sSpeculation about President Joe Biden’s health is rife following the president’s poor debate performance, marked by a stiff walk and soft voice and confusing answers. Also fueling conjecture are reports in New York Times and elsewhere that, according to visitor records, a neurologist specializing in movement disorders like Parkinson’s disease has come to the White House eight times in the past eight months.
The White House backed down, releasing a letter from Dr. Kevin O’Connor, physician to the president, explaining that the specialist, Dr. Kevin Cannard, was in residence in support of active duty service members assigned to White House operations, some of whom may have neurological problems related to their service. Cannard only examined Biden during his annual physicals, according to the White House. The president, according to O’Connor’s letter and the account of Biden’s physical examination details released in February, has no symptoms consistent with “any cerebellar disorder or other central neurological disorder, such as stroke, multiple sclerosis, Parkinson’s or ascending lateral sclerosis”.
Parkinson’s is not always easy to detect. Here, experts (who are not involved in Biden’s care) explain what people should know about how the disease typically presents and how it is diagnosed.
The varied signs and symptoms of Parkinson’s disease
Dr. Michael Okun, director of Fixel Institute of Neurological Diseases at the University of Florida and medical consultant for Parkinson Foundationsays Parkinson’s disease may be better called Parkinson’s disease – plural – because the disease has many different causes and expressions.
“There are multiple causes of Parkinson’s and many of them have similar symptoms, but we tend to group them together, because humans like to group things together – it’s easier to deal with,” he says.
On the one hand, explains Okun, about 15% to 20% of Parkinson’s cases are associated with a genetic abnormality, and in these cases, patients are more likely to develop symptoms earlier – at age 50, or even at age 45 or 40. years. Not being genetic, neurologists analyze possible environmental causes. “We’ve been interested in pesticides, chemicals and other things in the environment that might be triggering symptoms,” he says.
Whatever the causes, the brains of Parkinson’s patients often begin to show a deficit in three neurotransmitters: serotonin, dopamine and acetylcholine. These neurological changes, in principle, do not lead to the motor symptoms commonly associated with the disease. Instead, people may experience loss of smell, constipation, and sleep disturbances known as REM sleep behavior disorder. In these cases, dreams can become so vivid that people act them out. “Let’s say you’re fighting bad guys,” says Okun. “You might be punching in your sleep, and that’s not good for your bed partner.”
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Later symptoms begin to involve emotional functions. Parkinson’s patients are at greater risk than other people of suffering from depression, anxiety and apathy, and when anxiety, in particular, occurs for the first time later in life, a Parkinson’s screening may be warranted. “People with onset of anxiety over the age of 50 are at twice the risk of having Parkinson’s disease,” says Okun.
More common are the motor and cognitive deficits that most define the disease. People with Parkinson’s can become distracted or disorganized or find it difficult to plan or carry out tasks. Around 80% of people with the condition experience resting tremors in their hands – although this means that one in five do not experience this characteristic symptom. Posture may also be impaired and stiffness in the wrists and arms may be evident. The steps may become jumbled and there may be a general slowness, called bradykinesia.
“When people tap their fingers or open or close their hands, there is a certain slowness that the neurologist looks for,” says Okun. Speech may also be affected. “Sometimes people repeat syllables in the middle of speaking,” says Okun. “The voice may become increasingly soft and sometimes disappear.”
Other symptoms affect the face, with blinking becoming less frequent and facial muscles becoming stiff or immobile – a condition called masked face.
How Parkinson’s is diagnosed
In the early stages of Parkinson’s, an internist, family doctor, or neurologist is often the first to make a diagnosis, according to the Parkinson Foundation. The most common symptoms leading to the diagnosis are resting tremor; stiffness or stiffness in the arms, legs, or trunk; or balance problems and falls. Magnetic resonance imaging (MRI) or dopamine transport scan of the brain – in which a radioactive tracer that binds to dopamine receptors is injected into the blood – can also help confirm the diagnosis. Of course, no doctor can diagnose Parkinson’s in someone without seeing and evaluating the person. When it comes to the president or any other public official or celebrity, Okun follows the so-called Goldwater Rule—adopted by the American Psychiatric Association after hundreds of psychiatrists presumed, without examination, to diagnose mental illness in Republican presidential candidate Barry Goldwater in 1964.
“I was one of the doctors who took care of Muhammed Ali,” says Okun, “and we did not publish details of his medical record until we had permission from the family.”
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Still, Okun encourages family members and others to follow the “see something, say something” guideline. “If you see someone who isn’t blinking, if you see someone with diminished facial expression, if you see someone who is stiff or their arms are still, or shuffling or falling, get those people to the right doctors,” he says. “In Parkinson’s disease you need a whole team.”
Treatment options
There is no cure for Parkinson’s disease, but people with the disease are by no means without resources. There are about a dozen medications and medication cocktails, including levodopa, a dopamine replacement medication that helps alleviate physical symptoms. Selective serotonin reuptake inhibitors are also increasingly used (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which increase the availability of both neurotransmitters in the brain.
“There are other drugs that go straight to dopamine receptors and tickle the receptors,” says Okun. “These are called dopamine agonists.” Increasingly popular is also deep brain stimulationin which a thin probe is inserted into the brain and adjusts its firing, similar to the way a pacemaker affects the heart.
This story originally appeared on Time.com read the full story
