with the development of CTE include lifestyle, and genetics, such as the presence of the APOe-4 gene. Tau pathology is also a factor, Tau is a protein which plays an immune function in the neurons, however, this can become tangled. It is not yet known whether neurofibrillary tangles can be reversed.
The presence of Beta-amyloid plaques has been associated with AD (Alzheimer’s Disease) and CTE, some treatments may help slow, if not remove the generation of amyloid plaques, omega-3 fatty acids are one example.
Curcumin and Vitamin D may also help clear beta-amyloid plaques, and lab studies have been conducted on Curcumin, Curcumin is a compound that can be found in Turmeric, and other sources as well.
However, Beta-amyloid plaques are a single component in CTE development, and being able to reduce or remove these won’t necessarily prevent the development of CTE.
As far as I know, NFTs (Neuro-fibrillary tangles) and hyperphosphorylation of tau, cannot be treated, or at least, reversed, it is possible that they can be managed, but prevention before a TBI is vital, but its highly unlikely that this can be done in a contact sport such as boxing.
What can Boxers do?
In a boxing context, improving defence, hydration, reducing the number of fights and sparring sessions (both technical and hard sparring) may be the best way to reduce the risk of CTE, and certainly reduce the risk of higher stage CTE.
Boxers absolutely should be drilling defence regularly, and may need to reduce sparring in favour of pad work, bag work, shadow boxing etc.
Visualisation should also be used as a technique to mentally brace a fighter for the defensive moves they will need to perform as well as the offensive moves of their opponent in sparring, or a bout.
I also wonder if VR simulations can help here? The simulated environment offers a safe way to try things out, however, I don’t think this will be as effective as light technical sparring, at least for now.
Alcohol and smoking are also associated risk factors, so diet and lifestyle are very important, including sleep duration and quality, which can help recovery after a training session.
Sleep is of course important for brain health and improving performance, as this is the time period where the body calibrates itself and responds to stimuli exposure and training.
weight-cutting is a risk factor, as the effects of dehydration will impact the brain, as well as reduce the protective effects of intra-cranial fluid (CSF) that is around the brain.
Improving education on boxing and CTE is an ongoing development: helping boxers, trainers, and others associated with the sport identify the signs of development, and potentially prevent further risk.
fighters also need sufficient time after hard fights, or knockouts to recover, as they will be more vulnerable to brain trauma during the period of recovery. The suggested recovery time is anywhere between 30 and 60 days, with the latter being preferable for a full recovery.
it is possible that in the future, shorter, and or fewer rounds, may be proposed to further reduce the risk.
Boxers can also undergo MRI scans and other diagnostics to monitor brain, behavioural and mood changes, as these can show potential symptoms of the disease (this is however, an expensive process, but perhaps costs may be reduced in the future depending on the availability of the technology, and relative demand?).
Boxers who are showing the early signs, or at higher risk of developing the disease could, and should be encouraged to retire.
Closing statement
Research is ongoing, and more treatments may be found in due course, but so far, prevention and management can be implemented rather than curing the disease.
I have been reading through studies and articles to bolster my knowledge in this area, in which I will provide citations at the bottom of this article.
Citations
Gandy S, Ikonomovic MD, Mitsis E, Elder G, Ahlers ST, Barth J, Stone JR, DeKosky ST. Chronic traumatic encephalopathy: clinical-biomarker correlations and current concepts in pathogenesis. Mol Neurodegener. 2014 Sep 17;9:37. doi: 10.1186/1750-1326-9-37. PMID: 25231386; PMCID: PMC4249716.
Doherty R, Madigan SM, Nevill A, Warrington G, Ellis JG. The Sleep and Recovery Practices of Athletes. Nutrients. 2021 Apr 17;13(4):1330. doi: 10.3390/nu13041330. PMID: 33920560; PMCID: PMC8072992.
Pu H, Jiang X, Wei Z, Hong D, Hassan S, Zhang W, Liu J, Meng H, Shi Y, Chen L, Chen J. Repetitive and Prolonged Omega-3 Fatty Acid Treatment After Traumatic Brain Injury Enhances Long-Term Tissue Restoration and Cognitive Recovery. Cell Transplant. 2017 Apr 13;26(4):555-569. doi: 10.3727/096368916X693842. Epub 2016 Nov 24. PMID: 27938482; PMCID: PMC5531869.
Kempton MJ, Ettinger U, Schmechtig A, Winter EM, Smith L, McMorris T, Wilkinson ID, Williams SC, Smith MS. Effects of acute dehydration on brain morphology in healthy humans. Hum Brain Mapp. 2009 Jan;30(1):291-8. doi: 10.1002/hbm.20500. PMID: 18064587; PMCID: PMC6871128.
