From a physician: Parkinson's disease might be Joe Biden's BEST diagnosis

His clinical symptoms are impossible to ignore, this physician writes.

After this morning’s article about the repeated visits by a Parkinson’s disease specialist to the White House resident medical clinic since last summer, a physician emailed me to argue that the specifics of Biden’s diagnosis matter less than the fact his symptoms are now so visible.

He consented to have his email published, on the condition he not be named. This is edited only for length and minor copy-editing fixes:

All the disturbing symptoms we all see are called Parkinsonism. That is simply a fact. They consist of motor slowing, festinating gait with reduced arm swing, mask like ‘facies’, reduced vocal volume.

In fact in medical school we watch videos of patients with Parkinsonism like Biden to illustrate to the students how this manifests.

The only question is what’s causing it. The best case scenario for him would be that this is in fact, Parkinson’s disease. There’s a lot of treatment and the cognitive effects can be variable and sometimes not that significant.

Worst case would be Lewy body dementia. This can be rapidly progressive, and the diagnosis is usually only made postmortem or based on the rapid decline.

Other possibilities include Alzheimer’s disease, though that is less likely to have Parkinsonism. And then finally vascular dementia, which definitely can present like this, and the course can be variable, sometimes plateauing for long periods of time. There are other very obscure causes of Parkinsonism that certainly could be a possibility, but much much less likely.

So the question isn’t does he have Parkinsonism; that is something that is simply observable,  the question remains and the only question is what is causing this, and whether there’s likely to be significant, and or rapid decline, particularly in cognition.

The scandal is that they are hiding all this and that we are not having a public discussion about it. I did notice that [CNN chief medical correspondent Dr.] Sanjay Gupta was beginning to tiptoe into this conversation.

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(Join me in the fight for the truth.)

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One last thing to keep in mind. He did have some sort of neurosurgery for “aneurysm, bleed“ and people with those sorts of bleeds to have a higher incidence of neurocognitive decline as they age.

Just so you don’t get any criticism, there is one last possible explanation for his Parkinsonism and that would be a medication side effect. But if that were true, they would tell us what the medicine was by now, and it does not explain the confusion and some of the cognitive changes.

Medication-induced Parkinsonian features is a common thing as well though typically without mental status changes and in my experience without all the vocal changes that we see with him…

Another issue is that medication for Parkinson is can have protean effects on mental status. Sometimes bizarre things such as compulsive gambling. None of these changes would you want manifesting in someone in the Oval Office.

Finally, people become very critical whenever you use diagnostic terms, so it is always important to couch. Any conversation about diagnosis is merely reviewing what is called the differential diagnosis list for people with these symptoms. This is something we teach every medical student.

So it is not rendering a diagnosis. It is merely reviewing the common causes of these symptoms. And [I] always point out the diagnosis itself requires actually evaluat[ing] the patient with the list I’ve given you.