After this morning's article About repeated visits by a Parkinson's disease specialist to the White House resident medical clinic since last summer, one doctor emailed me to argue that the details of Biden's diagnosis matter less than the fact that his symptoms are now so visible.
He consented to his email being published, on the condition that he not be named. This is only edited for copy editing corrections and shorter lengths:
All the disturbing symptoms we all see are called parkinsonism. This is simply a fact. They consist of motor deceleration, festive gait with reduced arm swing, mask like 'faces', reduced vocal volume.
In fact, in medical school we watch videos of Parkinson's patients like Biden to illustrate to students how it manifests itself.
The only question is what is the cause. The best case scenario for him would be that this is, in fact, Parkinson's disease. There is a lot of treatment and the cognitive effects can be variable and sometimes not that significant.
The worst case scenario would be Lewy body dementia. This can be rapidly progressive and diagnosis is made only postmortem or based on rapid decline.
Other possibilities include Alzheimer's disease, although Parkinsonism is less likely. And finally vascular dementia, which can definitely present like this, and the course can be variable, sometimes stabilizing for long periods of time. There are other very obscure causes of parkinsonism that could certainly be a possibility, but are much less likely.
So the question is not whether he has parkinsonism; this is something that is simply observable, the question remains and the only question is what is causing this, and whether there is likely to be a significant or rapid decline, particularly in cognition.
The scandal is that they are hiding everything and we are not having a public discussion about it. I've realized [CNN chief medical correspondent Dr.] Sanjay Gupta was starting to tiptoe into this conversation.
—
(Join me in the fight for the truth.)
—
One last thing to consider. He had some type of neurosurgery for “aneurysm bleeding” and people with these types of bleeding have a higher incidence of neurocognitive impairment as they age.
Because you don't get any criticism, there is one last possible explanation for his parkinsonism and that would be a side effect of the medication. But if that were true, they would now tell us what the medicine was, and it doesn't explain the confusion and some of the cognitive changes.
Medication-induced parkinsonian features are also common, though usually without mental status changes and, in my experience, without all the vocal changes we see with him…
Another problem is that Parkinson's medication can have protean effects on mental state. Sometimes weird things like compulsive gambling. None of these changes would you want to manifest in someone in the Oval Office.
Finally, people get very judgmental whenever you use diagnostic terms, so it's always important to rest. Any conversation about diagnosis is simply reviewing what is called a differential diagnosis list for people with these symptoms. This is something we teach all medical students.
Therefore, it is not a diagnosis. It is simply a matter of reviewing the common causes of these symptoms. I [I] always point out that the diagnosis itself requires an effective assessment[ing] the patient with the list I gave you.
English 
Español de Venezuela 