As Trump surges his Gestapo and threatens to annex new territory, his brain is collapsing. He’s sundowning on Truth Social, nodding off in meetings, slurring words, slurping at the saliva pooling in his mouth. His insults and aggressions are as constant and predictable as his arms are, reaching out for handholds.
Up until this point, discourse on the mental health of this decrepit fascist leader has used the kid gloves of psychology, psychoanalysis, and psychiatry, in which even the most informed analyses were constrained by the fact that experts were interpreting his inner states. For our part, we’ve compared his fate to that of charismatic cult leaders at the end of the line—and we’ll do more of that today.
Now a new posse of clinical commentators on IG and TikTok have made it all much more biological: we are witnessing, they say, the predictable signs of fast-progressing dementia.
Show Notes
Goldwater Rule vs Duty to Warn, American Academy of Psychiatry and Law
World Health Organization: Dementia
Signs and Symptoms of Dementia
Alzheimer's disease: a comprehensive review of epidemiology, risk factors, symptoms diagnosis, management, caregiving, advanced treatments and associated challenges
USC study finds new evidence linking dementia to problems with the brain’s waste clearance system
A new drug could stop Alzheimer’s before memory loss begins
A 2025 update on treatment strategies for the Alzheimer’s disease spectrum
Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission
Broadening dementia risk models: building on the 2024 Lancet Commission report for a more inclusive global framework
Study finds disparities in diagnosis and treatment of dementia
Decomposing Racial and Ethnic Disparities in Risk and Protective Factors of Dementia in the U.S.
Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review
Dementia Diagnosis Disparities by Race and Ethnicity
Racial disparities in dementia determined by social factors
Straight-forward Explainer: What’s Going on With NIH Cuts to Alzheimer’s Research?
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I'm Matthew Remsky.
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For some reason, I joined Upscrold this week.
We'll see if that lasts, but I've been off TikTok for a while.
I got locked out of TikTok, actually, but I know Matthew, your anti-fascist dad, TikTok, has been blowing up.
So people, you can find him over there for sure.
Do you have an Upscrolled coming for Anti-Fascist Dad?
You know, it looked like, along with a lot of other, you know, leftist TikTokers yesterday, that I was completely shadow banned.
Like I posted something that actually got like zero views over 10 hours, which had never happened before.
It was grayed out in my little application.
It's bounced back today, but I don't think it's very stable for people who are doing content like we do.
So we'll see what happens.
Yeah, Upscroll does seem to be a little bit more less inclined to fascist tendencies.
We'll see how that goes though.
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Yale's Warning: Trump's Dementia?00:06:22
Episode 293, Trump and Fascist Dementia.
As Trump surges his Gestapo and threatens to annex new territory and makes his bets on what to say about Alex Predi murdered in the street by ICE, his brain is collapsing.
He's sundowning on Truth Social, nodding off in meetings, slurring words, slurping at the saliva pooling in his mouth.
His gait is widening because he's terrified of falling.
He's hiding his lock-kneed, forward-tilted Louis-lean behind every podium.
Both hands now are splotched with purple IV bruises on skin that's pallid compared to his orange spray-tanned face.
His insults and aggressions are as constant and predictable as his arms are as they flail out for handholds.
Up until this point, discourse on the mental health of this decrepit fascist leader has used the kid gloves of psychology, psychoanalysis, and psychiatry, in which even the most informed analyses were constrained by the fact that experts were interpreting his inner states.
For our part, we've compared his fate to that of charismatic cult leaders at the end of the line, and we'll do more of that today.
But now, a new posse of clinical commentators on Instagram and TikTok have made it all the much more sort of biological.
We are witnessing, they say, the predictable signs of fast-progressing dementia.
His frontal lobe is crumbling.
And with this shift from interpreting his psychology and divining his intentions to assessing his risk of aspirating on his own saliva on live stream, we've moved into harder materialism.
Okay, so as a private citizen with no expert qualifications, I think I speak for or with most of the Anglophone world in saying Trump is not okay.
He's never been okay.
He's only gotten worse.
In purely colloquial terms, he is as obvious a compulsive liar and a deeply insecure narcissistic bully as I can imagine.
He's as ignorant as he is incurious, as pathologically threatened by expertise as he is predictably flattered by sycophancy.
We knew most of this 10 years ago, but a good chunk of the American electorate either can't see it or can, but don't think it disqualifies him from being in the most powerful job in the world, or they actually like what they see.
The hypnotic spell cast by such a reactively fragile and physically infirm figure, portraying himself as the strongman political hero, reminds us, as you just said, Matthew, of a long list of idealized yet sickly cult leaders who were falling apart behind the scenes, even as they acted out their criminal pathologies.
And we'll get into those overlaps in a minute.
But now, with Trump in the second year of his second term and approaching his 80th birthday, the chorus of medical experts sounding the alarm on his psychological and cognitive health keeps getting louder as it comes in waves.
Again, this is not new, but it's grown more urgent.
So to get us started, here's a little timeline.
We'll rewind and then catch up.
Between 2017 and 2020, a Yale forensic psychiatrist named Bandi Lee organized conferences and edited a book titled The Dangerous Case of Donald Trump, which compiled essays from 27 psychiatrists, psychologists, and mental health professionals who felt a, quote, duty to warn.
They made the case that Trump's mental health represented a clear and present danger to the nation and the well-being of its individuals.
This is based on observations of his behavior and speech on the public stage.
And the book makes a case for malignant narcissism, which combines narcissistic personality disorder with sociopathy, paranoia, and sadism.
That entire endeavor also unfolded in the looming shadow of the Goldwater rule.
Now, this is part of the code of ethics of the American Psychiatric Association, which forbids members from expressing public diagnostic opinions without personal examination and patient consent.
And Bandi Lee was eventually actually fired from Yale for violating that rule.
We'll put in that for now and come back to it.
It's such an interesting book.
And one of the most haunting conditions I learned about in it was something called Extreme Present Hedonism.
Had you heard of that, Julian?
Extreme present hedonism.
I had not, but it's a fantastic turn of phrase.
All right.
So it's a personality profile that's linked to childhood trauma where it's believed that development was stunted to the point that the sufferer is completely dependent on the present moment for well, I guess, or it may be the opposite.
I don't know.
They need immediate pleasure, novelty, and sensation while avoiding pain and any thought of the future.
So it's about impulsivity, no regard for consequences, the willingness to do literally anything for ego protection, like in the moment.
So lying would just be standard.
It's like a reflex.
There's nothing more important than the needs of the moment.
And, you know, other people being other people, the people around him can't ever give him enough attention or reassurance.
And so ego protection is one through punishing others, like preemptively because of paranoia, but also maybe just spontaneously, like on a whim.
And also there's this penchant for dehumanizing.
And so that's all from the psychology stack.
And then it turns out that a lot of those symptoms are being pinged by the clinical experts we'll talk about today as being, you know, characteristic of neurological dementia.
Yeah, so interesting.
One contributor to the dangerous case of Donald Trump was psychologist and part-time faculty member at Johns Hopkins Medical School, John Gartner.
He founded a group called Duty to Warn and spearheaded a 2017 petition submitted to the Senate of 25,000 mental health professionals who declared that Trump was unfit for office and must be removed.
That's a lot.
25,000.
Yeah, and yet still, you know, just kind of yelling into the void.
Gartner's Petition Push00:04:38
In 2024, Gartner organized another petition, this time diagnosing Trump with probable dementia.
That gathered the signatures of a more modest 3,000 licensed professionals.
Gartner also co-hosted a podcast called Shrinking Trump, which is kind of a brilliant name, Shrinking Trump, which interviewed professionals on this topic over the course of 70 episodes starting in late 2023.
And then citing concerns about Trump's litigiousness in their reasons for discontinuing it in October 2025, they backed away slowly.
Bandy Lee, that's that Yale professor, also got involved in 2024, organizing an open letter from 50 distinguished mental health professionals warning of the national security risks of Trump's cognitive decline and calling for a full independent neurological workup.
And that year, George Conway's anti-psychopath PAC published an ad in the New York Times in the form of a letter signed by 230 mental health professionals detailing the physical and verbal signs of severe cognitive decline.
Over the last two years, Gartner and others have made many media appearances arguing that Trump's verbal incoherence, topic shifting, confabulation, difficulty pronouncing words, and his reduced vocabulary and impulse control all are suggestive of frontotemporal dementia.
They've also noted things like his wide-based gait, his shuffling steps, teetering instability, as well as a kind of discoordinated right leg swing combined with weakness in his arm and drooping face.
And this is actually all on the right side, which may be telltale signs that he had a stroke around the middle of 2025.
You know, I found the focus on the limited vocabulary and especially like the other term that's or phrase that's thrown around is repetitive adjectives.
It's very haunting, but it's also very funny because it's a staple of every Trump impersonator to master like the hits, the repetitive hits like huge or tremendous or very.
But these aren't just like rhetorical habits that he has, like they reflect language centers shrinking while the reflex to be bombastic like expands.
So we're literally laughing at a clear sign of brain atrophy.
But Matthew, Matthew, it's atrophy like no one's ever seen before.
People who say it's huge.
I know.
Yeah.
Also in the book, Philip Zimbardo, who has a checkered history over the Stanford prison experiment and another clinician named Rosemary Sword pointed out that Fred Trump suffered from Alzheimer's disease and dementia for the last number of years of his life.
Yeah, so that's telling too.
Now, meanwhile, with the exception of divulging his chronic venous insufficiency diagnosis, which explained his very swollen ankles at some points, every other official statement from the White House about Trump's medical and neurological health says he is in excellent condition.
Tremendous.
So that's very telling.
Meanwhile, with the exception of divulging his chronic venous insufficiency diagnosis, which explained his swollen ankles that a lot of people were noticing, every other official statement from the White House about Trump's medical and neurological health says he is in just excellent condition, which the rest of us have a hard time taking seriously, given that he's a 79-year-old obese man who never exercises and seems to survive pretty much on a diet of junk food and spray tanner.
Which, obviously, given Maha's mandate is just a glaring contradiction that they've never been able to swear and don't even try to.
I mean, RFK Jr. recently did during an interview.
He said he doesn't know how Trump is still alive given his diet, but it was presented in that old chummy, oh, you know, Donald sort of manner.
And maybe he was even cognizant of not pushing too hard against his boss because he also said that Trump has the highest testosterone levels ever measured for a 79-year-old man.
And this was all on Katie Miller's podcast, of course, Stephen Miller's equally awful wife.
So listening to Kennedy pull a Kim Jun ill shot 11 holes in one the first time he ever played golf level claim is disorienting, but it's really not surprising given how much leeway Trump has given him to destroy our public health system.
So a little quid pro quo going on there.
I also find it especially ironic given how hard Kennedy was pushing for Biden to, quote, prove his mental acuity.
Quid Pro Quoportunics00:15:52
And this was back in early 2024.
You also have some of Kennedy's buddies going full tilt at this as well.
Asim Maholtra, he's an anti-vax champion that we've covered before.
He believes Trump's health issues are the results of him taking statins.
But this is true to Maha form as well, because Maholtra is a longtime anti-statin activist.
So deflecting questions of Trump's fitness in a direction that serves him well makes a lot of sense.
Yeah, so Trump is either somehow superhuman and can just eat konzaki fried chicken all day but have incredibly high testosterone, or it's the statins that explain.
Like it's like we're just going to keep playing this kind of bingo with weird rationalizations.
So that's a bit of a timeline of how we got here.
The topic of Trump's cognitive fitness has actually been up again recently following his speech at the World Economic Forum in Davos.
And there he repeatedly referred to Greenland as Iceland.
He falsely claimed that the U.S. had settled eight wars and had paid 100% of NATO defense costs and that China manufactured the most windmills in the world, yet didn't use any, despite them actually being a global leader in wind power.
He also said that NATO had avoided frontline combat in Afghanistan, which is just completely untrue.
Well, there's 115 body bags that came back to Canada from Afghanistan.
So I'm sure their families are really surprised to hear that.
Absolutely.
Several other countries, including Greenland, were actually.
Exactly.
Some experts and experienced clinicians have taken to social media to suggest that these types of moments and those types of statements may be more than just compulsive lying and bullying, especially in combination with what we've listed about his physical presentation.
So here's one such commentator I've really been enjoying.
He goes by epistemic crisis on Instagram and has over a half a million followers there.
I'm a physical therapist with a doctorate in my field and 14 years of experience working in home healthcare treating geriatric patients with dementia, just like this guy.
It began with his arrival where he once again could not walk in a straight line on a red carpet.
This is happening because of his wide-based gait from most likely frontotemporal dementia.
His gait is widening to keep him from falling.
Decrease in gait speed, kyphotic posture, or leaned over posture are all indications that a patient at least subconsciously knows my risk of falling is high.
And here's a direct quote from the speech.
In Europe, I'm helping NATO, and I've, until the last few days, when I told them about Iceland, he means Greenland, they loved me.
They called me daddy right the last time.
A very smart person said, he's our daddy.
He's running it.
Folks, his frontal and temporal lobes are shrinking inside of his brain.
This is known as atrophy.
The frontal lobe is the filter for your limbic or emotional center of the brain.
It keeps you from saying crazy shit like this, but his is disintegrating on camera.
Yeah, so this guy doesn't pull any punches.
No.
He's also tracked Trump's telltale stroke symptoms, including falling asleep in meetings and the likelihood that he's been getting regular IV infusions over the last year or more through those bruised areas that we've seen on the back of both of his hands due to potential congestive heart failure and kidney disease.
Epistemic Crisis has said in multiple reels that he believes Trump likely only has months to live and, you know, take that for what it's worth, or months before he's removed because it's undeniable he can no longer serve.
Here's a little more from him, breaking down the recent press briefing Trump took over to crow about his first year in office.
He references Trump's former White House press secretary, Stephanie Grissom, sounding the alarm and saying that Congress needs to wake up to the obvious cognitive decline.
And then here he explains a key moment from the rambling speech.
And then he launches off into this random ass childhood memory that makes no fucking sense.
It's a combination of him losing his memory, but also filling in the holes in his memory with lies that he actually believes.
And in this clip, it's him having the potential to be a professional baseball player.
This is known as confabulation, which is a characteristic symptom of frontotemporal dementia.
I used to play Little League baseball there at the place called Cunningham Park.
It was quite the baseball player, you wouldn't believe.
But I said to my mother, Mom, she would be there always there for me.
She said, Son, you could be a professional baseball player.
I said, Thanks, Bob.
I said, Thanks, Bob.
This is just one of the many insane things he said while he rambled like a crazy person.
Like I've said many times before, I think he's got two to four months left in the land of the living.
Or before they invoke the 25th Amendment, impeach him.
Okay, so you're not going to believe this, guys, but he's Trump was actually lying about that.
And this is completely outrageous.
A good friend of mine, I went to his father's house once, and his father was actually on Trump's Little League team and showed me a photo of them on the team photo.
He was not a good baseball player.
What?
So I'm sorry to dispel any myths here.
And that is one of the more random experiences of my life, but that is actually true.
This is not a bit, Derek.
Like, you saw Trump in a picture with your friend's dad playing baseball.
Yes, he still had that from when he was young.
Absolutely.
Wait, and you're telling me that there was a kid who wasn't that good at baseball, but his mom said that he was really good.
Amazing.
It's incredible.
He sounded a lot like Joe Pesci in that clip, didn't he?
All right.
So baseball and future death predictions aside, this medical commentator is not alone in his observations and concerns.
CNN's medical expert Jonathan Reiner has called for an evaluation saying repeatedly falling asleep at your desk with a dozen people around you is not normal.
Medical commentator for NBC and MS Now, Vin Gupta, has also recently listed all of the signs of frontotemporal dementia.
You know, as I've done more reading on frontotemporal dementia, I came across this symptom description in a couple of papers that's actually like Venn diagrammy with that concept that I was talking about earlier, extreme present nihilism.
So the rules feel abstract and others feel unreal is the line that stood out.
And it really made me think about how every bit of protocol, law, process, the UN, the WEF, International Criminal Court, what ICE is and isn't supposed to do, what the DHS is responsible for, like all of that stuff must feel just so vague and irritating to him.
Like he must be constantly feeling like, what does that matter to me?
And then this line about others feeling unreal.
And I can only think of the Epstein files because, you know, of course he's hiding whatever he can because he has some vague memory of transgression.
And that must also be bizarre as well.
It's like, what happens when you forget about all of the terrible things that you've done?
Right.
Or he's been informed that the records are really a current threat to his power.
But what stands out most about his responses to the files is his utter lack of interest or concern in who the accusers are on a human level whatsoever.
Like they are just not real to him, just like the people, you know, in Minneapolis protesting ICE.
All right.
I have one last clip.
This one is from a certified speech and language pathologist who goes by concussion talks on social media.
She had a really interesting professional take on that same press briefing we were just talking about.
Donald Trump basically did a speech therapy session for dementia patients on TV.
Reminiscence therapy is something that as speech language pathologists, we would use for people who are struggling to speak, to have good memories of what's been going on.
And what we basically say is we say, hey, let's get some pictures for you.
Let's get some papers, some journals, things that you may have written, and let's talk about them.
And we talk about them in a very inviting way.
We don't say things like, do you remember when?
We don't confront when they are incorrect.
So any lies or confabulations that may be coming out, we kind of just go along with it, unless there's a safety issue, of course.
If they make comments like, you're not getting bored, are you?
We would say, absolutely not.
This is the most fascinating thing I've heard all day.
And then we say, that was very lovely.
Thank you so much for allowing me to participate in this with you.
There's nothing that he said that had any content in that speech.
And it really does look like just straight up reminiscence therapy.
That would be a very bad sign for the president of the United States to be participating in something that is so consistent with dementia speech therapy treatment.
This speech pathologist could have a side gig training people to be in the Trump cabinet.
Right, exactly.
Like, here's how you do it.
No, no, no.
This is deeply fascinating.
So in one of the cults I was in, the leader, his name was Charles Anderson, clearly started to have neurological events while giving his sermons every morning.
So he'd be in the midst of a stream of consciousness ramble and he would suddenly break off mid-sentence and his eyes would go glassy.
And it was anyone's guess how long he would pause for.
Usually he would snap back with a kind of sucking mouth noise and he wouldn't pick up where he left off, but he had the presence of mind or at least the muscle memory to turn his potentially embarrassing moment into a bit.
Like he'd say, he'd be slurring a bit, but he'd say, wow, well, Jesus almost took me out that time, right?
Or something like that.
He would refer to some sort of mystical occurrence.
And Trump has some of that recovery instinct.
Like you can see it when he fucks up a word and then part of his brain catches it and he'll pretend he was making a pun.
Now, at the time, I thought that these mini fugue states meant that he had paused his breath like some yogi in deep meditation and the spit had gathered and that's what the sucking was, right?
I mean, that's the story I told myself.
He also wore dentures, so that must have been a factor.
But one morning it went a lot farther.
And I can't remember which side of his face it was, but we all saw his shutdown verbally coincide with a slumping of his cheek and lip and the flesh around his eyes.
And that time he was out for a long time.
And I think two of the henchmen disciples had to help him out of his chair and guide him back to his room.
I think he had a foot drop as well on the same side.
But then with, here's what I want to say is that with the disciples, this very human and recognizable thing happened.
Like they were helping him, but also over their shoulders, they were looking out over the gathering, giving us expressions of reassurance, like everything's fine.
He's okay.
Trust in God.
Trust in the plan.
And it's a very normal thing that happens in families, I think, in that moment of fear and crisis, especially if there are kids in the room and you want to make sure that their distress doesn't add to your own tasks, right?
Like I like, this is disturbing enough.
I don't want to have to comfort you as well, right?
So I consider that a form of almost empathetic strategic lying, especially because you know you can't hide the truth forever.
Like you're going to have to tell the kids sometime.
But disciples have to hide the truth forever because they not only have to maintain the fiction of the peerless leader, they have to protect their own roles in the system he set up and dominates and that they benefit from.
And so the moment holds an opportunity for the disciple who is most able to reassure the crowd because their ability to reassure is linked to how well it seems they know the leader and his ways.
So when I watch Caroline Leavitt cover herself in shit day after day after day to deny what's happening in front of our eyes, it's not just deference to Trump, I think.
I think there's also the possibility that she's made a bet that showing herself to be a close confidant and nursemaid will grow her stock within a movement that's threatening to collapse.
But back to this guy's fugue states, when I was witnessing them, I had the sense that something was very wrong.
But as I suggested above, I rationalized it away by believing that his spiritual insight was in fact shining through in these moments of vacancy, that he was like too much for this body and this world.
And I was almost able to hold two things at once, that he was dying in front of our eyes, but that his spirit was also glowing brighter.
Like that's how much of a dualist I could be in my own brain at that time.
I think I was less credulous than a lot of people in that room who believed that he was getting downloads from the spirit realm, because that illusion can't last for everyone for very long.
But the fact that it does last is an artifact and echo of the leader's now vanished charisma.
Like people have to adjust to the fact that he no longer has it and it takes a while.
Like the people in that room were trained over years to not only tolerate but celebrate an increasingly incoherent leader.
And so the fugue state, it didn't come from nowhere.
Neither did the response to it.
The fugue state was preceded by the sermons getting longer, the language more garbled, the moods getting more extreme.
But because the context was that he was trying to wake us all up spiritually, the pretext was that he had to get more and more extreme in his tactics.
And I think what's crucial about this related to Trump is that there's a time lag that begins to develop and extend between whatever people realize is going wrong and their willingness to intervene.
And on the administrative level, the cabinet, they're definitely protecting their skins.
So they're not incentivized to intervene or name what's happening.
But the lower down the power ladder you go, the more you see, I believe, this time lag effect of training that comes from the charismatic feedback loop.
Like he held your attention in such a way.
And so you gave it to him and you made it make sense for yourself.
So years later, after that experience I had, I was doing journalism on groups like this.
And I hear from Leslie Hayes, who was one of Chogyam Trungpa's seven spiritual wives in the Shambhala Buddhist community in Boulder, Colorado, but it was, you know, had a number of places throughout the country and the world.
And he also would regularly vacate, just disappear, go blank.
He was a terminal alcoholic.
Likely he had untreated neurological conditions.
And then he would come back after his fugue state and say that he'd been visiting the Rigden kings of ancient Tibet in their celestial palace.
And he pulled off shit like that for years.
But as I interviewed Leslie, and then I interviewed a woman named Julie Salter, who was the personal attendant of Swami Vishnu Devananda of the Shivananda Yoga ashram, I got the picture of what devotees in the inner circle like this end up doing.
Devotees' Devotion Duties00:02:09
So Vishnadevananda was also very ill.
He also likely narcissistic personality disorder had devolved into paralysis via a stroke.
There are similar stories that come from the inner circles of Osho, who had a massive substance use issue and was perpetually disoriented.
And then also Yogi Bhajan, who spent a lot of time in his final years, very sick.
But the women disciples in attendance that I got to know had to do incredibly gross and humiliating things to keep the leader going.
A lot of that was toilet related.
But at the same time, they have to look good and they have to maintain the veneer.
And so they work so hard at this that they wind up being the beneficent faces of the cult.
Right.
So it wasn't just Julie's labor, Leslie's labor, you know, other people's labor, their attention that was exploited.
It was also their like service, their virtuousness, their faith in the ideals that, you know, the guru couldn't uphold.
And for all we know, never believed in himself.
So it was the affect of these servants, their visible devotion.
And so I keep this in mind when I consider what Leavitt has to maintain.
And I also think it might be a factor in the performativity of the other women caregivers around him.
There's a lot going on that people are saying about the Mar-O-Lago cosmetic surgery look.
And yes, it points to Trump's fetish for beauty pageants and his misogyny.
But if I'm right about this comparison between guru devotees and Trump's inner circle, there's a good chance, I think, that Leavitt and Christy Noam and Guilfoyle and Melania and Laura are also putting it on because they know the old man is dependent on the distractive power of their own charm.
Now, last year, around the time that Trump held that town hall where he gave up on his speech altogether and he just stood there DJing opera and show tunes from his iPad and Christy Noam, poor Christy, was on stage trying to MC the crowd into singing along, but she has like no talent as any kind of like choir director or anything like that.
Dementia's Shadow00:07:07
It was really kind of awful, cringe to watch.
I had psychoanalyst Dan Shaw on the show to talk about what his final ego or brain implosion would look like, not only for him, but for his followers.
Now, Shaw is the guy who came up with a framework of traumatic narcissism to understand the cult leader.
And this is a defensive identity formed when a child must attune to a caregiver's unmet emotional needs to survive.
It becomes traumatizing when this identity is imposed on others, which coerces them to mirror the narcissist's fragile self and deny their separate subjectivity and their emotional reality altogether.
What Shaw predicted with Trump was an escalation of defensive behaviors intended to protect a kind of unstable delusion of omnipotence.
Because this delusion shields the narcissist from catastrophic feelings of being impotent, small, weak, nothing, they will go to extreme lengths to prevent its collapse.
So according to Shaw, admitting to any vulnerability would be psychologically catastrophic.
They have to increase their paranoia and rage and find more malicious enemies and seek out more adoration, and it will never satisfy them.
It doesn't matter how many Nobel Prizes you get gifted by bootlickers, like every act of deference will just breed resentment and bitterness.
Like he will hold you in contempt for kissing your ass after a while.
The traumatizing narcissist has to exploit existing crises as well, you know, like the price of eggs, or he has to invent crises to maintain a sense of control and relevance and to build one on top of the other.
So the stolen election goes to January 6th, goes to claims of persecution, goes to the pardons, goes to hiring, you know, leaders into ICE because of migrant rapists.
And then all resistance, legal or moral, will just harden that position until it cracks.
Yeah.
So Matthew, that episode you did with Dan Shaw was so fascinating.
And back then, we talked about this a little bit.
And it's part of everything we're discussing today, too, which is that this diagnosing from afar of someone's psychopathologies or even their neurological issues, it kind of happens in the shadow of the Goldwater rule, which I mentioned earlier is this ethical principle instantiated by the APA, the American Psychiatric Association, back in 1973.
And this was after, it's kind of an interesting story, Fact Magazine published a 1964 article about Barry Goldwater, who was then running for president.
And they polled over a thousand psychiatrists who agreed that he was mentally unfit for the job.
He lost the election.
That's probably not the reason why.
But then Fact Magazine also lost a hefty lawsuit about that article.
And the APA would go on to officially then deem it unethical for psychiatrists to offer public opinions that diagnose anyone from afar without personal examination or consent.
And it's worth noting here that if they, in fact, had engaged in a personal examination, they would then be bound not to speak because of rules of confidentiality.
Yeah, it just removes the mental health professional from the political sphere or the commentarial sphere altogether.
Like there's just not going to be public figures that way.
Yeah, yeah.
Now, in contrast to this is another ethical principle, which within these particular circles and academies, which is called the duty to warn.
And this compels psychological professionals to break confidentiality without patient consent when it is for the valid purpose of protecting others from harm.
Now, the case most often referenced here involves that of a therapist who failed to warn a victim and that victim's family and everyone else involved that his patient had told him he planned to murder her and then went ahead and did that.
In addition to this case, many opponents of the Goldwater rule today point out that over the last 50 years, diagnostic methods have moved away from prioritizing personal examination and from sort of Freudian psychoanalytic methods and more towards behavioral observation.
And they argue, look, if you have hundreds of hours of video to examine, that's plenty of data to render reasonable diagnostic opinions, especially when those involve warning of extreme danger to the world.
So the ethical debate, and you set this up really beautifully at the beginning, Matthew, usually swirled around Trump's psychology.
But the red flags now are more about his neurology.
And that's even more about medical criteria based on observation than it is about psychoanalyzing him, right?
Yeah.
Well, Shaw and a lot of the writers in the book that Lee put together, they knew that they were working with a soft science, but it was a soft science that helped a lot of people gain clarity on the relational dynamics like they see or are enmeshed in.
Like when I read Shaw describing the traumatized narcissist as a myth in his own mind, that just hits different for me personally in the language of neuropsychiatry.
I think the fact that it's compelling to me is an artifact of me growing up with that language.
And maybe that'll be less true for folks in the future because the DSM-5 language will continue to squeeze out the older stuff.
But what I find compelling about this shift to focusing on clinical evidence of brain collapse is that it suddenly gets a lot more palpable.
It's less mythic, you know, to use Dan's word.
If you're talking about falling and catheters and brain plaques and probably incontinence, you're talking about something very intimate, non-negotiable, very obvious in terms of what you have to do.
And in this way, I think it actually rhymes with a shift from understanding Trump as a right-wing charlatan and then realizing he's a fascist.
Like there's a category difference there.
It's a shift.
And it's also a shift away from a more liberal manner and etiquette that has typically in a lot of the institutions been allergic to criticisms that seem like invasions of privacy.
You know, the shit really is running down this guy's leg now.
So there's nothing really to talk about or to convince anybody about or to be polite about.
Actually, you just have to name it and then clean it up.
One of the most tragic aspects about watching someone powerful decline in front of everyone's eyes is that this moment offers us an opportunity to broadly discuss dementia, which touches millions of families every year.
It could provide that opportunity to be honest and open about what this mental health condition entails, where the science is, and what people can do if a loved one starts to show signs, but not in this America or really most of Americas that we know of from history, because everything has to be a show of strength, even as everything we're watching unfold with our own eyes is anything but that.
Opportunity Lost?00:09:34
According to the World Health Organization, which thanks to RFK Jr. America just left last week, 57 million people are living with dementia.
So I just, for the last segment here, I kind of want to go over sort of the science, what we know about dementia, what we can possibly do about it if it's in your family, which it most likely is.
It's important to note, though, that over 60% of dementia patients reside in low and middle income countries.
And that also plays out in America in terms of who suffers from it the most.
10 million new cases are identified each year.
In the U.S., an estimated 6.9 million Americans age 65 and older currently live with dementia.
It's important to note as well that experts say dementia is not necessarily a normal part of aging.
Many people live their entire lives without developing it.
So we'll get into the genetic and environmental factors that lead to it as well.
Also, it's not quite an it either.
Dementia is not a single disease, but a variety of disorders that progressively destroy nerve cells and damage the brain, typically leading to mild to severe deterioration in cognitive functions.
So I'll briefly go over a few types because the neurodegenerative processes underlying dementia vary considerably.
The most common, we flagged it already, Alzheimer's disease, which is a chronic progressive neurodegenerative disorder that includes cognitive decline, memory loss, and impaired reasoning.
Alzheimer's is marked by pathological accumulation of amyloid beta plaques and neurofibrillary, neurofibrillary tangles, which trigger neuroinflammation, synaptic dysfunction, and widespread neuronal death.
Amyloid plaques have long been the main focus, but newer research points to dysfunction in the brain's waste clearance system, which is really interesting as well, which is partly why good sleep is really important in staving off dementia as you age.
The second most common is called vascular dementia that results from reduced blood flow to brain tissue, and it typically follows stroke or chronic small vessel disease.
Then you have Lewy body dementia, which involves abnormal collections of a specific protein within neurons, and that affects brain regions that control cognition, movement, sleep, and autonomic function.
That's the one with the tilting forward leaning and the sort of like loch-knead stance that's attempting to hold balance, right?
Right.
And you flagged it in the intro with the Lewy lean.
Exactly.
And then there's frontotemporal dementia, which encompasses several disorders caused by progressive nerve cell loss in the frontal and temporal lobes.
Genetic factors are implicated to varying degrees across dementia types.
For example, a lot of people have heard of the APO4 alleles, which significantly increases Alzheimer's risk.
This genetic variant does not guarantee disease development, though, but it is interesting to note.
It was sort of in the culture broadly with 23andMe, for example, because it was one of the first risk factors that those at-home DNA tests were looking for when consumer testing became available.
Now, that said, early detection is challenging because initial symptoms often overlap with normal aging.
Most of us lose some sharpness as we get older, but that doesn't necessarily mean we're suffering from one of these disorders.
Common early signs, you have memory problems, particularly difficulty forming new memories while retaining distant memories.
So Julian, you flagged this earlier with epistemic crisis.
That's what he's pointing out.
There's problems with communication, reasoning, judgment, and problem solving.
This is often called out as well when it comes to TRUMP.
Then there's vision problems, getting lost in a familiar neighborhood, using unusual words to refer to familiar objects, forgetting names, and an inability to complete common tasks.
The presentation of each one differs across dementia types as well.
There are a number of treatments that are being discovered right now, which is really fascinating.
They include an experimental drug called NU9, and this blocks early damage caused by toxic proteins in the brain that reduces inflammation linked to Alzheimer's disease progression.
Monoclonal antibodies have proven efficacy in slowing cognitive decline in early stage Alzheimer's.
And choline terrace inhibitors, which work by preventing the breakdown of acid, this word always gets me.
Acetylcholine.
Acetylcholine.
I always put it across.
Acetylcholine.
Thank you.
Which is actually a song that I really like too.
That's a neurotransmitter that's depleted in Alzheimer's disease.
So it's important to note that all pharmacological interventions carry risk, but there are also non-pharmacological interventions.
There's cognitive stimulation therapy, music therapy, learning a new language, reading, exercise.
Regular movement and load-bearing exercises have shown to be effective at staving cognitive decline.
And this has been known for many years.
You know, I have a question from the non-science part of the staff, which is when you go through those, that list of non-pharmacological interventions, is your immediate intuitive understanding that something like music therapy would be helpful when we're talking about like a material biological problem like, you know, plaques or proteins in the brain, because why?
Because it would sort of allow the person to grow new pathways around those plaques or because I think I still have kind of like a new age feeling that music therapy would purify the plaques in my brain.
And I can't really get rid of, like, that's immediately where I go to, right?
Like music therapy cleansed my brain, right?
What you just said about growing new neuronal connections is exactly it.
So one of the most fascinating aspects of our brain is that there are brain regions implicated in certain functions, and we know this, but when a part of the brain actually goes out of commission from a stroke, for example, those connections can be made in other parts of the brain.
So there's a pretty famous case of A nun who, in let's just say, I'm not, I'm not sure of her age, but in her 70s had a pretty massive stroke.
She continued to do a crossroad puzzle every day, and she didn't die till her 90s.
She never got dementia.
And when they looked at her brain later, they realized that she was growing those connections around the part of her brain that was no longer in use.
Music therapy is really interesting.
I've read Dan Leviton has written books about this, but there is something nostalgic and romantic about it that people with severe dementia, what that actually helps is it just connects them back to older parts of themselves.
So people who can't form new memories can remember the lyrics to songs from when they were 10 years old, for example.
Right.
And this guy is like spending his evenings whenever he can spinning tunes on his iPad for his guests at Mar-a-Lago that are all coming out of the 1970s and 80s.
It's like Broadway show tunes and like it is his, it is his music.
I don't think he's purifying his brain.
No, he's not purifying his brain.
He is, though, connecting to some emotional sense, right, of his own identity, which no longer is probably very much present in how he appears on the stage.
And in the moment in which he's doing that, he's not causing any trouble, right?
Like, I have to encourage it.
I had this old Tibetan teacher years and years and years ago saying, when he was asked, like, well, you know, why should we, Llama, why should we meditate?
He would say, well, at least when you're meditating, you're not causing shit, right?
You're not like doing bad deeds.
If you're just sitting on your ass, everybody's pretty safe, right?
Yeah, keeps you off.
It was very practical.
Yeah, keeps you off the streets.
Yeah, I just want to say here, too, that like, yeah, we have these new age, often like pseudoscience notions that, okay, if the music is the certain kind of frequency, it's going to have this effect.
That's exactly it.
Like, what kind of music should I play, right?
But I think the deeper kind of truth that we're fumbling towards is that there are certain types of experiential exercises that you can engage in, which do promote neuroplasticity and which can actually be like the experiential piece of it is not necessarily unscientific.
It's just like understanding it from both of those angles, I think is the important thing.
Right.
I would also extend that to what you referenced about Trump and the iPad and playing DJ that day.
Also, if you remember when he spoke in front of McDonald's C-suite and he was so happy about it, I haven't actually eaten McDonald's since high school.
And yet, my senior year of high school was a number two value meal every day, and I still fondly remember it.
And if I ever walk by one and catch the smell of the fries, you know, it will still trigger that in me, even though it's been 30-some years since I've ever since I've eaten there.
Administrative Challenges in Higher Education00:06:38
So it's very powerful.
Well, he's got that going on every day, right?
Like that's his, that's his lunch.
He's got a bag full of yeah.
So maybe like even that, there's a lot of comfort behaviors, I guess, right?
Yeah.
The Proustian Trump.
Yeah.
So some factors are within our control when it comes to dementia, but not all of them.
I want to go over a few of the risk factors.
A 2024 update of the Lancet Commission on Dementia lists many risk factors.
They include education, hearing loss, hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption, traumatic brain injury, air pollution, social isolation, vision loss, and high LDL cholesterol.
Now, the report found that 45% of dementia cases are potentially preventable by addressing those risk factors at different stages of your life.
The report also recognizes that dementia is shaped not only by genetics, but also by socioeconomic, environmental, and lifestyle factors, which include poverty, limited healthcare access, and educational disparities, which all heighten risk.
And this to me is really important because it's yet another example of how the social determinants of health affect every aspect of an individual's health.
So, when I flagged earlier that lower and middle-income countries have higher incidences of dementia, it's partly because of some of those reasons.
So, what can the average person do?
Well, we know that cardiovascular health significantly influences dementia risk.
So, regular exercise is paramount if you're able-bodied and able to do so.
Continually learning new things and engaging in cognitively stimulating activities is very helpful.
And maintaining strong social connections is really huge.
And yet, this administration is doing everything in its power to create more dementia.
And I'm not being hyperbolic by that.
We know about the administration's allergy to anything DEI related, yet a study from UC Davis Health and Oregon Health and Science University found that people living with dementia from minority racial and ethnic populations are less likely to receive an accurate and timely diagnosis compared to white people.
Oh, that's fascinating because that's an extension of like not assessing pain accurately, right?
Yes.
Denying that, oh, you can't possibly be suffering like that or just a sort of racist, uncultured misreading of your actual client.
Yes, correct.
Black participants in another study had nearly three times higher odds of developing dementia compared to white people.
Hispanic participants had 1.2 times higher odds.
A higher proportion of blacks and Hispanics had a missed or delayed clinical dementia diagnosis, to your point, Matthew, compared to white people.
And then a study at Washington University School of Medicine found that racial disparities in brain health are due to social factors, with genetic ancestry playing no role in that particular study.
In fact, structural racism was found to contribute to disparities through multiple pathways.
This includes higher rates of cardiovascular risk factors in Black and Hispanic communities.
That's driven by discrimination, limited access to healthy foods and safe spaces for exercise, occupational exposures, and chronic stress, which all increase dementia risk.
The type of shit that Mahas should be really focused on instead of selling supplements to their white base.
And all this is once again why this administration, particularly the HHS, is such a joke when it comes to combating disease.
Some Alzheimer disease research centers are still waiting for funding to be renewed from last year.
And of course, there was an executive order against DEI initiatives in March 2025 that resulted in permanent withdrawal from some dementia-related research.
That said, the House Appropriations Committee did advance a $15 million increase for Alzheimer's and dementia research funding for this year back in September.
So we'll see if that gets approved in the latest budget requests this week.
Now that we have a number of Democrats coming out saying they're not going to fund it because it's going to fund ICE, we're going to see how that all plays out because, you know, there's always negotiations and Kennedy is always looking to cut more from HHS.
So it's pretty much still a shit show right now.
Derek, thanks so much for the scientific review.
think that it's really great that we're able to offer some clear information that's bouncing off of this political and moral disaster.
I think it really helps me as well to realize that what I'm looking at at the center of this political storm is also this human problem that I can always understand better and help to care for better.
And I think especially the stuff around the social determinants of health being crucial to these late stage life mental health risks is just really, really so important.
Right.
And yeah, hopefully, you know, I posted two things on our Instagram earlier this week.
One of them on Monday was an article in Science that has shown that over 10,000 STEM PhDs are now gone from the administration, which represents something like 14% of the workforce.
Incredible.
And then some people, some of our listeners commented that, yeah, then you have to take into consideration the fact that so many universities are not bringing in foreign students and there's been, you know, people who are not being trained right now.
So, you know, I mentioned a number of universities and health systems that are still doing this work.
It's so, so important.
But the very briefest sign of hope I included in a video over the weekend, which is the fact that there's actually been an increase in people enrolling in STEM programs in universities in America because I think they're so disgusted by what they're seeing.
It's sort of what happened early in COVID, where a number of people rushed to become doctors and nurses and start schooling because of what they saw and wanting to be of service.
I think we are going to see that type of swinging back.
But as long as this administration stays in power, funding for it is going to be limited.