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What to know about Parkinson’s disease in light of speculation about Biden

Concerns over President Joe Biden’s mental acuity and physical fitness following his disastrous showing during the June 27 presidential debate have sparked curiosity over whether he may be suffering from Parkinson’s disease.

Speculation about Biden’s condition shifted toward Parkinson’s this weekend as reports surfaced of neurologist Kevin Cannard, an expert in the disease for Walter Reed National Military Medical Center, visiting the White House 10 times since 2022.

The White House has denied that Cannard, a Biden campaign donor, treated Biden during any of these visits except for that of his annual physical.

Kevin O’Connor, the physician to the president, reiterated the findings of Biden’s Feb. 28 annual exam that said the president does not demonstrate signs of “any cerebellar or other central neurological disorder, such as a stroke, multiple sclerosis, Parkinson’s, or ascending lateral sclerosis.”

With nearly 90,000 new cases of the disease each year, Parkinson’s has a range of symptoms that are often difficult to diagnose.

What are the physical signs of Parkinson’s?

Parkinson’s disease is better understood as a collection of symptoms rather than a singular disease. Often this set of symptoms is referred to collectively as Parkinsonian progression or Parkinsonism.

Although tremors are one of the hallmark signs of Parkinson’s, other movement symptoms including stiffening of gait and smaller steps are classic signs of the disease.

Other symptoms can be more subtle, including difficulty making facial expressions, slowed and slurred speech, and difficulty with voice projection.

What is Parkinsonian dementia?

Parkinson’s-related dementia is thought to be caused by Lewy bodies, or abnormal protein clusters in the brain. Dementia with Lewy bodies, or DLB, can develop alongside the mobility symptoms of Parkinson’s, whereas Parkinson’s disease dementia, or PDD, only develops after years of physical symptoms.

Parkinson’s cognitive impairment mostly affects problem-solving, speed of thinking, and mood. It can also cause delusions or hallucinations, sleep disturbances, irritability, and anxiety.

Problems recalling and producing words as well as difficulty understanding complex sentences are also associated with DLB.

“Fluctuating cognition is common and refers to changes in levels of attention, concentration and functional ability,” the Lewy Body Dementia Association says. “Fluctuations may present as staring spells or confusion that lasts from minutes to hours. Transient episodes of unresponsiveness may also occur.”

How is Parkinson’s different from Alzheimer’s?

Alzheimer’s disease, a different form of cognitive decline under the umbrella term of dementia, is somewhat similar to Parkinsonian dementia but has some key differences.

Alzheimer’s is caused by the buildup of amyloid plaques in the brain, most often targeting memory centers. Two new drugs to slow the progression of Alzheimer’s, Leqembi and Kisunla, work by removing excessive amyloid deposits.

Although both Alzheimer’s and Parkinsonian dementia are thought to be caused by abnormal proteins in the brain, Alzheimer’s is different in that it is not typically associated with difficulties in movement. It is first diagnosed by problems with memory and recognition.

Parkinson’s, by contrast, begins with mobility symptoms and may or may not progress to cognitive decline.

Other cognitive conditions that share symptoms with Parkinson’s

There are a host of other conditions that could bear similar resemblance to Parkinsonian symptoms.


Corticobasal degeneration also has similarities to Parkinson’s in that it affects mobility, coordination, and speech. According to the Mayo Clinic, corticobasal degeneration can progress over a period of six to eight years, eventually resulting in losing the ability to walk.

Vascular dementia, caused by damage to blood vessels in the brain, can also contribute to cognitive decline in individuals with cardiovascular dementia. Strokes or TIAs, also called ministrokes, can cause cells to die in any region of the brain, impacting both cognitive and physical function.

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