James Fallows's description of John Kerry's debating skills ("When George Meets John," July/August Atlantic) was interesting, but what was most remarkable was Fallows's documentation of President Bush's mostly overlooked changes over the past decade -- specifically, "the striking decline in his sentence-by-sentence speaking skills." Fallows points to "speculations that there must be some organic basis for the President's peculiar mode of speech -- a learning disability, a reading problem, dyslexia or some other disorder," but correctly concludes, "The main problem with these theories is that through his forties Bush was perfectly articulate."

I, too, felt that something organic was wrong with President Bush, most probably dyslexia. But I was unaware of what Fallows pointed out so clearly: that Bush's problems have been developing slowly, and that just a decade ago he was an articulate debater, "artful indeed in steering questions and challenges to his desired subjects," who "did not pause before forcing out big words, as he so often does now, or invent mangled new ones." Consider, in contrast, the present: "the informal Q&As he has tried to avoid," "Bush's recent faltering performances," "his unfortunate puzzled-chimp expression when trying to answer questions," "his stalling, defensive pose when put on the spot," "speaking more slowly and less gracefully."

Not being a professional medical researcher and clinician, Fallows cannot be faulted for not putting two and two together. But he was 100 percent correct in suggesting that Bush's problem cannot be "a learning disability, a reading problem, [or] dyslexia," because patients with those problems have always had them. Slowly developing cognitive deficits, as demonstrated so clearly by the President, can represent only one diagnosis, and that is "presenile dementia"! Presenile dementia is best described to nonmedical persons as a fairly typical Alzheimer's situation that develops significantly earlier in life, well before what is usually considered old age. It runs about the same course as typical senile dementias, such as classical Alzheimer's -- to incapacitation and, eventlually, death, as with President Ronald Reagan, but at a relatively earlier age. President Bush's "mangled" words are a demonstration of what physicians call "confabulation," and are almost specific to the diagnosis of a true dementia. Bush should immediately be given the advantage of a considered professional diagnosis, and started on drugs htat offer the possibility of retarding the slow but inexorable course of the disease.

Joseph M. Price, M.D.
Carsonville, Mich.

The Washington Post has an [in]side baseball account of Kerry's August collapse, but for all the focus on tactics, the weakness of Kerry as a candidate is obvious from the fact that it has now been 38 days since Kerry sat down on camera with a major figure from American journalism for an in-depth interview that would be certain to bring up Kerry's whoppers about his Vietnam service. Kerry's still in the box he built from himself of fables of CIA men and hats and gun-running to Cambodia.