When a cluster of Pasifika men presented to Middlemore Hospital with dementia symptoms over a 45-month period, doctors decided to dig a little deeper into their backgrounds to look for patterns.
What they found was that eight of the South Auckland men had a background in either amateur or professional boxing and seven of them were suffering from early-onset dementia. They eighth started showing signs of dementia at 71.
The case studies are outlined today in an article in the New Zealand Medical Journal. The authors, Drs Vahid Payman and Susan Yates of Middlemore and Susan Cullum from the University of Auckland, state that while more research is needed to establish whether boxing is a contributory factor, sports physicians should advise young Pasifika boxers about the long-term risks of their sport.
New Zealand's former WBO world champion heavyweight Joseph Parker told the Herald he endorsed those sentiments.
The South Auckland born-and-raised Samoan said: "In boxing I take my health very seriously and take all the precautions I can.
"People will always be free to choose to box but any study that can help improve health outcomes at the grassroots level has to be a good thing for the sport."
The authors say the study is unique and interesting for a number of reasons, most notably the unusually large number of early-onset patients from a single ethnic grouping.
"It casts some light on the growing understanding of the probable multi-factorial nature of early onset dementia in boxers," the report notes, and, "suggests that a large-scale dementia prevalence study is needed in New Zealand to determine whether New Zealand Pacific people present with earlier onset dementia compared to their European counterparts."
Of the eight case studies, the range at which they started to show cognitive decline were between 46 and 71. Four cases occurred before the age of 55, significantly earlier than the norm.
Six men were Samoan, two were Tongan.
Aside from boxing and ethnicity, there were several threads that connected the men.
Seven of the eight were moderate to heavy drinkers, all were married, most had limited education and several were violent outside the ring, including spousal abuse.
The authors pointed to cultural aspects that made boxing attractive to the Pasifika population, including historic and financial factors.
"Boxing subcultures flourish in urban centers in which ethnic minorities are over-represented," the article stated.
"Boxers often tend to be the children of first generation immigrants, who have not yet established themselves financially in a new country…
"Seven of the cases reported in our series lived in either Otara or Mangere, which are the two localities in Counties Manukau with the lowest incomes."
Samoan-born amateur heavyweight Patrick Mailata, who won bronze at the recent Commonwealth Games, said he was aware of the risks associated with boxing, but to this point the worst head injuries he had suffered were playing rugby and league.
Mailata, 23, felt boxers needed to put a finite timeline on that part of their life.
"I believe it's a fast man's game, a young man's game. I have other ambitions in life and think 10-15 years, if you're pushing it, is about right for boxing."
Boxing's link to dementia is well-established. Punch-drunk syndrome was recognised as early as the 1920s and several high-profile boxers have suffered in later life, including arguably the greatest boxer of all, Muhammad Ali, who died from complications associated with Parkinson's disease.
More recently, there has been persuasive links made between concussions suffered in contact sports like American football, rugby and league and Chronic Traumatic Encephalopathy.