If I, at 58 years old, agreed to a boxing match with someone half my age, it would cause a lot of alarm. My daughters started crying, my partner said some strong words, and my students gave me final confirmation that I had lost the plot. But I’m no “Iron Mike” Tyson.

On July 20, the former heavyweight boxing world champion will step into the ring at AT&T Stadium in Arlington, Texas, to take on YouTuber-turned-boxer Jake Paul. Tyson will be 58 years old and Paul will be 27.

Let’s take a look at what happens biologically to Iron Mike.

Repeated blows to the body can fatigue a boxer, and a shovel hook aimed at the liver can cause a “technical knockout,” but the main target is the head. Boxers are always looking for a knockout blow, but that only happens with a blow to the head.

However, the head takes many powerful blows before a knockout is achieved, if at all. Many boxers “fight to the end”, that is, they manage to fight to the end, from 4 to 12 rounds, each round lasting 3 minutes. So what are the potential effects of such a head injury?

The immediate impact may be minimal. The boxer may recover easily. However, in some cases, the effects can be devastating, such as when a subdural hematoma develops. In this condition, shear forces cause tearing of the bridging veins between the brain and blood vessels within the brain covering or meninges.

Bleeding from these torn veins causes blood to collect and compress the brain. This can cause confusion, loss of consciousness, neurological damage, and even death.

In older people, brain volume tends to decrease. This makes the bridging veins longer and more susceptible to rupture. Alcoholism is known to accelerate brain atrophy, and Tyson appears to have had this as a past risk factor.

I recall a patient, a boxer, who had previously suffered from a subdural hematoma, resulting in disability and severe depression. These were devastating and lasting effects.

Shear forces applied to the brain damage neurons (brain cells). Nerve fibers can be ruptured, which can have subtle or very serious effects. This so-called “diffuse axonal damage” accumulates over time and can lead to early loss of cognitive function. This is known as dementia pagilistica, or chronic traumatic encephalopathy (CTE).

Read more: Sports-related traumatic brain injury: Family reveals the ‘hell’ of living with the condition

Repeated injuries cause abnormal tau proteins to accumulate in the brain. As a result, brain cells are lost and the brain becomes smaller. Patients experience changes in behavior, mood, and ability to think.

In some cases, a condition similar to Parkinson’s disease can be caused by the loss of neurons in a part of the brain called the substantia nigra. Muhammad Ali may have suffered from this as well, but this has never been confirmed.

heart problems

In middle age, the likelihood of cardiac events such as arrhythmia (irregular heartbeat), angina (reduced blood flow to the heart muscle), and myocardial infarction (heart attack) increases. Staying healthy prevents cardiovascular disease, and Tyson’s exercise habits will benefit him greatly. But there’s always the temptation to overdo it in the gym.

Extreme exercise can cause cardiac fibrosis (scarring of the heart muscle), which over time can lead to heart failure and even sudden death.

Coronary atherosclerosis (narrowing of the heart’s arteries) is common in middle-aged people, even in apparently healthy people. However, it can cause sudden death during exercise. Regular exercise reduces this risk, but a cocaine habit greatly increases the risk. And Tyson is known to have used the drug in the past.

Blows to the chest can also be nasty. Myocardial infarction is a condition in which the heart muscle is damaged by such a shock. This can lead to arrhythmia, decreased ability of the heart muscle to contract, and death. Although very rare, coronary artery disease can make the situation worse.

Age doesn’t have to be a barrier

So far we’ve focused on Iron Mike, but what about his opponent Jake Paul? He is a much younger man and likely does not have heart disease or brain atrophy, so he may be protected to some extent. However, he had little boxing experience and entered boxing late.

There are many examples of boxers in their 50s and 60s still competing and defeating younger competitors. If Tyson maintains his speed, power and ability to outwit Paul, he might win.

Finally, remember that exercise is good for your health at any age, and there is ample evidence that moderate boxing has many health benefits.