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Neurologists frequently make diagnoses by observation. In fact, most movement disorder diagnoses are made by direct observation or description by patients and families. Mr. Biden has Parkinsonism, an umbrella term that refers to neurologic conditions that cause slowed movements, rigidity, and tremors. By observation, he has a masked face, reduced blinking, stiff and slow gait, hunched posture, low volume voice, imbalance, freezing, mild cognitive disturbance, and difficulty turning. I have seen one video of tremor. All these diagnose Parkinsonism. He would need further investigation by experts to determine which specific disease within the broad term he has, such as idiopathic Parkinson's disease or another specific disease.
While there is no cure for the many conditions comprising Parkinsonism, there are effective treatments for many of the symptoms. By failing to get a diagnosis, the president is denying himself such treatments, and so worsens his own situation.
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Soon after reading this, I had lunch with a neuropathologist friend. I mentioned this report, and, without hesitation, he refined the diagnosis. "There's no doubt he has Lewy Body Dementia." No doubt. From someone who hasn't come within a thousand miles of the Occupant.
The only absolute test for PD and its variants comes with a post-mortem examination of the sufferer's brain. I know that inquiring minds might think that's a good idea for us to do yesterday, but it will have to wait until after Joe assumes room temperature on his own.
Before a post-mortem, the only way to diagnose every PD variant comes from observation. There are no diagnostic tests. CT and MRI don't help.
The problem is that a small area of the brain called the "substantia nigra" (black substance) stops making dopamine that it normally sends to various parts of the brain to help them function. Since this is inside the blood-brain barrier, blood tests don't help. And since the shape and size of the substantia nigra doesn't change with the disease, imaging doesn't help, either.
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PD is a waxing and waning disease. Today can be awful, and tomorrow better. Treatment can make the awful somewhat better but doesn't change the disease. It just changes how it looks. And it doesn't change the fact that there is, at present, no treatment that will reverse the disease. Joe's over the hill and gaining speed.
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LBD has some recall problems, such as when Joe claimed to have spoken with long-dead French President Mitterand. And while we can't distinguish between Biden's fabulist tendencies and bad memory, it's clear from Robert Hur's report that Joe can't remember some important things.
Unfortunately, this train doesn't stop here. PD variants demonstrate an inability to return to a train of thought when distracted. This was front and center when Joe stumbled at the debate and then finished with an incoherent rambling word salad. It even shows up when he's reading a teleprompter.
Worst of all, PD sufferers have extreme difficulty reasoning from A to B. And don't push them toward C. I've watched this decline with a good friend, and now he must have full-time care where he's not allowed to make decisions. This is Joe's near future.
Sounds persuasive to me. But I have no experiences from which to draw.
Thoughts from those that have some experience with this?
