What Makes A Syndrome?

The concatenation of multiple symptoms.

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1. Dhruv Khullar:

Since the debate, I’ve asked nine doctors—including an internist, geriatricians, neurologists, and a neurosurgeon—to reflect on President Biden’s health. Most of them are, politically speaking, left of center; they practice in different parts of the country and range in age from their thirties to their sixties. They were careful to stipulate that they couldn’t diagnose the President from afar, and none wanted to be quoted by name. But almost all of them were concerned about the possibility that Biden’s symptoms might go beyond a gradual, aging-related decline, and could potentially be attributed to something more serious, such as a meaningful cognitive impairment or neurodegenerative condition. Most felt that an evaluation for neurological disorders would be reasonable. One neurologist, who practices on the West Coast and identifies as a Democrat, told me that Biden’s debate performance troubled a large number of her colleagues. “All of us had a gut reaction that this is not normal,” the neurologist told me.

Of the doctors I spoke to, a neurologist in New York was the most confident in his assessment. He told me that, after reviewing footage of Biden from the past ten years, he would “take the odds” that the President has a neurodegenerative condition. “In medical school, they teach you about syndromes,” he told me. “What makes a syndrome? It’s the concatenation of multiple symptoms, which by themselves are not that concerning but together are a cause for concern.” He asked me to imagine a neurologist taking a board exam with a question asking about an eighty-one-year-old man with a shuffling gait, decreased arm swing, and progressive impairment in the ability to speak clearly and remember words. “If you said, ‘That’s a healthy older gentleman with some spinal stenosis,’ you would fail,” he said. (Source: newyorker.com)

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