Is Trump really ill – or just old? The experts weigh in ...Middle East

More than a year into Donald Trump‘s second term and speculation about the state of the US President’s health has reached fever pitch.

Trump is the oldest person ever elected to the presidency, and the visible symptoms of health issues including bruising on the back of his hands and swollen ankles have drawn questions over the wider state of his health.

The White House said Trump, 79, had been diagnosed with chronic venous insufficiency, which can cause swollen ankles, while too much hand shaking had caused the bruising.

The President is notorious for his bad diet of fast food and Diet Coke, and sleeping for just few hours a night.

Trump has frequently claimed that he is the healthiest and strongest president to have ever graced the Oval Office. Dr James Jones, the White House physician’s assistant, claimed that Trump was in better health than former president Barack Obama, and his aides said he maintained a vigorous schedule. 

Trump admitted last month that he had undergone a CT scan in October, after incorrectly saying he had undergone an MRI scan. One of his doctors said the scan was to “to definitively rule out any cardiovascular issues” and that it revealed no abnormalities.

However, such explanations have been unable to deflect from growing scrutiny in the US over the state of the physical and mental health of the President, with speculation now a matter of near-daily public debate.

Trump’s relentless attacks on his predecessor, Joe Biden, alleging mental and physical incapacity for office for sins including mumbling his speeches, confusion in front of TV cameras and forgetting names, have drawn inevitable comparisons to Trump’s own failings.

From his rambling, often incoherent speeches that confuse the names of countries and stories that appear entirely fabricated to his erratic policy-making and napping on the job, Trump’s behaviour has prompted increasing questions from not only his critics, but the American public, as to his fitness to hold the office of presidency.

Bruised hands and thin blood – what’s the truth?

The White House’s explanation of Trump’s health conditions has not dampened speculation that not all is being disclosed, and his physical ailments are still grabbing headlines.

Trump was seen with a bruised left hand at the World Economic Forum in Davos, Switzerland last month. He has previously been seen with bruising on his right hand.

Trump’s press secretary, Karoline Leavitt, claimed the bruising was caused by “tissue damage from frequent handshaking”. However, after the left-hand bruising was seen – the hand he would not use to shake those of other people – the White House said Trump had unintentionally hit his hand on the corner of a table.

A tendency to bruise more easily is common in elderly people, experts say.

“As we get older, the skin becomes thinner and loses some of the protective fat that cushions blood vessels underneath,” Thorrun Govind, health expert and former chair of the English Pharmacy Board of the Royal Pharmaceutical Society, said.

“Small blood vessels can break more easily. This means even a minor knock can lead to noticeable bruising, particularly on areas like the hands and arms.”

Trump’s swollen ankles have often caught the media’s attention during his second term, with photographs showing them bulging over the top of his shoes.

The chronic venous insufficiency cited by the White House is a common condition in elderly people. This where key valves in leg veins are no longer able to help blood flow back up to the heart, leading to blood collecting in the legs.

Trump said he had been advised to wear compression socks but he declined.

Govind said that swelling in the ankles could also occur “when your body holds on to extra fluid. This can sometimes be a sign of heart, kidney, or liver problems. It can also happen from sitting or standing for long periods or eating a lot of salty food.”

Trump has also said he takes larger doses of aspirin than recommended. Taking aspirin can help to prevent strokes and heart attacks in older people by thinning the blood, according to the Mayo Clinic.

“They say aspirin is good for thinning out the blood, and I don’t want thick blood pouring through my heart,” Trump told The Wall Street Journal last month.

He said he took 325mg of aspirin a day. The Mayo Clinic says the daily dose for aspirin therapy is between 75mg and 325mg. “They’d rather have me take the smaller one,” Trump said.

Trump said aspirin also caused him to bruise more easily.

Govind said: “Taking a high dose of aspirin every day can increase the risk of bleeding, including easy bruising, nosebleeds, and bleeding in the stomach or gut. It can also irritate the stomach lining.”

Trump’s mental capacity – what do we know?

Trump critics have frequently suggested that he could be suffering from Alzheimer’s disease. His niece Mary Trump, psychologist, cited his family history, pointing out that his father had died aged 93 while suffering from the disease.

Trump hit back last month in an interview, claiming that while his father had Alzheimer’s, he did not. However, in doing so, he forgot the name of the disease.

“At a certain age, about 86, 87, he started getting, what do they call it?” Trump said, pointing to his forehead and addressing Leavitt. “Alzheimer’s,” Leavitt said.

“Like an Alzheimer’s thing. Well, I don’t have it,” Trump added.

Medical professionals have cautioned against drawing conclusions and attempting to diagnose him from family history. The Alzheimer’s society says that diagnosing somebody without a thorough assessment by a health official is impossible. Under the Goldwater rule, they should not diagnose a public figure they have not spoken to themselves.

However, increasing signs of confusion and other symptoms have prompted such concern, that some professionals are raising questions.

In a speech at Davos last month, he confused Greenland and Iceland several times, and has mixed up other countries in numerous previous speeches; he has veered off into apparently random tangents, and often cites stories which have no basis in reality.

“The main way to diagnose dementia is that we see a deterioration from someone’s own baseline in these four areas: language, memory, behaviour, and psychomotor performance,” said Dr John Gartner, American psychologist, psychiatrist and former assistant professor at John Hopkins Medical School.

Trump, on the world stage at Davos, is having difficulty walking in a straight line again pic.twitter.com/QqUFudHzkv

“First of all, if you look at tapes of him in the 1980s, he was actually quite articulate. He was still a jerk… but he was speaking in polished paragraphs.

“Now he has trouble completing a sentence, a thought and sometimes even a word… That’s a huge deterioration from his baseline and he also used to be quite physically co-ordinated, and now he can barely walk a straight line.

“He’s also showing signs of tangential speech. He goes from one topic to another in a way that’s really just kind of a loose association,” Gartner added.

He also pointed to Trump’s gait in the past month, which appeared to suggest a major decline.

“On the red carpet at Davos you may have noticed him weaving. That relates to one of the signs of what I think he has: frontotemporal dementia. That walk is called a wide base gait where he swings his right leg in kind of a semicircle and that drives him to the left,” he said.

“That seems to have gotten dramatically worse recently. It may be related to the stroke I think he’s had on the left side of his body.”

Speculation was rife last September during a 9/11 commemoration when Trump was seen with a pronounced droop on the right of his face.

Weakness, paralysis or numbness on one side of the face is one of the best known indicators of a stroke, but can also be the result of many other, less serious health issues.

The White House quickly pushed back, calling the claims “another BS Fake News story”, adding: “President Trump is in excellent health, despite all of your deranged wishcasting.”

‘Memories that didn’t happen’

Confabulation – or telling a completely false story while believing it to be true – can be a sign of early dementia.

“Confabulation is when you tell stories about memories that didn’t happen,” said Gartner.

Trump has been known to tell, in great detail, made-up stories before, including that his uncle taught the “Unabomber” terrorist Theodore “Ted” Kaczynski at the Massachusetts Institute of Technology (MIT).

Trump said his uncle had spoken to him about teaching Kaczynski. “I said, ‘What kind of a student was he, Uncle John?’… And then he said, ‘Seriously, good.’ He said, ‘He’d correct – he’d go around correcting everybody.’ But it didn’t work out too well for him.”

Kaczynski went to Harvard and the University of Michigan, not MIT. Furthermore, he was only revealed to be the Unabomber in 1996. Trump’s uncle died in 1985, and there is no reason Trump would have heard of Kaczynski at that time.

Trump’s military aggression

Gartner speculated that Trump might be showing signs of frontotemporal dementia, pointing to his growing military adventurism in foreign countries, notably Venezuela, embrace of force against the American public, and threats to invade others, including Iran and Greenland.

While this form does not produce the same level of memory decay as Alzheimer’s, it “does produce is tremendous disinhibition of behaviour because it’s the frontal lobes that are the brakes of the brain. So that’s what inhibits us from acting out,” he said.

“Part of his brain [appears to be] deteriorating disproportionately so he’s losing the brakes and this is someone who was always impulsive and always acted out aggressively… Whilst he’s becoming confused about what’s happening, he’s also becoming aggressively disinhibited to act in impulsive and erratic ways.”

Gartner said: “He’s deteriorated since his last administration noticeably but now we’re seeing deterioration almost week over week. The rate of decline is accelerating.” He added: “The high-pressure job can also accelerate cognitive dysfunction.”

However, it is hard to say whether Trump’s increasingly reckless and hardline policies at home and abroad are down to health conditions so much as character.

Experts strongly caution that we need to be careful before presuming to diagnose the President, or anybody, with dementia.

“It is very difficult to distinguish between early stages of dementia and normal age-related memory loss,” Rosalind Willis, associate professor in gerontology, at University of Southampton said:

“However, as time goes on, a person with dementia will get progressively worse. Whereas a person with normal ageing will not deteriorate further.”

Could an unfit president be stopped?

But were any US President to be found unfit for office, what could practically be done?

Under the US Constitution, Section four of the 25th Amendment leaves open the possibility that mental incapacity could one ground to remove the president.

There is no precedent for the 25th Amendment being used for this. However, it has been used six times when presidents and vice presidents have resigned or had to undergo surgery.

Gartner said it was unlikely that this would be used because “none of the people in this cabinet have either the integrity or the courage”.

James Pennebaker, Professor Emeritus at University of Texas at Austin said: “If my department chair, dean, or university president spoke in ways similar to Trump over several weeks, I would urge the administration to remove the person from their responsibilities at least temporarily to determine the status of their mental health.”

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