🕷️ Crawler Inspector

URL Lookup

Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 163 (from laksa075)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa163.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical, ml_categories_json AS ml_categories_json, ml_types_json AS ml_types_json, ml_intent_types_json AS ml_intent_types_json, meta_language AS meta_language, attrs_author AS attrs_author, ifNull(toUnixTimestamp(attrs_publish_time), 0) AS attrs_publish_time, ifNull(toUnixTimestamp(attrs_original_publish_time), 0) AS attrs_original_publish_time, ifNull(attrs_is_republished, 0) AS attrs_is_republished, ifNull(attrs_nr_words, 0) AS attrs_nr_words, ifNull(attrs_boilerpipe_nr_words, 0) AS attrs_boilerpipe_nr_words, ifNull(body_ext_links_number, 0) AS body_ext_links_number, ifNull(body_int_links_number, 0) AS body_int_links_number, ifNull(meta_nofollow, 0) AS meta_nofollow, ifNull(meta_noarchive, 0) AS meta_noarchive, ifNull(props_was_rendered, 0) AS props_was_rendered, ifNull(src_redirect, \'\') AS src_redirect, ifNull(download_time_msec, 0) AS download_time_msec, ifNull(download_ttfb_msec, 0) AS download_ttfb_msec, ifNull(download_size, 0) AS download_size FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.sfchronicle.com/opinion/openforum/article/trump-mental-decline-19861259.php\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.sfchronicle.com/opinion/openforum/article/trump-mental-decline-19861259.php\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.sfchronicle.com\/opinion\/openforum\/article\/trump-mental-decline-19861259.php","crawl_time":1777090564,"first_indexed_time":1730053280,"http_code":200,"src_unparsed":"com,sfchronicle!www,\/opinion\/openforum\/article\/trump-mental-decline-19861259.php s443","src_root_hash":"14097438092688553363","history_drop_reason":null,"meta_title":"Trump’s mental decline could be caused by something hard to detect","meta_descriptions":["Trump’s behavior may be all a calculated, contrived act to win the election. If not, then there is some serious pathology going on here."],"attrs_boilerpipe_text":"Donald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline.\nAnna Moneymaker\/Getty Images\nConcerns about Donald Trump’s mental fitness have heightened since his latest\nrefusal to release his medical records\nto the public.\nReports\nfrom some of his closest associates over the past eight years have noted a marked decline in his ability to remain on topic and his fanciful rambling.\nFacts have become confused\n, threats have been made and a sense of grandiosity, mixed with paranoia, prevails.\nHis behavior may be all a calculated, contrived act to win the presidential election. If not, then there is some serious pathology going on here.\nI have practiced internal medicine for 45 years, and it is not uncommon for family or friends to bring me someone who is beginning to mentally unravel. My job is to figure out what, among the multiple plausible causes, is contributing to the patient’s deterioration, and what, if anything, I can do to improve the situation.\nArticle continues below this ad\nAlthough I cannot definitively assess Trump’s cognitive functioning without examining him in person, physicians regularly explore the potential causes of a patient’s illness as part of a time-honored tradition during what we call “Grand Rounds.”\nMore Opinions\nIn this format, a patient case is presented, and a senior clinician discusses the probable causes of the patient’s ailment, known as a “differential diagnosis.” The senior clinician has never seen the patient and admits to only receiving information secondhand. Therefore, a best guess is all that can be offered in a differential diagnosis of multiple diseases. \nSan Francisco Chronicle Logo\nMake us a Preferred Source to get more of our news when you search.\nAdd Preferred Source\nWhile physicians rightfully continue to genuflect to the\nGoldwater Rule\n — the idea that a specific diagnosis requires a personal examination — the concept does not extend to a reasonable inquiry by physicians offering a differential diagnosis, as done during Grand Rounds.\nArticle continues below this ad\nIn Trump’s case, the differential of cognitive decline is extensive.\nAlzheimer’s disease, for example, could be at play but also a host of other medical conditions could be causing his symptoms, including poor blood flow to the brain due to hardening of the arteries, vitamin B12 deficiency, low thyroid function, mercury and other heavy metal ingestion, diffuse tumors such as lymphoma, and infection, to name a few.\nMost of these disorders are detected readily with simple blood tests and a physical exam. But there is one disease, if not thought about, might slip by, with devastating consequences: syphilis.\nNeurosyphilis is an infection of the brain by an infectious agent called a spirochete.\nBrain damage due to syphilis is a rare but fatal disease if not treated. It begins with a small sore on the genitals that is not painful and goes away on its own. However, the spirochete, if not diagnosed and treated appropriately, can continue to spread throughout the body. A secondary phase, associated with a rash, lymph node swelling, and fatigue can occur a few weeks to months later, but that too can resolve on its own. The disease, however, is relentless and can remain dormant for 25 years before reemerging as cognitive impairment. Patients with neurosyphilis have often been confused with having other types of dementia. For this reason, it has gained the moniker\nthe Great Imitator\n.\nArticle continues below this ad\nWhen syphilis affects the brain, it is a progressive dementing illness. In addition to memory loss, the symptoms include impaired judgment, uninhibited speech and actions, delusions, confusion, paranoia and grandiose thoughts. The most common blood test for the disease can be negative after so many years, and the only way to confirm the diagnosis is to perform a spinal tap to evaluate the fluid around the brain.\nNot exactly a routine procedure for an annual physical exam.\nThe spirochete has a predilection to attack the frontal lobe of the brain — the area of the brain responsible for our judgment and inhibition. It helps us filter our thoughts and not just pop off with anything that comes to mind, no matter how inappropriate. Recent events, such as Trump’s \nvulgar behavior at the Al Smith dinner\n, his bizarre\n39-minute break to listen to a playlist\nrather than address the audience, and especially his\nreference to Arnold Palmer’s genitalia\n, are a clear sign the frontal lobe is not doing its job.\nTrump’s\ninsistence that he won the 2020 presidential election\nseems delusional. Believing that heads of state will bow to his personality and charm is a sign of grandiosity and\nthreats to prosecute his adversaries\ndemonstrates paranoia. Meandering speeches about\nsharks\nand\ncannibals\n,\ndisorientation to what state he is in\n and disassembled facts that blur the difference between truth and fiction are further, but nonspecific, signs of mental decay.    \nAgain, without a personal exam, I am unable to make a specific diagnosis of Trump’s cognitive decline. I must rely on his public remarks and behaviors to guide my analysis. What is clear though, is something is not right.\nArticle continues below this ad\nWe do not know what blood tests the former president has taken, but even if his doctors rule out most possible causes for his mental decline, The Great Imposter needs to be ruled out as well.\nUnlike most causes of dementia, syphilis is treatable. Since the 1950s, penicillin has been recognized as halting the progression of the disease in some cases.\nAbout Opinion\nGuest opinions in\nOpen Forum and Insight\nare produced by writers with expertise, personal experience or original insights on a subject of interest to our readers.\nTheir views do not necessarily reflect\nthe opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership.\nBefore assuming the most powerful position in the world, Trump needs a thorough exam by a neurologist and a qualified infectious disease specialist.\nIf you do not believe me, ask your doctor, “Is syphilis in the differential?”\nArticle continues below this ad\nDr. William Andereck is a bioethicist and internist in private practice in San Francisco.  ","attrs_markdown":"San Francisco Chronicle Logo\n\nHearst Newspapers Logo\n\n[Skip to main 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One may not show up on a blood test\nBy William Andereck\n\nOct 27, 2024\n\n![Donald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline.]()\n\nDonald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline.\n\nAnna Moneymaker\/Getty Images\n\nConcerns about Donald Trump’s mental fitness have heightened since his latest [refusal to release his medical records](https:\/\/www.cnbc.com\/2024\/10\/18\/trump-health-records-harris-exhausted.html) to the public. [Reports](https:\/\/www.politico.com\/story\/2018\/08\/12\/omarosa-trump-mental-state-book-kelly-773889) from some of his closest associates over the past eight years have noted a marked decline in his ability to remain on topic and his fanciful rambling. [Facts have become confused](https:\/\/www.nytimes.com\/2024\/10\/06\/us\/politics\/trump-speeches-age-cognitive-decline.html), threats have been made and a sense of grandiosity, mixed with paranoia, prevails.\n\nHis behavior may be all a calculated, contrived act to win the presidential election. If not, then there is some serious pathology going on here.\n\nI have practiced internal medicine for 45 years, and it is not uncommon for family or friends to bring me someone who is beginning to mentally unravel. My job is to figure out what, among the multiple plausible causes, is contributing to the patient’s deterioration, and what, if anything, I can do to improve the situation.\n\nAdvertisement\n\nArticle continues below this ad\n\nAlthough I cannot definitively assess Trump’s cognitive functioning without examining him in person, physicians regularly explore the potential causes of a patient’s illness as part of a time-honored tradition during what we call “Grand Rounds.”\n\nMore Opinions\n\n[MAGA Swifties exist, and they don’t seem to care that the pop singer endorsed Kamala Harris](https:\/\/www.sfchronicle.com\/entertainment\/article\/taylor-swift-maga-election-19857787.php)\n\n[As the election draws near, Taylor Swift’s Eras Tour has seen a number of prominent Donald Trump supporters in its sold-out crowds.](https:\/\/www.sfchronicle.com\/entertainment\/article\/taylor-swift-maga-election-19857787.php)\n\n[![Taylor Swift’s Eras Tour has been attracting a number of known Donald Trump supporters as the election draws near. ]()](https:\/\/www.sfchronicle.com\/entertainment\/article\/taylor-swift-maga-election-19857787.php)\n\n[Why the Harris campaign’s attempt to court Black men is incomplete and even alienating](https:\/\/www.sfchronicle.com\/opinion\/openforum\/article\/harris-campaign-black-men-19854455.php)\n\n[Vice President Kamala Harris has embarked on a mission to court Black male voters, a demographic crucial to Democratic success yet often misunderstood.](https:\/\/www.sfchronicle.com\/opinion\/openforum\/article\/harris-campaign-black-men-19854455.php)\n\n[![Vice President Kamala Harris is a guest of Charlamagne tha God’s “Breakfast Club” radio show in Detroit on Oct. 15. Harris’ campaign is reaching out to Black men.]()](https:\/\/www.sfchronicle.com\/opinion\/openforum\/article\/harris-campaign-black-men-19854455.php)\n\nIn this format, a patient case is presented, and a senior clinician discusses the probable causes of the patient’s ailment, known as a “differential diagnosis.” The senior clinician has never seen the patient and admits to only receiving information secondhand. Therefore, a best guess is all that can be offered in a differential diagnosis of multiple diseases.\n\nSan Francisco Chronicle Logo\n\n### See more S.F. Chronicle on Google\nMake us a Preferred Source to get more of our news when you search.\n\n[Add Preferred Source](https:\/\/www.google.com\/preferences\/source?q=sfchronicle.com)\n\nWhile physicians rightfully continue to genuflect to the [Goldwater Rule](https:\/\/www.sfchronicle.com\/opinion\/openforum\/article\/trump-mental-health-19821030.php) — the idea that a specific diagnosis requires a personal examination — the concept does not extend to a reasonable inquiry by physicians offering a differential diagnosis, as done during Grand Rounds.\n\nAdvertisement\n\nArticle continues below this ad\n\nIn Trump’s case, the differential of cognitive decline is extensive.\n\nAlzheimer’s disease, for example, could be at play but also a host of other medical conditions could be causing his symptoms, including poor blood flow to the brain due to hardening of the arteries, vitamin B12 deficiency, low thyroid function, mercury and other heavy metal ingestion, diffuse tumors such as lymphoma, and infection, to name a few.\n\nMost of these disorders are detected readily with simple blood tests and a physical exam. But there is one disease, if not thought about, might slip by, with devastating consequences: syphilis.\n\nNeurosyphilis is an infection of the brain by an infectious agent called a spirochete.\n\nBrain damage due to syphilis is a rare but fatal disease if not treated. It begins with a small sore on the genitals that is not painful and goes away on its own. However, the spirochete, if not diagnosed and treated appropriately, can continue to spread throughout the body. A secondary phase, associated with a rash, lymph node swelling, and fatigue can occur a few weeks to months later, but that too can resolve on its own. The disease, however, is relentless and can remain dormant for 25 years before reemerging as cognitive impairment. Patients with neurosyphilis have often been confused with having other types of dementia. For this reason, it has gained the moniker [the Great Imitator](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9859468\/).\n\nAdvertisement\n\nArticle continues below this ad\n\nWhen syphilis affects the brain, it is a progressive dementing illness. In addition to memory loss, the symptoms include impaired judgment, uninhibited speech and actions, delusions, confusion, paranoia and grandiose thoughts. The most common blood test for the disease can be negative after so many years, and the only way to confirm the diagnosis is to perform a spinal tap to evaluate the fluid around the brain.\n\nNot exactly a routine procedure for an annual physical exam.\n\nThe spirochete has a predilection to attack the frontal lobe of the brain — the area of the brain responsible for our judgment and inhibition. It helps us filter our thoughts and not just pop off with anything that comes to mind, no matter how inappropriate. Recent events, such as Trump’s [vulgar behavior at the Al Smith dinner](https:\/\/www.washingtonpost.com\/politics\/2024\/10\/17\/trump-harris-al-smith-dinner\/), his bizarre [39-minute break to listen to a playlist](https:\/\/www.washingtonpost.com\/politics\/2024\/10\/14\/trump-music-sways-town-hall\/) rather than address the audience, and especially his [reference to Arnold Palmer’s genitalia](https:\/\/www.sfchronicle.com\/opinion\/openforum\/article\/trump-arnold-palmer-19852844.php), are a clear sign the frontal lobe is not doing its job.\n\nTrump’s [insistence that he won the 2020 presidential election](https:\/\/www.politico.com\/news\/2024\/09\/10\/trump-harris-debate-2020-fiction-00178511) seems delusional. Believing that heads of state will bow to his personality and charm is a sign of grandiosity and [threats to prosecute his adversaries](https:\/\/www.npr.org\/2024\/10\/21\/nx-s1-5134924\/trump-election-2024-kamala-harris-elizabeth-cheney-threat-civil-liberties) demonstrates paranoia. Meandering speeches about [sharks](https:\/\/www.washingtonpost.com\/politics\/2024\/07\/26\/trump-shark-ev-boat-electrocution\/) and [cannibals](https:\/\/www.washingtonpost.com\/politics\/2024\/08\/14\/why-trump-keeps-talking-about-fictional-serial-killer-hannibal-lecter\/), [disorientation to what state he is in](https:\/\/www.newsweek.com\/donald-trump-confusing-state-hes-raises-questions-1940779) and disassembled facts that blur the difference between truth and fiction are further, but nonspecific, signs of mental decay.\n\nAgain, without a personal exam, I am unable to make a specific diagnosis of Trump’s cognitive decline. I must rely on his public remarks and behaviors to guide my analysis. What is clear though, is something is not right.\n\nAdvertisement\n\nArticle continues below this ad\n\nWe do not know what blood tests the former president has taken, but even if his doctors rule out most possible causes for his mental decline, The Great Imposter needs to be ruled out as well.\n\nUnlike most causes of dementia, syphilis is treatable. Since the 1950s, penicillin has been recognized as halting the progression of the disease in some cases.\n\nAbout Opinion\n\nGuest opinions in **Open Forum and Insight** are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. **Their views do not necessarily reflect** the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership.\n\n[*Read more about our transparency and ethics policies*](https:\/\/www.sfchronicle.com\/standards\/)\n\nBefore assuming the most powerful position in the world, Trump needs a thorough exam by a neurologist and a qualified infectious disease specialist.\n\nIf you do not believe me, ask your doctor, “Is syphilis in the differential?”\n\nAdvertisement\n\nArticle continues below this ad\n\n*Dr. William Andereck is a bioethicist and internist in private practice in San Francisco.*\n\nOct 27, 2024\n\nWilliam Andereck\n\nMost 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[Subscriptions](http:\/\/www.sfchronicle.com\/subscribeofferfooter)\n- [Membership](https:\/\/www.sfchronicle.com\/membership\/)\n\nHearst Newspapers Logo\n\n© 2026 Hearst Communications, Inc.\n\n[Terms of Use](https:\/\/www.sfchronicle.com\/terms\/)[Privacy Notice](https:\/\/www.sfchronicle.com\/privacy\/)[CA Notice at Collection](https:\/\/www.sfchronicle.com\/privacy\/#california)[Your CA Privacy Rights (Shine the Light)](https:\/\/www.sfchronicle.com\/privacy\/#shinethelight)[DAA Industry Opt Out](https:\/\/www.sfchronicle.com\/privacy\/#daaindustryoptout)\n\n[Your Privacy Choices (Opt Out of Sale\/Targeted Ads)](https:\/\/www.sfchronicle.com\/yourdata\/)","attrs_readable_markdown":"![Donald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline.]()\n\nDonald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline.\n\nAnna Moneymaker\/Getty Images\n\nConcerns about Donald Trump’s mental fitness have heightened since his latest [refusal to release his medical records](https:\/\/www.cnbc.com\/2024\/10\/18\/trump-health-records-harris-exhausted.html) to the public. [Reports](https:\/\/www.politico.com\/story\/2018\/08\/12\/omarosa-trump-mental-state-book-kelly-773889) from some of his closest associates over the past eight years have noted a marked decline in his ability to remain on topic and his fanciful rambling. [Facts have become confused](https:\/\/www.nytimes.com\/2024\/10\/06\/us\/politics\/trump-speeches-age-cognitive-decline.html), threats have been made and a sense of grandiosity, mixed with paranoia, prevails.\n\nHis behavior may be all a calculated, contrived act to win the presidential election. If not, then there is some serious pathology going on here.\n\nI have practiced internal medicine for 45 years, and it is not uncommon for family or friends to bring me someone who is beginning to mentally unravel. My job is to figure out what, among the multiple plausible causes, is contributing to the patient’s deterioration, and what, if anything, I can do to improve the situation.\n\nArticle continues below this ad\n\nAlthough I cannot definitively assess Trump’s cognitive functioning without examining him in person, physicians regularly explore the potential causes of a patient’s illness as part of a time-honored tradition during what we call “Grand Rounds.”\n\nMore Opinions\n\nIn this format, a patient case is presented, and a senior clinician discusses the probable causes of the patient’s ailment, known as a “differential diagnosis.” The senior clinician has never seen the patient and admits to only receiving information secondhand. Therefore, a best guess is all that can be offered in a differential diagnosis of multiple diseases.\n\nSan Francisco Chronicle Logo\n\nMake us a Preferred Source to get more of our news when you search.\n\n[Add Preferred Source](https:\/\/www.google.com\/preferences\/source?q=sfchronicle.com)\n\nWhile physicians rightfully continue to genuflect to the [Goldwater Rule](https:\/\/www.sfchronicle.com\/opinion\/openforum\/article\/trump-mental-health-19821030.php) — the idea that a specific diagnosis requires a personal examination — the concept does not extend to a reasonable inquiry by physicians offering a differential diagnosis, as done during Grand Rounds.\n\nArticle continues below this ad\n\nIn Trump’s case, the differential of cognitive decline is extensive.\n\nAlzheimer’s disease, for example, could be at play but also a host of other medical conditions could be causing his symptoms, including poor blood flow to the brain due to hardening of the arteries, vitamin B12 deficiency, low thyroid function, mercury and other heavy metal ingestion, diffuse tumors such as lymphoma, and infection, to name a few.\n\nMost of these disorders are detected readily with simple blood tests and a physical exam. But there is one disease, if not thought about, might slip by, with devastating consequences: syphilis.\n\nNeurosyphilis is an infection of the brain by an infectious agent called a spirochete.\n\nBrain damage due to syphilis is a rare but fatal disease if not treated. It begins with a small sore on the genitals that is not painful and goes away on its own. However, the spirochete, if not diagnosed and treated appropriately, can continue to spread throughout the body. A secondary phase, associated with a rash, lymph node swelling, and fatigue can occur a few weeks to months later, but that too can resolve on its own. The disease, however, is relentless and can remain dormant for 25 years before reemerging as cognitive impairment. Patients with neurosyphilis have often been confused with having other types of dementia. For this reason, it has gained the moniker [the Great Imitator](https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9859468\/).\n\nArticle continues below this ad\n\nWhen syphilis affects the brain, it is a progressive dementing illness. In addition to memory loss, the symptoms include impaired judgment, uninhibited speech and actions, delusions, confusion, paranoia and grandiose thoughts. The most common blood test for the disease can be negative after so many years, and the only way to confirm the diagnosis is to perform a spinal tap to evaluate the fluid around the brain.\n\nNot exactly a routine procedure for an annual physical exam.\n\nThe spirochete has a predilection to attack the frontal lobe of the brain — the area of the brain responsible for our judgment and inhibition. It helps us filter our thoughts and not just pop off with anything that comes to mind, no matter how inappropriate. Recent events, such as Trump’s [vulgar behavior at the Al Smith dinner](https:\/\/www.washingtonpost.com\/politics\/2024\/10\/17\/trump-harris-al-smith-dinner\/), his bizarre [39-minute break to listen to a playlist](https:\/\/www.washingtonpost.com\/politics\/2024\/10\/14\/trump-music-sways-town-hall\/) rather than address the audience, and especially his [reference to Arnold Palmer’s genitalia](https:\/\/www.sfchronicle.com\/opinion\/openforum\/article\/trump-arnold-palmer-19852844.php), are a clear sign the frontal lobe is not doing its job.\n\nTrump’s [insistence that he won the 2020 presidential election](https:\/\/www.politico.com\/news\/2024\/09\/10\/trump-harris-debate-2020-fiction-00178511) seems delusional. Believing that heads of state will bow to his personality and charm is a sign of grandiosity and [threats to prosecute his adversaries](https:\/\/www.npr.org\/2024\/10\/21\/nx-s1-5134924\/trump-election-2024-kamala-harris-elizabeth-cheney-threat-civil-liberties) demonstrates paranoia. Meandering speeches about [sharks](https:\/\/www.washingtonpost.com\/politics\/2024\/07\/26\/trump-shark-ev-boat-electrocution\/) and [cannibals](https:\/\/www.washingtonpost.com\/politics\/2024\/08\/14\/why-trump-keeps-talking-about-fictional-serial-killer-hannibal-lecter\/), [disorientation to what state he is in](https:\/\/www.newsweek.com\/donald-trump-confusing-state-hes-raises-questions-1940779) and disassembled facts that blur the difference between truth and fiction are further, but nonspecific, signs of mental decay.\n\nAgain, without a personal exam, I am unable to make a specific diagnosis of Trump’s cognitive decline. I must rely on his public remarks and behaviors to guide my analysis. What is clear though, is something is not right.\n\nArticle continues below this ad\n\nWe do not know what blood tests the former president has taken, but even if his doctors rule out most possible causes for his mental decline, The Great Imposter needs to be ruled out as well.\n\nUnlike most causes of dementia, syphilis is treatable. Since the 1950s, penicillin has been recognized as halting the progression of the disease in some cases.\n\nAbout Opinion\n\nGuest opinions in **Open Forum and Insight** are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. **Their views do not necessarily reflect** the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership.\n\nBefore assuming the most powerful position in the world, Trump needs a thorough exam by a neurologist and a qualified infectious disease specialist.\n\nIf you do not believe me, ask your doctor, “Is syphilis in the differential?”\n\nArticle continues below this ad\n\n*Dr. William Andereck is a bioethicist and internist in private practice in San Francisco.*","meta_canonical":null,"ml_categories_json":"{\"\/Health\":837,\"\/Health\/Mental_Health\":811,\"\/Health\/Mental_Health\/Other\":364,\"\/People_and_Society\":149,\"\/News\":114}","ml_types_json":"{\"\/Article\":998,\"\/Article\/Opinion_Piece\":892}","ml_intent_types_json":"{\"Informational\":999}","meta_language":"en","attrs_author":"William Andereck","attrs_publish_time":1730026800,"attrs_original_publish_time":1730026800,"attrs_is_republished":0,"attrs_nr_words":"1685","attrs_boilerpipe_nr_words":"1033","body_ext_links_number":48,"body_int_links_number":115,"meta_nofollow":0,"meta_noarchive":0,"props_was_rendered":1,"src_redirect":"","download_time_msec":3880,"download_ttfb_msec":908,"download_size":111651}

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Trump’s mental decline could be caused by something hard to detect

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Trump’s behavior may be all a calculated, contrived act to win the election. If not, then there is some serious pathology going on here.

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Donald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline. Anna Moneymaker/Getty Images Concerns about Donald Trump’s mental fitness have heightened since his latest refusal to release his medical records to the public. Reports from some of his closest associates over the past eight years have noted a marked decline in his ability to remain on topic and his fanciful rambling. Facts have become confused , threats have been made and a sense of grandiosity, mixed with paranoia, prevails. His behavior may be all a calculated, contrived act to win the presidential election. If not, then there is some serious pathology going on here. I have practiced internal medicine for 45 years, and it is not uncommon for family or friends to bring me someone who is beginning to mentally unravel. My job is to figure out what, among the multiple plausible causes, is contributing to the patient’s deterioration, and what, if anything, I can do to improve the situation. Article continues below this ad Although I cannot definitively assess Trump’s cognitive functioning without examining him in person, physicians regularly explore the potential causes of a patient’s illness as part of a time-honored tradition during what we call “Grand Rounds.” More Opinions In this format, a patient case is presented, and a senior clinician discusses the probable causes of the patient’s ailment, known as a “differential diagnosis.” The senior clinician has never seen the patient and admits to only receiving information secondhand. Therefore, a best guess is all that can be offered in a differential diagnosis of multiple diseases. San Francisco Chronicle Logo Make us a Preferred Source to get more of our news when you search. Add Preferred Source While physicians rightfully continue to genuflect to the Goldwater Rule — the idea that a specific diagnosis requires a personal examination — the concept does not extend to a reasonable inquiry by physicians offering a differential diagnosis, as done during Grand Rounds. Article continues below this ad In Trump’s case, the differential of cognitive decline is extensive. Alzheimer’s disease, for example, could be at play but also a host of other medical conditions could be causing his symptoms, including poor blood flow to the brain due to hardening of the arteries, vitamin B12 deficiency, low thyroid function, mercury and other heavy metal ingestion, diffuse tumors such as lymphoma, and infection, to name a few. Most of these disorders are detected readily with simple blood tests and a physical exam. But there is one disease, if not thought about, might slip by, with devastating consequences: syphilis. Neurosyphilis is an infection of the brain by an infectious agent called a spirochete. Brain damage due to syphilis is a rare but fatal disease if not treated. It begins with a small sore on the genitals that is not painful and goes away on its own. However, the spirochete, if not diagnosed and treated appropriately, can continue to spread throughout the body. A secondary phase, associated with a rash, lymph node swelling, and fatigue can occur a few weeks to months later, but that too can resolve on its own. The disease, however, is relentless and can remain dormant for 25 years before reemerging as cognitive impairment. Patients with neurosyphilis have often been confused with having other types of dementia. For this reason, it has gained the moniker the Great Imitator . Article continues below this ad When syphilis affects the brain, it is a progressive dementing illness. In addition to memory loss, the symptoms include impaired judgment, uninhibited speech and actions, delusions, confusion, paranoia and grandiose thoughts. The most common blood test for the disease can be negative after so many years, and the only way to confirm the diagnosis is to perform a spinal tap to evaluate the fluid around the brain. Not exactly a routine procedure for an annual physical exam. The spirochete has a predilection to attack the frontal lobe of the brain — the area of the brain responsible for our judgment and inhibition. It helps us filter our thoughts and not just pop off with anything that comes to mind, no matter how inappropriate. Recent events, such as Trump’s vulgar behavior at the Al Smith dinner , his bizarre 39-minute break to listen to a playlist rather than address the audience, and especially his reference to Arnold Palmer’s genitalia , are a clear sign the frontal lobe is not doing its job. Trump’s insistence that he won the 2020 presidential election seems delusional. Believing that heads of state will bow to his personality and charm is a sign of grandiosity and threats to prosecute his adversaries demonstrates paranoia. Meandering speeches about sharks and cannibals , disorientation to what state he is in and disassembled facts that blur the difference between truth and fiction are further, but nonspecific, signs of mental decay. Again, without a personal exam, I am unable to make a specific diagnosis of Trump’s cognitive decline. I must rely on his public remarks and behaviors to guide my analysis. What is clear though, is something is not right. Article continues below this ad We do not know what blood tests the former president has taken, but even if his doctors rule out most possible causes for his mental decline, The Great Imposter needs to be ruled out as well. Unlike most causes of dementia, syphilis is treatable. Since the 1950s, penicillin has been recognized as halting the progression of the disease in some cases. About Opinion Guest opinions in Open Forum and Insight are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. Their views do not necessarily reflect the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership. Before assuming the most powerful position in the world, Trump needs a thorough exam by a neurologist and a qualified infectious disease specialist. If you do not believe me, ask your doctor, “Is syphilis in the differential?” Article continues below this ad Dr. William Andereck is a bioethicist and internist in private practice in San Francisco.

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One may not show up on a blood test By William Andereck Oct 27, 2024 ![Donald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline.]() Donald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline. Anna Moneymaker/Getty Images Concerns about Donald Trump’s mental fitness have heightened since his latest [refusal to release his medical records](https://www.cnbc.com/2024/10/18/trump-health-records-harris-exhausted.html) to the public. [Reports](https://www.politico.com/story/2018/08/12/omarosa-trump-mental-state-book-kelly-773889) from some of his closest associates over the past eight years have noted a marked decline in his ability to remain on topic and his fanciful rambling. [Facts have become confused](https://www.nytimes.com/2024/10/06/us/politics/trump-speeches-age-cognitive-decline.html), threats have been made and a sense of grandiosity, mixed with paranoia, prevails. His behavior may be all a calculated, contrived act to win the presidential election. If not, then there is some serious pathology going on here. I have practiced internal medicine for 45 years, and it is not uncommon for family or friends to bring me someone who is beginning to mentally unravel. My job is to figure out what, among the multiple plausible causes, is contributing to the patient’s deterioration, and what, if anything, I can do to improve the situation. Advertisement Article continues below this ad Although I cannot definitively assess Trump’s cognitive functioning without examining him in person, physicians regularly explore the potential causes of a patient’s illness as part of a time-honored tradition during what we call “Grand Rounds.” More Opinions [MAGA Swifties exist, and they don’t seem to care that the pop singer endorsed Kamala Harris](https://www.sfchronicle.com/entertainment/article/taylor-swift-maga-election-19857787.php) [As the election draws near, Taylor Swift’s Eras Tour has seen a number of prominent Donald Trump supporters in its sold-out crowds.](https://www.sfchronicle.com/entertainment/article/taylor-swift-maga-election-19857787.php) [![Taylor Swift’s Eras Tour has been attracting a number of known Donald Trump supporters as the election draws near. ]()](https://www.sfchronicle.com/entertainment/article/taylor-swift-maga-election-19857787.php) [Why the Harris campaign’s attempt to court Black men is incomplete and even alienating](https://www.sfchronicle.com/opinion/openforum/article/harris-campaign-black-men-19854455.php) [Vice President Kamala Harris has embarked on a mission to court Black male voters, a demographic crucial to Democratic success yet often misunderstood.](https://www.sfchronicle.com/opinion/openforum/article/harris-campaign-black-men-19854455.php) [![Vice President Kamala Harris is a guest of Charlamagne tha God’s “Breakfast Club” radio show in Detroit on Oct. 15. Harris’ campaign is reaching out to Black men.]()](https://www.sfchronicle.com/opinion/openforum/article/harris-campaign-black-men-19854455.php) In this format, a patient case is presented, and a senior clinician discusses the probable causes of the patient’s ailment, known as a “differential diagnosis.” The senior clinician has never seen the patient and admits to only receiving information secondhand. Therefore, a best guess is all that can be offered in a differential diagnosis of multiple diseases. San Francisco Chronicle Logo ### See more S.F. Chronicle on Google Make us a Preferred Source to get more of our news when you search. [Add Preferred Source](https://www.google.com/preferences/source?q=sfchronicle.com) While physicians rightfully continue to genuflect to the [Goldwater Rule](https://www.sfchronicle.com/opinion/openforum/article/trump-mental-health-19821030.php) — the idea that a specific diagnosis requires a personal examination — the concept does not extend to a reasonable inquiry by physicians offering a differential diagnosis, as done during Grand Rounds. Advertisement Article continues below this ad In Trump’s case, the differential of cognitive decline is extensive. Alzheimer’s disease, for example, could be at play but also a host of other medical conditions could be causing his symptoms, including poor blood flow to the brain due to hardening of the arteries, vitamin B12 deficiency, low thyroid function, mercury and other heavy metal ingestion, diffuse tumors such as lymphoma, and infection, to name a few. Most of these disorders are detected readily with simple blood tests and a physical exam. But there is one disease, if not thought about, might slip by, with devastating consequences: syphilis. Neurosyphilis is an infection of the brain by an infectious agent called a spirochete. Brain damage due to syphilis is a rare but fatal disease if not treated. It begins with a small sore on the genitals that is not painful and goes away on its own. However, the spirochete, if not diagnosed and treated appropriately, can continue to spread throughout the body. A secondary phase, associated with a rash, lymph node swelling, and fatigue can occur a few weeks to months later, but that too can resolve on its own. The disease, however, is relentless and can remain dormant for 25 years before reemerging as cognitive impairment. Patients with neurosyphilis have often been confused with having other types of dementia. For this reason, it has gained the moniker [the Great Imitator](https://pmc.ncbi.nlm.nih.gov/articles/PMC9859468/). Advertisement Article continues below this ad When syphilis affects the brain, it is a progressive dementing illness. In addition to memory loss, the symptoms include impaired judgment, uninhibited speech and actions, delusions, confusion, paranoia and grandiose thoughts. The most common blood test for the disease can be negative after so many years, and the only way to confirm the diagnosis is to perform a spinal tap to evaluate the fluid around the brain. Not exactly a routine procedure for an annual physical exam. The spirochete has a predilection to attack the frontal lobe of the brain — the area of the brain responsible for our judgment and inhibition. It helps us filter our thoughts and not just pop off with anything that comes to mind, no matter how inappropriate. Recent events, such as Trump’s [vulgar behavior at the Al Smith dinner](https://www.washingtonpost.com/politics/2024/10/17/trump-harris-al-smith-dinner/), his bizarre [39-minute break to listen to a playlist](https://www.washingtonpost.com/politics/2024/10/14/trump-music-sways-town-hall/) rather than address the audience, and especially his [reference to Arnold Palmer’s genitalia](https://www.sfchronicle.com/opinion/openforum/article/trump-arnold-palmer-19852844.php), are a clear sign the frontal lobe is not doing its job. Trump’s [insistence that he won the 2020 presidential election](https://www.politico.com/news/2024/09/10/trump-harris-debate-2020-fiction-00178511) seems delusional. Believing that heads of state will bow to his personality and charm is a sign of grandiosity and [threats to prosecute his adversaries](https://www.npr.org/2024/10/21/nx-s1-5134924/trump-election-2024-kamala-harris-elizabeth-cheney-threat-civil-liberties) demonstrates paranoia. Meandering speeches about [sharks](https://www.washingtonpost.com/politics/2024/07/26/trump-shark-ev-boat-electrocution/) and [cannibals](https://www.washingtonpost.com/politics/2024/08/14/why-trump-keeps-talking-about-fictional-serial-killer-hannibal-lecter/), [disorientation to what state he is in](https://www.newsweek.com/donald-trump-confusing-state-hes-raises-questions-1940779) and disassembled facts that blur the difference between truth and fiction are further, but nonspecific, signs of mental decay. Again, without a personal exam, I am unable to make a specific diagnosis of Trump’s cognitive decline. I must rely on his public remarks and behaviors to guide my analysis. What is clear though, is something is not right. Advertisement Article continues below this ad We do not know what blood tests the former president has taken, but even if his doctors rule out most possible causes for his mental decline, The Great Imposter needs to be ruled out as well. Unlike most causes of dementia, syphilis is treatable. Since the 1950s, penicillin has been recognized as halting the progression of the disease in some cases. About Opinion Guest opinions in **Open Forum and Insight** are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. **Their views do not necessarily reflect** the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership. [*Read more about our transparency and ethics policies*](https://www.sfchronicle.com/standards/) Before assuming the most powerful position in the world, Trump needs a thorough exam by a neurologist and a qualified infectious disease specialist. If you do not believe me, ask your doctor, “Is syphilis in the differential?” Advertisement Article continues below this ad *Dr. William Andereck is a bioethicist and internist in private practice in San Francisco.* Oct 27, 2024 William Andereck Most Popular 1\. [Here’s exactly what happens after you win ‘The Price Is Right’ — financially](https://www.sfchronicle.com/personal-finance/article/game-show-winnings-taxes-price-is-right-22212441.php) 2\. [San Francisco records first overdose death involving new street drug more potent than fentanyl](https://www.sfchronicle.com/sf/article/sf-records-first-od-death-with-new-potent-drug-22224574.php) 3\. [Exclusive: First details on Bi-Rite’s next San Francisco store](https://www.sfchronicle.com/food/restaurants/article/bi-rite-richmond-san-francisco-21962133.php) 4\. [California has a new way of getting gasoline, for the first time in modern memory](https://www.sfchronicle.com/california/article/oil-ships-jones-act-22216424.php) 5\. [S.F. icon Ghirardelli Square, destination for tourists and locals, has been sold](https://www.sfchronicle.com/sf/article/ghirardelli-square-sold-22224936.php) Top of the News [![A person prepares to use fentanyl on Wiese Street in San Francisco on Thursday, April 3, 2025.]()](https://www.sfchronicle.com/sf/article/sf-records-first-od-death-with-new-potent-drug-22224574.php) [San Francisco](https://www.sfchronicle.com/sf/) [S.F. records first overdose death involving new street drug more potent than fentanyl](https://www.sfchronicle.com/sf/article/sf-records-first-od-death-with-new-potent-drug-22224574.php) [San Francisco health officials rang the alarm Friday about a new synthetic opioid 10 times more potent than fentanyl that surfaced for the first time in an overdose victim earlier this month.](https://www.sfchronicle.com/sf/article/sf-records-first-od-death-with-new-potent-drug-22224574.php) [San Francisco](https://www.sfchronicle.com/sf/) [S.F. icon Ghirardelli Square, destination for tourists and locals, has been sold](https://www.sfchronicle.com/sf/article/ghirardelli-square-sold-22224936.php) [Giants](https://www.sfchronicle.com/sports/giants/) [Firm with Trump family ties expected to buy minority stake in Giants](https://www.sfchronicle.com/sports/giants/article/firm-trump-family-ties-likely-buy-minority-stake-22225011.php) [Food](https://www.sfchronicle.com/food/) [Exclusive: First details on Bi-Rite’s next San Francisco store](https://www.sfchronicle.com/food/restaurants/article/bi-rite-richmond-san-francisco-21962133.php) [Politics](https://www.sfchronicle.com/politics/) [Eric Swalwell paid \$40,000 in campaign funds to lawyer defending him against assault claims](https://www.sfchronicle.com/politics/article/eric-swalwell-campaign-spending-22223410.php) Let's Play - 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![Donald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline.]() Donald Trump speaks at a campaign rally Wednesday in Duluth, Ga. His bizarre behavior, delusional claims and visions of grandeur could be attributed to mental decline. Anna Moneymaker/Getty Images Concerns about Donald Trump’s mental fitness have heightened since his latest [refusal to release his medical records](https://www.cnbc.com/2024/10/18/trump-health-records-harris-exhausted.html) to the public. [Reports](https://www.politico.com/story/2018/08/12/omarosa-trump-mental-state-book-kelly-773889) from some of his closest associates over the past eight years have noted a marked decline in his ability to remain on topic and his fanciful rambling. [Facts have become confused](https://www.nytimes.com/2024/10/06/us/politics/trump-speeches-age-cognitive-decline.html), threats have been made and a sense of grandiosity, mixed with paranoia, prevails. His behavior may be all a calculated, contrived act to win the presidential election. If not, then there is some serious pathology going on here. I have practiced internal medicine for 45 years, and it is not uncommon for family or friends to bring me someone who is beginning to mentally unravel. My job is to figure out what, among the multiple plausible causes, is contributing to the patient’s deterioration, and what, if anything, I can do to improve the situation. Article continues below this ad Although I cannot definitively assess Trump’s cognitive functioning without examining him in person, physicians regularly explore the potential causes of a patient’s illness as part of a time-honored tradition during what we call “Grand Rounds.” More Opinions In this format, a patient case is presented, and a senior clinician discusses the probable causes of the patient’s ailment, known as a “differential diagnosis.” The senior clinician has never seen the patient and admits to only receiving information secondhand. Therefore, a best guess is all that can be offered in a differential diagnosis of multiple diseases. San Francisco Chronicle Logo Make us a Preferred Source to get more of our news when you search. [Add Preferred Source](https://www.google.com/preferences/source?q=sfchronicle.com) While physicians rightfully continue to genuflect to the [Goldwater Rule](https://www.sfchronicle.com/opinion/openforum/article/trump-mental-health-19821030.php) — the idea that a specific diagnosis requires a personal examination — the concept does not extend to a reasonable inquiry by physicians offering a differential diagnosis, as done during Grand Rounds. Article continues below this ad In Trump’s case, the differential of cognitive decline is extensive. Alzheimer’s disease, for example, could be at play but also a host of other medical conditions could be causing his symptoms, including poor blood flow to the brain due to hardening of the arteries, vitamin B12 deficiency, low thyroid function, mercury and other heavy metal ingestion, diffuse tumors such as lymphoma, and infection, to name a few. Most of these disorders are detected readily with simple blood tests and a physical exam. But there is one disease, if not thought about, might slip by, with devastating consequences: syphilis. Neurosyphilis is an infection of the brain by an infectious agent called a spirochete. Brain damage due to syphilis is a rare but fatal disease if not treated. It begins with a small sore on the genitals that is not painful and goes away on its own. However, the spirochete, if not diagnosed and treated appropriately, can continue to spread throughout the body. A secondary phase, associated with a rash, lymph node swelling, and fatigue can occur a few weeks to months later, but that too can resolve on its own. The disease, however, is relentless and can remain dormant for 25 years before reemerging as cognitive impairment. Patients with neurosyphilis have often been confused with having other types of dementia. For this reason, it has gained the moniker [the Great Imitator](https://pmc.ncbi.nlm.nih.gov/articles/PMC9859468/). Article continues below this ad When syphilis affects the brain, it is a progressive dementing illness. In addition to memory loss, the symptoms include impaired judgment, uninhibited speech and actions, delusions, confusion, paranoia and grandiose thoughts. The most common blood test for the disease can be negative after so many years, and the only way to confirm the diagnosis is to perform a spinal tap to evaluate the fluid around the brain. Not exactly a routine procedure for an annual physical exam. The spirochete has a predilection to attack the frontal lobe of the brain — the area of the brain responsible for our judgment and inhibition. It helps us filter our thoughts and not just pop off with anything that comes to mind, no matter how inappropriate. Recent events, such as Trump’s [vulgar behavior at the Al Smith dinner](https://www.washingtonpost.com/politics/2024/10/17/trump-harris-al-smith-dinner/), his bizarre [39-minute break to listen to a playlist](https://www.washingtonpost.com/politics/2024/10/14/trump-music-sways-town-hall/) rather than address the audience, and especially his [reference to Arnold Palmer’s genitalia](https://www.sfchronicle.com/opinion/openforum/article/trump-arnold-palmer-19852844.php), are a clear sign the frontal lobe is not doing its job. Trump’s [insistence that he won the 2020 presidential election](https://www.politico.com/news/2024/09/10/trump-harris-debate-2020-fiction-00178511) seems delusional. Believing that heads of state will bow to his personality and charm is a sign of grandiosity and [threats to prosecute his adversaries](https://www.npr.org/2024/10/21/nx-s1-5134924/trump-election-2024-kamala-harris-elizabeth-cheney-threat-civil-liberties) demonstrates paranoia. Meandering speeches about [sharks](https://www.washingtonpost.com/politics/2024/07/26/trump-shark-ev-boat-electrocution/) and [cannibals](https://www.washingtonpost.com/politics/2024/08/14/why-trump-keeps-talking-about-fictional-serial-killer-hannibal-lecter/), [disorientation to what state he is in](https://www.newsweek.com/donald-trump-confusing-state-hes-raises-questions-1940779) and disassembled facts that blur the difference between truth and fiction are further, but nonspecific, signs of mental decay. Again, without a personal exam, I am unable to make a specific diagnosis of Trump’s cognitive decline. I must rely on his public remarks and behaviors to guide my analysis. What is clear though, is something is not right. Article continues below this ad We do not know what blood tests the former president has taken, but even if his doctors rule out most possible causes for his mental decline, The Great Imposter needs to be ruled out as well. Unlike most causes of dementia, syphilis is treatable. Since the 1950s, penicillin has been recognized as halting the progression of the disease in some cases. About Opinion Guest opinions in **Open Forum and Insight** are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. **Their views do not necessarily reflect** the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership. Before assuming the most powerful position in the world, Trump needs a thorough exam by a neurologist and a qualified infectious disease specialist. If you do not believe me, ask your doctor, “Is syphilis in the differential?” Article continues below this ad *Dr. William Andereck is a bioethicist and internist in private practice in San Francisco.*

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