In one of those coincidences that sometimes make you stop and think, at the time I first heard of the death of Muhammad Ali I was, for no obvious reason, looking at a framed photograph of him in my study. It’s one of the all-time great sporting images, of Ali towering over a stricken Sonny Liston and bellowing at him to get up and start fighting again, and shows him at his athletic pomp. The reason I have always found it interesting, however, apart from the sporting spectacle itself, is that it is personally signed by Ali at a time when he was starting to show the signs of progressive Parkinson’s disease. Unusually, he signed it as ‘Muhammad Ali, aka Cassius Clay’ and it shows his writing getting smaller and more shaky as so often happens during the course of the illness.
In fact, it was Ali himself who guessed what was happening to him during the battery of tests he had just before his diagnosis was made at the age of 42. Saying to his doctor: ‘I’ve been in the boxing ring for 30 years and taken a lot of punches, so there’s a great possibility something is seriously wrong’, he may have been afraid he was suffering not from Parkinson’s but dementia pugilistica — the term given to the progressive brain damage caused by repeated blows to the head, a condition that afflicted boxers such as Joe Louis and Sugar Ray Robinson. (Doctors now suspect that elderly footballers may also suffer this as a consequence of heading heavy leather footballs in their youth and I have a handful of patients who are former professional footballers now in their 70s who all have symptoms of dementia at various stages of progression and severity.)
The term ‘punch drunk’ entered the language in 1928, when the syndrome was first described by an American doctor called Dr Martland, who at the time wondered rather prophetically whether some of the boxers he was seeing with the condition were also showing symptoms of Parkinson’s disease.
The 64,000 dollar question remains — did boxing cause Ali’s Parkinson’s disease? The short answer is that no one is able to say, but the longer one is that it may well have done so because of the length of time he continued to box way past his prime. What is unequivocal is that professional boxing triggers brain damage. It is unique in that the aim of the sport is to inflict damage to the head with the ultimate aim being a knockout and loss of consciousness, and, in addition to the term dementia pugilistica, we now have one known as ‘pugilistic parkinsonism’ in medicine.
Parkinson’s disease was recognised by general practitioner James Parkinson some two centuries ago and occurs when certain nerve cells (neurons) in a part of the brain called the substantia nigra die or become impaired. Normally, these cells produce a vital chemical known as dopamine, and this allows smooth, coordinated function of the body’s muscles and movement. However, when about 80 per cent of the dopamine-producing cells are damaged, the symptoms of Parkinson disease appear and worsen as more such cells are lost. The loss of dopamine production in the brain causes the primary symptoms of Parkinson’s disease, key signs of which are tremor (shaking), slowness of movement, rigidity (stiffness) and difficulty with balance.
Other signs of Parkinson’s disease may include a stiff facial expression, shuffling walk and muffled speech — signs starting to appear in Ali two years after retirement from boxing, although there were earlier indications, such as when he appeared on the Michael Parkinson chat show late in his boxing career. This was so apparent that Parkinson repeatedly inquired as gently as possible whether boxing was affecting his intellect — a query Ali waved aside, essentially ducking the question.
Parkinson’s disease affects both men and women in almost equal numbers and shows no social, ethnic, economic or geographic boundaries. The condition usually develops after the age of 65 — only 15 per cent of those diagnosed are under 50 and so Ali was statistically young to be diagnosed with it. He will be remembered for many of the things he did and said, both inside a boxing ring and outside it, and George Foreman perhaps put it most succinctly on the Today programme after the news of Ali’s death broke. He said: ‘The greatest boxer? Give that to some boxer. Muhammad Ali was one of the greatest human beings that I’ve ever met in my life and that other human beings have ever met.’
For me, I’ll raise a glass to that photograph, look at that shaky signature and wonder if he would still be with us if he had only stopped boxing when age started to catch up with him and the punches started to rain down on that once untouchable head.