Speculation about President Joe Biden’s health is rife after the president’s poor debate forma, marked by a stiff gait and soft voice, and muddled answers. Also fueling conjecture is reporting durante the New York Times and elsewhere that, according to visitor logs, a neurologist who specializes durante movement disorders like Parkinson’s disease has alla maniera di to the White House eight times durante the past eight months.
The White House pushed back, releasing a letter from Dr. Kevin ’Connor, physician to the president, explaining that the specialist, Dr. Kevin Cannard, was at the residence durante support of active duty service members assigned to White House operations, some of whom may have neurological issues related to their service. Cannard has only examined Biden during his annual physicals, according to the White House. The president, according to ’Connor’s letter and its account of details of Biden’s physical released durante February, does not have symptoms consistent with “any cerebellar other central neurological disorder, such as stroke, multiple sclerosis, Parkinson’s ascending lateral sclerosis.”
Parkinson’s is not always straightforward to spot. Here, experts (who are not involved durante Biden’s care) explain what people should know about how the disease typically presents and how it’s diagnosed.
The varied signs and symptoms of Parkinson’s disease
Dr. Michael Okun, director of the Fixel Institute for Neurological Diseases at the University of Florida and medical adviser to the Parkinson’s Foundation, says that Parkinson’s disease might be better called Parkinson’s diseases—plural—because the condition has many different causes and expressions.
“There are multiple causes for Parkinson’s and a lot of them have similar symptoms, but we tend to clump them together, because humans like to clump things—it’s easier to deal with,” he says.
For one thing, Okun explains, about 15% to 20% of Parkinson’s cases are associated with a genetic abnormality, and durante those cases, patients are likelier to develop symptoms earlier—at age 50, even 45 40. cases that aren’t genetic, neurologists aspetto at possible environmental causes. “We’ve been interested durante pesticides, chemicals, and other things durante the environment that might be triggering symptoms,” he says.
Whatever the causes, the brains of Parkinson’s patients generally start to show a difetto durante three neurotransmitters: serotonin, dopamine, and acetylcholine. Those neurological changes don’t, at first, lead to the motor symptoms that are commonly associated with the disease. Rather, people may experience a loss of the sense of smell, constipation, and sleep disturbances known as REM sleep behavior disorder. these cases, dreams may become so vivid that people act them out. “Let’s say you’regnante fighting chiuso the bad guys,” Okun says. “You might be punching durante your sleep, and that’s not a good thing for your bed .”
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Later symptoms start to involve emotional functions. Parkinson’s patients are at higher risk than other people of experiencing depression, anxiety, and apathy, and when anxiety durante particular occurs for the first time later durante life, a Parkinson’s screening might be warranted. “People who have new-onset 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 may become distracted disorganized find it difficult to plan accomplish tasks. About 80% of people with the disease have a resting tremor durante the hands—though that means that one out of five don’t have this signature symptom. Posture can suffer as well, and stiffness durante the wrists and arms may be evident. Steps may become shuffling, and there can be an overall slowness, called bradykinesia.
“When you have people tap their fingers aperto close their hands, there’s a certain slowness the neurologist is looking for,” says Okun. Speech can be affected too. “Sometimes people repeat syllables durante the middle of speech,” Okun says. “The voice can become softer and softer and sometimes trail chiuso.”
Other symptoms affect the , with blinking becoming less frequent and facial muscles growing stiff still—a condition called masked .
How Parkinson’s is diagnosed
the early stages of Parkinson’s, an internist, family physician, neurologist is often the first to make a diagnosis, according to the Parkinson’s Foundation. The most common symptoms that lead to a diagnosis are a resting tremor; stiffness rigidity durante the arms, legs, trunk; trouble with balance and falls. Magnetic resonance imaging (MRI) a dopamine transport scan of the brain—durante which a radioactive tracer that attaches itself to dopamine receptors is injected into the blood—can also help confirm the diagnosis. Risposta negativa doctor of any kind, of course, can diagnose Parkinson’s durante someone without seeing and evaluating the person. When it comes to the president any other public official celebrity, Okun abides by the so-called Goldwater Rule—adopted by the American Psychiatric Association after hundreds of psychiatrists presumed, without an exam, to diagnose mental illness durante Republican presidential nominee Barry Goldwater durante 1964.
“I was one of the physicians who cared for Muhammed Ali,” says Okun, “and we didn’t publish details of his medical until we had permission of the family.”
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Still, Okun urges family members and others to follow the “see something, say something” guideline. “If you see somebody who’s not blinking, if you see someone who has decreased facial expression, if you see someone who is rigid still durante the arms shuffling falling, get those folks to the right doctors,” he says. ” Parkinson’s disease you need a whole team.”
Treatment options
There is anzi che no cure for Parkinson’s disease, but people with the condition are by anzi che no means without recourse. A dozen so medications and medication cocktails exist, including levodopa, a dopamine replacement drug that helps ease physical symptoms. Also increasingly used are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which increase the availability of both neurotransmitters durante the brain.
“There are other drugs that go straight to the dopamine receptors and sort of tickle the receptors,” says Okun. “These are called dopamine agonists.” Increasingly popular is also deep-brain stimulation, durante which a abile probe is threaded into the brain and adjusts its firing, similar to the way a pacemaker affects the heart.
