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Dementia Pugilistica F057

Document
Last amended 
11 January 2021
Current RMA Instruments
Reasonable Hypothesis SOP
90 of 2021
Balance of Probabilities SOP
91 of 2021
Changes from previous Instruments

SOP Bulletin 218

ICD Coding
  • ICD-9-CM Codes: 294.1
  • ICD-10-AM Codes: F02.8

Brief description

Dementia pugilistica is the name given to the chronic neurological (cognitive, motor and / or behavioural) impairment that occurs as a sequelae of repeated, forceful blows to the head.  It was first described and most commonly occurs in professional boxers (in around 20% of such boxers), though may occur as a consequence of other high‑impact sports or activities where there are forceful impacts to the head. 

There is accumulating evidence that repeated mild traumatic brain injuries can contribute to a condition termed "chronic traumatic encephalopathy" (CTE). CTE has been described in professional sport settings, and others with a history of repeated head traumas. Symptoms typically include progressive cognitive impairment and neuropsychological symptoms.

The RMA has indicated that ‘chronic traumatic encephalopathy’ (CTE) and ‘traumatic encephalopathy syndrome’ are synonyms for dementia pugilistica and as such are covered by the dementia pugilistica SOP.

Importantly, the RMA has investigated ‘post-concussion syndrome’ and has declared that this is not considered an injury or disease for the purposes of the VEA or MRCA, and is therefore not able to be related to service.  This means that claims for this condition (‘post-concussion syndrome’) cannot be accepted with that diagnosis. If post-concussion syndrome is claimed, investigation should focus on whether an alternate diagnostic label such as CTE or dementia pugilistica would be appropriate.

See also the Concussion SOP page at Concussion S024 | SOP Information, SOPs and Supporting Information – alphabetic listing, C to D (dva.gov.au).

Confirming the diagnosis 

Diagnosis is made from a combination of history, neurological/cognitive assessment which may include neuropsychological testing and brain imaging.  Diagnosis may also occur after death during post‑mortem investigations of brain tissue.

The relevant medical specialist is a neurologist.

Additional diagnoses covered by SOP

  • "slap-happy syndrome"
  • "punch drunk syndrome"
  • chronic progressive traumatic encephalopathy
  • chronic traumatic encephalopathy
  • traumatic encephalopathy syndrome

Conditions not covered by SOP

  • Any type of dementia other than dementia pugilistica
  • Post-concussion syndrome^
  • Concussion*
  • Mild Traumatic Brain Injury, single injury - should be considered under the concussion SOP
  • Parkinson disease and secondary parkinsonism*
  • Moderate to Severe Traumatic Brain Injury*

* another SOP applies

^declared not to be a disease or injury by the RMA

Clinical onset

Once the diagnosis has been established/confirmed (with a sufficient level of neurological decline) it may be possible to back-date onset to a minor extent, based on symptoms/signs, but it may be difficult to establish a point at which the decline in function reached a level sufficient to warrant diagnosis. The onset date is unlikely to be a specific trauma.