Letter from Dr. Mary Anne Whelan

Re: Biden’s Mental Status

The recent performance of Biden in the debate of June 28 has given rise to much concern about the president’s cognitive status. Recently it has been suggested, by neurologists and others, that the president has Parkinson’s disease. A starting point should be an understanding of what that implies.

Parkinson’s disease is a neurological condition generally considered as first described by James Parkinson as “Shaking Palsy” in 1813 (though a late 17th-century description also exists, in Spanish). Now, as then, it remains a condition defined by its symptoms, and by observation and examination of the person. It cannot be diagnosed by an imaging study such as a CT scan or an MRI, or by laboratory findings, though more recently some lab findings have been associated with it. They are not, however, diagnostic.

Family history is not a generally important or prominent risk factor. Parkinson’s disease, or Parkinsonism, is age-related, but has a wide range of onset and clinical symptoms: the cardinal signs are given as tremor/shakiness; postural instability; gait changes, such as an increasingly slowed and short-stepped gait which may progress to imbalance and retropulsion (involuntarily stepping backward, especially when arising or turning); diminished facial expressivity; decreased blinking, a resting tremor/shaking of limbs which improves or disappears on intended movement (this distinguishes it from the more common “intention tremor,” which gets worse with purposeful movement).

There is a characteristic stiffness of, particularly, wrist motion, known as “cogwheeling,” when the wrist is passively rotated by an examiner. Parkinson’s is associated with cognitive impairment, but this is extremely variable in onset and degree. Given the advanced age of most patients, it is often initially difficult to distinguish from age-related decline of such functions as facial recognition and other aspects of memory or cognition. It is characterized by softening of the voice and, with progression, difficulties in word-finding and other language skills.

All of these characteristics vary enormously in age of onset, degree of severity, and time course of progression. Michael J. Fox was diagnosed with the condition at age 29. Decades later, he remains active in his selected organizations. Parkinson’s disease may be associated with prior vascular events (strokes due to insufficient blood flow or, conversely, hemorrhages) in some brain areas (the basal ganglia), but this is relatively less common than so-called “idiopathic” Parkinsonism. It may be associated with, or caused or precipitated by, head trauma—Mohammed Ali’s condition has been attributed to that cause. Exposure to heavy metals and some other chemicals are associations.

Functional difficulties associated with Parkinsonism may fluctuate from one time to another—”good days” and “bad days”—or specific factors such as fatigue or illness. It has been my opinion, and that of respected colleagues with whom I have discussed the question, that Biden does have observational characteristics consistent with Parkinsonism. In and of itself this does not render him incompetent to function as a president of the United States. He has been steadfast in his articulated policies, and achieved remarkable goals in the areas of employment, economic growth, and appointments to key advisory and leadership positions such as the military, the State Department, and the Department of Justice. He has demonstrated a deep commitment to the principles of equality under the law, civil rights, and the strengthening of infrastructure nationwide. He stands head and shoulders above the presumed Republican candidate who is a convicted felon, who will not commit himself to abiding by electoral results, a politically independent Department of Justice, or the reduction of any future federal debt through more equitable taxes, to the continuation of Social Security, or to the continued support of the nation’s most significant healthcare plans—Medicare and Medicaid. Trump cannot open his mouth without telling a lie, except to describe plans for his own ongoing empowerment and enrichment.

Both the Democratic and the Republican parties should be excoriated for their failure to present us with candidates who are experienced, capable, honorable, and vigorous—most importantly, faithful to the non-partisan principals upon which this nation was founded. In these most important aspects of the presidency, Biden is overwhelmingly qualified to continue as our president.

Mary Anne Whelan PhD, MD
Cooperstown