4th May 2018, Volume 131 Number 1474

Vahid Payman, Susan Yates, Sarah Cullum

We present a case series of eight former amateur or professional boxers, all of Pacific background and all living in South Auckland, New Zealand, seven of whom present with early…

Subscriber content

The full contents of this page is only available to subscribers.

To view this content please login or subscribe


We found an unusually large number of Samoan and Tongan former boxers in South Auckland who were suffering from early onset (40 and 50 years of age) dementia. When we looked into their histories, we found that most of had drunk heavily in their youth and also had other risk factors for dementia such as diabetes, high blood pressure or high cholesterol. We think that a combination of head injuries from boxing as well as these other risk factors puts young Pacific boxers at increased risk of developing early onset dementia. Sports physicians should warn young Pacific boxers about this risk.



To describe the biopsychosocial characteristics of a series of Pacific men living in South Auckland with a history of boxing presenting with early onset dementia. We discuss the history of boxing in Pacific people and the possibility of increased risk of early onset dementia in New Zealand Pacific men compared to their European counterparts.


We reviewed the files of Pacific men with a history of amateur or professional boxing who presented to our memory and older adult mental health services with early onset dementia over a 45-month period. We gathered relevant information to construct a biopsychosocial paradigm as possible explanation of this phenomenon.


We identified a series of eight New Zealand Pacific men with early onset dementia and with a history of boxing. Alcohol was a contributing factor in seven of the eight cases, and vascular risk factors in five.


Historical, cultural and socio-economic factors underpin the attraction of some Pacific men to boxing as a sport. Given that New Zealand Pacific peoples may have an earlier onset of dementia than their European counterparts, further research is required to establish whether boxing is a contributory factor. Sports physicians should advise young New Zealand Pacific boxers about the long-term risks associated with their sport.

Author Information

Vahid Payman, Koropiko Mental Health Services for Older People, Middlemore Hospital, Otahuhu, Auckland; Susan Yates, The Memory Team, Middlemore Hospital, Otahuhu, Auckland;
Sarah Cullum, Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland Mail Centre, Auckland.


The authors wish to acknowledge Dr Staverton Kautoke and Dr Mark Fisher for comments on earlier drafts of this paper, Dr Francis Wu for reporting the CT scans, and Susan Brock for help in retrieving patient files. 


Dr Vahid Payman, Koropiko Mental Health Services for Older People, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland.

Correspondence Email


Competing Interests



  1. Counties Manukau DHB (2011). Residential Locality Profiles for Counties Manukau DHB, CMDHB Overview.
  2. Storey JE, Rowland JTJ, Conforti DA, et al. The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. Int Psychogeriatr. 2004; 16:13–31.
  3. Mioshi E, Dawson K, Mitchell J, et al. The Addenbrooke’s Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Intl J Geriatr Psychiatry. 2006; 21:1078–1085.
  4. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12:189–198.
  5. Dubois B, Slachevsky A, Litvan I, et al. A frontal assessment battery at bedside. Neurology. 2000; 55:1621–1626.
  6. Nasreddine ZS, Phillips NA, Bedirian V. The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment. J Am Geriatr Soc. 2005; 53:695–699.
  7. Mallon S. Punching Above Their Weight: A Hard Hitting History of Polynesian Fighters from New Zealand. 2015. Available at: http://fightland.vice.com/blog/punching-above-their-weight-a-hard-hitting-history-of-polynesian-fighters-from-new-zealand. Accessed 8 September 2015.
  8. Scott RM, Buckley HR. Exploring Prehistoric Violence in Tonga: Understanding Skeletal Trauma from a Biocultural Perspective. Current Anthropology. 2014; 55:335–347.
  9. Samwell D. Some Account of a Voyage to South Sea’s. In: The Journals of Captain James Cook, The Voyage Of The Resolution and Discovery, 1776–1780 Part Two. Beaglehole JC (ed) London, Cambridge University Press For The Hakluyt Society, 1967
  10. Boxing New Zealand. New Zealand Amateur Champions. Available at: www.boxingnz.org.nz/default.aspx?page=champions&cat=2 Accessed 22 February 2016.
  11. Wikipedia. Boxing at the Pacific Games. Available at: http://en.wikipedia.org/wiki/Boxing_at_the_Pacific_Games Accessed 11 February 2016.
  12. Veblen T. The theory of the leisure class. New York, Mentor, 1956. 
  13. Stoner L, Shultz SP, Lambrick DM, et al. The Combating Obesity in Māori and Pasifika Adolescent School-Children Study: COMPASS Methodology and Study Protocol. Int J Prev Med. 2013; 4:565–579. 
  14. Sugden J. Boxing and society, an international analysis. Manchester, Manchester University Press, 1996.
  15. Smith DH, Johnson VE, Stewart W. Chronic neuropathologies of single and repetitive TBI: substrates of dementia? Nat Rev Neurol. 2013; 9:211–221.
  16. Forstl H, Haass C, Hemmer B, et al. Boxing – Acute Complications and Late Sequelae. Dtsch Arztebl Int. 2010; 107:835–839.
  17. Nowak LA, Smith GG, Reyes PF. Dementia in a retired world boxing champion: case report and literature review. Clin Neuropathol. 2008; 28:275–280.
  18. Johnson J. Organic Psychosyndromes due to Boxing. Br J Psych. 1969; 115:45–53.
  19. Feigin VL, McNaughton H, Dyall L. Burden of stroke in Māori and Pacific peoples of New Zealand. Intl J Stroke. 1969; 2:208–210.
  20. Joshy G, Simmons D. Epidemiology of diabetes in New Zealand: revisit to a changing landscape. N Z Med J. 2006; 119:91–105.
  21. Ministry of Health (2013) The Health of Pacific Adults and Children. Available at: http://www.health.govt.nz/system/files/documents/publications. Accessed November 2014.
  22. Ministry of Health 2013 Hazardous drinking in 2011/12: findings from the NZ Health Survey. Available at: http://www.health.govt.nz/system/files/documents/publications/12-findings-from-the-new-zealand-health-survey.pdf. Accessed 26 November 2014.
  23. Jatrana S, Blakely T. Ethnic inequalities in mortality among the elderly in New Zealand. Aust N Z J Public Health. 2008; 32:437–43.
  24. Baxter J, Kokaua J, Wells J, et al. Ethnic comparisons of the 12 month prevalence of mental disorders and treatment contact in Te Rau Hinengaro: the New Zealand Mental Health Survey. Aust N Z J Psych. 2006; 40:905–913.
  25. Schu MC, Sherva R, Farrer LA, et al. The Genetics of Alzheimer’s Disease. In: Alzheimer’s Disease – Modernizing Concept, Biological Diagnosis and Therapy. Advances in Biological Psychiatry. Hampel H & Carrillo MC (eds) Basel, Karger, 2012.


The downloadable PDF version of this article is only available to subscribers.

To view this content please login or subscribe