First Debate — What did the neurologist think?

As my brother sometimes says “everyone is entitled to my opinion”.  Why should you be interested in mine?  Because I was a clinical neurologist from 1968 to 2000 seeing probably 25,000 patients over the years. Because I was board certified by the American Board of Psychiatry and Neurology.  Because later I examined candidates for certification for the same board.  Because I have an extensive experience with dementia in patients, and (unfortunately) with close friends and their kin and in our family.

The main question I had before the debates, was “Is Joe Biden cognitively impaired”, given the selection of his statements and gaffes.

The short answer is no.  He held his own, and moreover did so for 90 stressful minutes.

The more nuanced answer is that there are a few things about him that are not 100%.  As the time wore on, he mispronounced and slurred more words.  Also the right corner of his mouth appeared to sag a bit more (but no one has a perfectly symmetrical face).

The most unusual feature is Biden’s upper face — it doesn’t move. The masklike face is a symptom of Parkinsonism, but if so it is the only one.  I’m ashamed to admit that I didn’t notice how often his eyes blinked, but since I didn’t notice infrequent blinking (another sign of Parkinsonism) it probably wasn’t present. The prosody of his speech  (https://en.wikipedia.org/wiki/Prosody_(linguistics)) is normal, not diminished as it would be in Parkinsonism.  Is he on botox?  He has a remarkably unlined face for a man his age.

Biden often appeared to be looking down at something — talking points?  mini-teleprompter?

Is Trump impaired cognitively?  No sign of it.  His responses were quick, sometimes funny and often not to the point.   Both men are smart, but Trump appears (to me) to be smarter.

Although Chris Wallace is from Fox News hence suspect for many,  I thought he was a tough and impartial moderator, which is exactly what I wanted.

I did look at a C-Span segment of the audience settling down before the actual debate and was horrified.  50% not wearing masks, people shaking hands, getting far closer than 6 feet from each other.   Even if they’d all been recently tested for the virus, this was irresponsible behavior and an extremely poor model for the country.