As anyone who has read me for the last year or so knows, I don't think the president has had a stroke or mini-strokes, I think he has dementia. It makes a difference, because you can recover from a stroke, but dementia is all downhill.

And with dementia, by the time really noticeable symptoms show up you are far into the progress of the disease.

The arc of it is that things change very slowly over time in almost imperceptible ways until you get the point where everyone notices what's wrong - and then it goes more rapidly downhill.

One mechanism for this is that your balance slowly worsens until you get to a place where you start falling, and then falls accelerate the decline.

I'm not a doctor, but to me, this pattern seems a better fit for what I've observed in the president's demeanor, language, and motor ability.

For instance - as I've mentioned before - one of the early signs of dementia is disinhibition. That is, losing your filter. Saying whatever comes to mind, however inappropriate.

Trump's language has also had a long, slow decline. The first noticeable thing was that his vocabulary seemed to shrink - e.g., the way he calls everything "perfect" or "beautiful" where another adjective makes more sense.

We're now at the point that his sentence structure is deteriorating and he communicates in sentence fragments. He also repeats the fragments over and over - and this kind of repetition is another big glaring clue.

The real tell for me, though, is that he exhibits increasing paraphasias in his speech - word substitution or adding wrong or extra syllables to a word.

The first time I noticed this was the origins/oranges incident at around the time the Mueller report came out, and now I notice it all the time. For instance, the way he says Minnianapolis instead of Minneapolis.

The fact that these kind of errors were once subtle and now are more frequent and glaring would seem to fit the dementia arc better than the stroke or strokes one.

With a single stroke, in particular, we would have observed changes overnight.

I suppose it's possible that he has some vascular form of dementia, but the phonetic paraphasias he exhibits are more consistent with the fronto-temporal variety.

I have some personal experience with dementia, since my aunt had it. But even after I observed similar symptoms in Trump, I didn't know what to make of them, because he is not a typical dementia patient.

I'd say there are two main things setting him apart - the fact that he has some kind of personality disorder as an underlying pathology, and the fact that so many small tasks are taken care of for him by others.

Many of us have had an inkling that something is wrong with Trump this whole time. But the most obvious problem used to be his personality disorder - malignant narcissism.

It's only in the last year or so that the dementia symptoms could compete.

At first, it took some doing to tease the conditions apart. But now almost everyone is starting to see that he is, indeed, in decline. It's starting to dominate the headlines.

For typical dementia patients, being unable to complete mundane tasks is a sign to relatives that they need to step in.

For instance, my cousin got my aunt into a memory care facility after she stopped being able to clean her apartment.

But other people cook Trump's food and clean his house and drive him around. So in some ways his impairment is not so obvious.

It's rather bracing to think of how far past the usual crisis points Trump actually is.

Him being at the White House protects *him* from the consequences of his impairment. Of course, it does not protect the rest of us.