Is Dick Cheney Demented?

The question is not posed maliciously, but out of genuine concern for the health of the vice president and the country.

My 85-year-old father has vascular dementia, what used to be called senility. Over the years, he had numerous small strokes and transient ischemic attacks (TIAs).

Dementia is a slow and insidious process. My father never fell ill, never took time off work, never had any obvious signs of stroke such as sudden paralysis. Nobody knew how bad things were until a magnetic resonance image showed his brain pockmarked with dead areas.

Small arteries in the brain gradually lose their flexibility and become narrowed by atherosclerotic plaque. Blood clots can form on inflamed arterial lining, or travel from elsewhere within the circulatory system, and block a vessel. When it happens in the coronary arteries, it’s a heart attack. In the brain, a stroke.

Deprived of oxygenated blood, the function of the brain nourished by that artery is instantly lost – motor control, sensation, memory, cognition.

I’m hardly the first person to suggest that something is seriously wrong with Cheney’s mind. Several people who have known the vice president for a long time have observed marked changes in his personality and character.

In an October, 2005, article in New Yorker, former national security advisor and close Bush family insider remarked on the anomalous character Cheney has become. “I consider Cheney a good friend – I’ve known him for 30 years,” Scowcroft said. “But Dick Cheney I don’t know anymore.”

“Is the vice president losing his influence, or perhaps his mind?” posed Jim Hoaglund in the March 8 Washington Post, quoting a European statesman who has known the vice president for many years: “What has happened to Dick Cheney?”

Michelle Cottle probed Cheney’s medical history in the New Republic last March. She quotes DC insiders who openly ask, “What is wrong with Dick Cheney?”

Dick Cheney has a complex medical history that includes four heart attacks, his first when he was only 37 years old. In 1988, after his third heart attack at age 47, Cheney had quadruple bypass surgery. He had a stent placed in a coronary artery in the fall of 2000, a repeated angioplasty procedure the following spring, and had a cardioverter/defribrillator implanted in June of 2001.

Mental impairment is common after bypass surgery and cardiac interventions such a angioplasty. A Duke study published in the February 8, 2001, New England Journal of Medicine found that 42% of people who have undergone coronary artery bypass surgery have measurable cognitive decline within 5 years

There is evidence that Cheney has heart failure and peripheral artery disease, both of which have a risk of throwing clots and other cardiovascular complications. In March of 2007, it was reported that Cheney has deep vein thrombosis.

In the June 2004 issue of The Atlantic, Howard Markel described the assessment of seven cardiologists given Cheney’s anonymized medical history. “It’s a testament to medical science that he’s alive,” said one.

I’m aware that right-wing pundit Charles Krauthammer, who was a practicing psychiatrist, has already given Cheney a clean bill of health. I consider this about as reliable as former GOP senator Bill Frist’s assessment of Terri Shiavo.

To somebody who has seen dementia up close, the signs and symptoms are unambiguous.

Cerebrovascular disease can cause varying degrees of hemiplegia – weakness or paralysis on one side of the body. Neurological deficit can be subtle. Mild muscular weakness may be noted by asymmetry of the mouth when a person speaks or grimaces:

Paranoia and suspicion are common features of dementia. According to a recent Washington Post profile, Cheney invented his own secrecy classification and has a man-sized safe in his office.

The demented person may become disoriented and confused. For example, he may be uncertain whether he works in the executive or legislative branch of government. One approach is to affix labels to objects around the home and workplace. A sign on his desk that says, “You work here” may be helpful.

The demented person may be forgetful, and may embark on ill-conceived action that is inconsistent with previous, less impaired behavior:

Poor impulse control is another common feature of dementia. The demented person may act in a manner that is shocking or inappropriate for the social context, such as blurting out, “Go fuck yourself.” However tempting, responding in kind is unproductive.

It is important to remember that these behaviors are the product of a diseased mind. As NY democratic Rep. Charles Rangel said about Cheney in 2005, “"I would like to believe he's sick rather just mean and evil.”