Many Americans seem to have understandably concluded that Joe Biden has dementia based on his very public displays of confusion, aphasia, and incoherence.  But the question we should actually be asking is What is going on with Joe out of public view? 

Like many Americans who have cared for parents with dementia, I witnessed my father’s decline firsthand and, sadly, Joe Biden is presenting exactly as my father did in the early stages -- right down to the vacant look in his eyes.  While I am neither doctor nor expert, physicians and other medical professionals rely heavily on caregiver observations because they monitor the disease’s progression 24/7 over the long haul, and can add valuable input that is not always obvious at an appointment or measurable with a cognitive test.  I am relying on my experience as my father’s caregiver, corroborated by medical professionals, health consultants, literature, research, and the shared experiences of others.  Of course, not every dementia victim will experience every symptom, but the commonalities are significant. 

As the disease grabs hold of one’s faculties, men like Biden and my father continue to view themselves as experienced executives -- in control, commanding, and coherent; holding court as the family patriarch; the old dude who’s seen it all.  They don’t doubt their ability to express complex ideas with the right words.  And so, they conduct business as usual and, for the most part, things go fine until they stammer over a word, get frustrated, then confused, and either babble their way out or shut down.  It isn’t long before lost words, forgotten names, and elusive ideas are replaced by whatchamacallit, whosimajig, whatshername, and the thing.

These lapses can be easily hidden during the early stages.  It’s not uncommon for loved ones, spouses in particular, to make excuses for the afflicted, cover up the messes, and run interference with others.  In those embarrassing moments when a dementia patient fails to recognize someone he should know, the dutiful spouse (often in denial) will swoop down, rush to his side, and handle the mishap.  Of course X remembers you.  He’s just very tired from our trip.  Can you excuse us for a second? She will answer the phone and put the caller on speaker to assist with answering questions her spouse might find confounding.  She will accompany him everywhere and serve as backup if he starts to frazzle.  But for those occasional “senior moments,” he seems put together to the outside world. 

That’s because sub rosa the dutiful spouse makes sure medicine is taken, hygiene and grooming are attended to, and meals are provided and eaten.  She controls his schedule and prepares him for the day’s events.  She learns mornings are best, he tires and gets confused as the day ensues, and that crowds and noise are triggers.  If she doesn’t manage his life, he won’t be able to manage it.  But the charade can only last so long -- she cannot anticipate everything and the effects of the disease can be unpredictable.

What many people don’t realize is that stress is a huge trigger and maintaining “life as usual” can add untold stress to a dementia patient’s life.  Things we generally take for granted can be monumental stressors: a change in schedule or routine, a visit to a new place, travel, a new doctor, crowds, too many people talking at once, loud noises, a rare visit from an adult child. 

As stress incidents accumulate over time, anxiety increases.  As anxiety builds, confusion mounts.  Eventually, it seems none of the brain’s electrical impulses can get where they need to go and the individual devolves into delusions and hallucinations.  It can happen at the end of a “normal” day where the patient decompensates and becomes disoriented, confused, anxious, belligerent, or agitated (“sundowning”) or amass over months and give way to hallucinations. I call it the anxiety-confusion-delusion loop but I honestly don’t recall if I coined that caring for my father or if I read it somewhere.

What should give every voter pause is the likelihood that Biden is already experiencing or, due to high stress levels, has a very high risk of experiencing disorientation, crippling anxiety, paranoia, serious behavioral changes, delusions, and intense cognitive decline. Dementia cannot be reversed and will only worsen.  He might deliver a short speech and take a few questions without incident, but he invariably falters as he tires -- indicia of other symptoms that will intensify with the hourly rigors of a campaign.

It isn’t far-fetched to anticipate a president in the White House who forgets to dress, thinks night is day, wanders aimlessly in the middle of the night looking out windows, opening drawers, trying to get somewhere else.  The laundry list of behavioral changes is vast and not conducive to a functioning presidency.  However, he will be propped up by Jill and his handlers, groomed, medicated, and fed, and might appear just fine at the next day’s events, even reading from notes and teleprompters… until he forgets how to read, what the notes are for, or how the teleprompter works.   Forget about multitasking, handling complex economic or geopolitical issues, and running the country 24/7. 

With today’s technology, deep fake videos, and a COVID-inspired virtual presidency, perhaps the DNC is confident they can pull a fast one on the American people, run a shadow government with Joe as the face of the presidency, and cover up his infirmity and ineptitude with the aid of the press -- think Woodrow Wilson and FDR.   Maybe they just hope to defeat Trump by any means necessary and plan to invoke the 25^th Amendment elevating Kamala Harris to the presidency -- someone who couldn’t convince more than 2% of the primary voters to consider her for the nomination. Or, they could be running Biden-Harris  knowing they’re unwinnable, but fully intending to contest the election, accuse Trump of stealing it, calling (again) for his impeachment/removal, and causing just enough bedlam to destroy his second term.

The Democrat-Media Complex has been explicit about taking Trump down by any means necessary so none of this is overblown or hyperbole.  In fact, these tactics have either been deployed during Trump’s first term (i.e., impeachment) or suggested as potential tools against him in another context (i.e., 25^th Amendment). 

Fortunately for Jill Biden and Joe’s political handlers, COVID has played right into their hands, requiring limited exposure to crowds, a controlled schedule, and scaled-back social interactions. But lurking behind those senior moment-y, Joe Biden-y gaffes is his inability to function independently for a full day at peak performance.  Of course they don’t want a normal campaign season. They just need to get Joe to the finish line and, if they’re lucky, over it. 

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