You don’t see much about Donald Trump having frontotemporal dementia (FTD) these days, but here are some of its presenting symptoms:
Inappropriate actions
Apathy, or lack of interest or enthusiasm in activities
Reduced empathy
Lack of inhibition or restraint
Neglect of personal hygiene and care
Compulsive behavior
Difficulty understanding speech
Speech fluent but does not make sense
Loss of reading and writing skills
Sentences reduced to one or two words
Difficulty with social interactions
Changes in eating habits
Lack of insight into the self
What do you think?
Dr. Google says FTD typically begins between the ages of 40 and 65, although it can begin at 70 or later. It accounts for at least a tenth of the dementias in this country, with somewhere near 700,000 current victims.
Symptoms get worse over time. The cause is unknown, although having a relative with FTD or a brain injury both increase your chances of getting it yourself.
You probably don’t want to ask Dr. Google about FTD if you’re older than 45. (If you’re older than 70, like me, you probably don’t want to ask Dr. Google about anything related to brain atrophy.)
Too late.
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Dr. Google notes that 37.9% of people 75 to 84 have Alzheimer’s. That doesn’t include FTD and vascular dementia. All in all, 85-year-olds have about a 50% chance of losing their mind, although above 85, the chance drops back into the 40s. That’s because a bunch of Alzheimer’s victims don’t make it to 85, and their deaths skew the percentages.
So does a general reluctance to diagnose an incurable disease. Alzheimer’s begins years before it presents in a way that cannot be ignored. A lot of demented people do just fine for decades before they’re diagnosed. Look at Ronald Reagan.
Okay, okay. We don’t have to look at Ronald Reagan, who turned neurological deficits into deficit spending.
Dementia scares the bejeezus out of people. They don’t like to think about it, and they will insist you’re okay in the face of strong evidence you’re not. Your lack of personal insight might be a symptom, but it also might be a plain old lack of personal insight, which doesn’t require brain damage to manifest. Most people will give you the benefit of the doubt.
If you’re demented, the key is to ritualize as many aspects of behavior as possible. What was once spontaneous becomes habit, what was once conversation becomes scripted dialog. If you have a greatest hits list, stick to it.
If you don’t have Alzheimer’s or FTD in your family, you don’t need to feel like you’re missing out. Dr. Google specializes in the long-distance diagnosis of rare syndromes and previously unsuspected side effects, usually as they afflict the lives of the people who consult Dr. Google.
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It’s a safe assumption that both Trump’s and Biden’s brains aren’t working as well as they used to. I’m a lot more worried about Trump.
The difference is in their style of wielding authority. Trump doesn’t trust his underlings, which means he cannot delegate responsibility. His decisions are not subject to appeal. Biden’s are. He’s surrounded himself with people he’s in the habit of listening to. He also has a spouse strong enough to pull the rip cord for him if full-on catastrophic dementia strikes.
This may be carrying the metaphor a bit too far, but Trump not only lacks a rip cord, he’s not even packing a parachute.
Trump surrounds himself with people he can control, which means they tend to be motivated entirely by money (the one characteristic Trump seems to trust in other human beings) or they act as weaselly lickspittles around the boss and as sadists around their underlings. Anybody who deviates from the party line is quickly fired.
That’s the trouble with authoritarians. When they go down, so does the locus of control. Nobody who is worth a damn is left. The Russians faced this situation after the death of Stalin, and they’ll face it again after the death of Putin.
If you’re going to get dementia, it’s wise to surround yourself with people you love, respect, and trust, because your future will be full of loss and hard choices. Life will not be worth living if the people around you don’t love, respect, and trust you back.
Somebody needs to carry on after you cannot. Somebody needs to care enough for a country and a people to do the hard work of living, and thinking, and making sure other people live and think, too.
The 2024 election will see Americans voting not only on the character of their leaders, but also on whether they’re suicidal or not.
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My mother died of Alzheimer’s Disease at the age of ninety, but she had shown signs of dementia for twenty years before that. She had lived through the deaths of her sisters, a son, her parents, and a husband. To each of these losses she presented an inconsolable, never-ending grief and rage at the injustice of the world. She never accepted that the world could be so wrong and so cruel, and I think that over the years she lost her mind because of it.
I know there is no scientific evidence that grief causes the physiological changes of Alzheimer’s, just as there isn’t any indication that rage and paranoia cause FTD. Still, if you look at your habitual thoughts as the bath your brain sits in, it’s easy to think that some ideas might drown a few neurons.
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Over the course of my mother’s dementia, I became expert on that aspect of the disease that presents as a brilliantly perverse antagonist to an adult child trying to act as a caregiver.
This person you loved, to whom you owe so much, someone you would give anything for a five-minute conversation with thirty years ago—is gone. The person who is left will twist your expressions of care and love into useless platitude. She will ask endless questions about who among her friends has died (all of them). She will play on any guilt you have over mistakes you made as a 13-year-old, she will remember things you wish you (and she) could forget. She will forget—again and again—the things you wish she would, if only for a moment, remember.
Your face, for instance.
Caring for a demented person is a series of horrifying reveals for everyone involved. You encounter reflex instead of response, incomplete personalities you’ve never seen before, and a weird, inhuman kind of intelligence that makes you question your own sanity. You realize that demonic possession isn’t such a far-fetched concept.
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As most of you know, I’ve been going through a series of medical appointments, and one of the things medical personnel are on the lookout for is old hostile crazy people. You can tell by the relief they show when your responses to their questions are sane and devoid of anger.
It's bad enough that most people my age have diminished cognitive capacity. The damage can be genetic, environmental, or the result of a lifetime of rage, bitterness, and denial. I suspect each variety of damage looks the same on a cellular level.
I consider myself lucky that I still have my wits about me, although other people may have a different opinion about my wits or my luck.
A definitive diagnosis of dementia requires post-mortem examination, which is an argument for living with uncertainty in the matter.
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My own case aside, the obituary columns are full of people, younger than I am, who died of Alzheimer’s or Parkinson’s or frontotemporal dementia—enough of them that I think dementia is underreported as a cause of death. And if I look at world events since the start of the pandemic, I can affirm that dementia is underreported among world leaders.
All over the world, demented people are in power, and thus far they seem to favor murder-suicide as a standard what’s-left-of-the-ego defense.
These are strong words, but we’re in a gerontocracy, and brains don’t last forever. If neurologists had a say in it, a lot of people in our government would be taken straight to assisted living. But neurologists have a code of ethics, and unless they’re demented, they usually adhere to it.
As I’ve noted before, chances are slim that Trump will occupy the Oval Office again. That said, he will cause a lot of pain and blood for the country along the way, and it’s not clear the country will survive it.
If you’re planning to vote for Trump—I know lots of people are—you are setting yourself up for a trip under the bus. He may betray you for entirely sane reasons, depending on who you are, but it’s more likely you’ll be betrayed by the failure of his judgment and the lack of any restraint on his actions and emotions.
Mostly you’ll be betrayed by old age, your own and Trump’s. How each of us face old age is usually intensely personal, but you won’t last forever and you will face a final reckoning with the things you’ve done and said. If you believe in an eternal afterlife, it’s worth thinking about what things you’ll be proudest of after the first ten million years or so. That might be the moment when a much older, wiser, non-demented version of yourself corrects the person you are now, and for good, humane reasons.
As for Trump, long before he’s dead, he will be used and abused by the snakes he harbors in his heart. When his ego gets too weak to restrain them, they’ll seize control. We’ll all see how confused and cruel and self-destructive a country can become, when the demons leading it want it to die before they do.