Column: Are you an armchair diagnostician? Your medical opinions about Biden are useless

A couple of weeks ago, I wrote about a TV ad asking whether President Biden’s claims on the economy were a case of dishonesty or dementia.

You can’t diagnose dementia from afar, I wrote.

Then came the debate last week, and I began getting trolled.

“You can’t lie about it anymore,” said a reader named Bob. “We all saw it.”

What I saw was a man who walked stiffly, struggled with coherence and looked addled at times. He seemed to be suffering some form of impairment.

Was it dementia?

Maybe, but as I’ve said before, we don’t know for sure. I heard from other readers, by the way, who were convinced Biden has Parkinson’s disease.

I can understand the argument that whatever his condition, Biden’s fitness to serve another four years is a legitimate concern. But a specific diagnosis can be tricky, in the same way it’s difficult to know whether we are witnessing a pathological, sociopathic, delusional or obsessive compulsive condition in regard to former President Trump’s habitual lying.

The impressions of an “armchair diagnostician” are useless and insulting, said Anne Ellett, a nurse practitioner and dementia specialist who runs a consulting company called Memory Care Support. She believes Biden looked frail in the debate and suspects he may have some type of neurological disorder, but even with decades of experience, she couldn’t pinpoint it from afar.

“I really take offense to people throwing around the word dementia,” said Ellett. “It’s a complicated medical diagnosis.”

In fact, dementia is not any one thing. As the Alzheimer’s Assn. puts it, dementia is “an umbrella term for loss of memory and other thinking abilities severe enough to interfere with daily life.” The various types include Alzheimer’s, vascular, Lewy body and frontotemporal. Doctors diagnose “based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type.”

And yet the term dementia is used by lay people as a catch-all for any fumble by an older person. It’s also become a convenient political weapon, and even Amazon is selling “Dementia Joe” yard signs.

“If someone loses weight, or has fatigue, it would be unkind and irresponsible to say they have cancer,” Ellett said. “There are many causes…other than cancer, just as there are many causes for word-stumbling and misspeaking other than dementia.”

During the debate, we got a good look at Biden for 90 minutes, and he clearly struggled at times with words and his train of thought.

But if you’ve witnessed decline in a loved one, as I have with both parents, you know the changes can be subtle and nonlinear, and that even doctors can differ in their diagnosis. You also know there are specific causes of temporary changes, such as when my mother appeared lost in a full-blown cognitive fog, only to return to normal after a urinary tract infection was cleared up.

“A number of years ago, my own mom was worried about her memory,” said Dr. Michael Wasserman, a recently retired geriatrician. “First of all, she knew that she was forgetful, which is actually a good thing. When the doctors reduced a medication that she was taking for her neuropathy, her memory miraculously improved.”

Wasserman said that after decades of seeing patients with memory loss, and having seen what he took to be evidence of cognitive impairment on the part of former President Reagan while he still held office, he doesn’t think either Biden or Trump have dementia.

“One of the normal changes …is that the speed at which our brain cells process things slows down. I generally think this is a good thing, keeping us from compulsively responding to others too quickly,” Wasserman said.

Dr. Gene Dorio, a Santa Clarita geriatrician, has many long-time patients, and as a house-call specialist, he gets to see them in an environment that sharpens his diagnostic abilities. “I am able to recognize the subtle decline in my patients’ physical and cognitive abilities. The important word is ‘subtle,’ as most of the time, changes associated with memory loss are slow…providing us with advance notice of what one might face down the line,” Dorio said.

“When we see a public person like the president…we are only allowed a small peek into his neurologic makeup…We don’t get to see how he interacts behind the scenes with family members, friends, and those in government.”

For anyone who’s worried about the health of a loved one, Dorio offered a list of changes to keep an eye on, from the dramatic (falls, movement impairment, confusion, balance issues) to more gradual signs of decline (forgetting to take medication, poor eating habits, weight loss, lapses in personal hygeine, breaks in daily routines, loss of driving skills).

“One thing seniors commonly face is depression and isolation,” said Dorio. “Too many feel alone and are frustrated with the physical and mental challenges as they age.” And it can be difficult, he added, even for a trained and experienced physician, to immediately differentiate between depression and dementia.

There’s no proven cure for the various types of dementia. But early detection, evaluation and treatment are critical. So if you’re seeing the kinds of changes described by Dorio, make a doctor’s appointment sooner rather than later.

You can provide the support the loved one needs, but let a qualified professional make the diagnosis.

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