Does Putin have Parkinson's disease? | Updated

he British press are claiming that Vladimir Putin has cancer or Parkinson's disease (PD). Videos show him with a stiff, unsteady gait and grasping the table with his right arm while he talks, almost as if it keeps trying to salute involuntarily.

We've heard it all before, and it's not as easy to diagnose Parkinson's disease (PD) as some people think.

Hitler and Parkinson's disease

Take Hitler. To diagnose PD, at least two of these three have to be present: tremor, rigidity, and dysarthria or difficulty in movement. PET scans and CAT scans are often used to increase the probability of an accurate diagnosis. Even so, PD diagnosis is correct only about 80–90% of the time.

Historical films also show that Hitler had a hand tremor, and some authors ^[1] claim his bad decisions were caused by PD. Indeed, some articles blame it for all of Hitler's bad character traits, including his brutality, rage, restlessness, lack of empathy, and megalomania. We've seen this with many historical figures,^[2] including the philosopher Nietzsche, who was popularly (and incorrectly) thought to have tertiary syphilis. Though such pseudo-diagnoses gain wide publicity, they often turn out to be incorrect.

One author claimed that Hitler's “Parkinsons” was temporarily cured by the 1944 bomb assassination attempt. This is impossible (although to be fair, I know of no clinical trials testing whether setting off a bomb next to the patient is an effective treatment. The FDA might also have questions about its safety—though the way the FDA is run these days, who knows). Instead, it suggests methamphetamine or other drug use, which produces reversible myoclonus, tremor, and asterixis (a type of hand-flapping movement, see below). ^[3] It has also not escaped the public's notice that the majority of PD sufferers rarely if ever attempt land invasions in Asia during winter.

Types of tremor

There are two main types of tremor: action tremor, which occurs during voluntary movement, and resting tremor, which is suppressed by voluntary movement. Action tremor can be postural, kinetic or isometric.^[4] One distinguishing feature, according to the MDS Classification of Tremors,^[5] is whether the tremor is unilateral or bilateral.

Essential tremor, or ET, is the most common action tremor, affecting 0.4 to 6.7% of the public. It tends to worsen over time and a subset of patients are at high risk of PD.^[4] It is also associated with Cognitive Affective Cerebellar Syndrome, which is mild impairment of attention, executive function, and verbal memory. ET can be career-limiting for patients. Recently it's been re-classified as a continuum. It seems to be caused by neuron loss in the cerebellum, where motor control is coordinated.^[6] A controversial variant called ET Plus is ET with additional neurological “soft” signs.^[7]

Asterixis

Asterixis is technically not a tremor, but a flapping of the hands while the patient tries to hold the wrists flexed. It's classically associated with liver, kidney, or lung disorders, and it's a symptom of metabolic encephalopathy, where ammonia or other toxic products impair brain function.^[9] It is often caused by medication, especially in combination (phenytoin, lorazepam, gabapentin, or valproic acid for epilepsy; acetaminophen/oxycodone, gabapentin, or morphine for pain; antibiotics), so it is often an iatrogenic effect of treatment for some other problem such as epilepsy or pain.

The asterixis usually disappears when the metabolic cause clears. However, it is non-specific and is also seen in Wilson's disease (excess copper), hypoxia, metastatic neoplasia, parasitic brain diseases such as trypanosomiasis, toxoplasmosis, cerebral malaria, CJD, and viral encephalitis.^[10]

Other types of tremor

Klinefelter syndrome (XXY), caused by an extra X chromosome in males, can cause a tremor, usually an action tremor in upper extremities. Fragile X syndrome and multiple sclerosis can also cause tremor.^[11] Structural brain lesions often cause unilateral tremor. Many other things can cause tremor, including Wilson's disease, hypothyroidism, alcohol withdrawal, and non-alcoholic steatohepatitis or NASH.

Snarky conclusion

So, does he have Parkinson's? Maybe. If you want to engage in wishful mis­dia­gnos­ing, you might as well pick something really nasty, like kuru or mad cow disease. As many doctors have discovered, diagnose enough random things and sooner or later you'll be right.

Update

The news media are still showing Putin's strange foot twisting movements and table-gripping as evidence of Parkinson's. In my opinion these movements are not neurological but displacement behavior. His particular sideways slouching posture is especially significant: it is classic of someone with intense abdominal pain, not PD. The same posture could be seen with the great political pundit Charles Krauthammer.

may 11 2022, 7:11 am