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The strokes that killed Churchill, Roosevelt, and Stalin

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Abstract

From February 4 to 11, 1945, President Franklin D. Roosevelt of the United States, Soviet Union Premier Joseph Stalin, and British Prime Minister Winston Churchill met near Yalta in Crimea to discuss how post-World War II (WWII) Europe should be organized. Within 2 decades of this conference, all 3 men had died. President Roosevelt died 2 months after the Yalta Conference due to a hemorrhagic stroke. Premier Stalin died 8 years later, also due to a hemorrhagic stroke. Finally, Prime Minister Churchill died 20 years after the conference because of complications due to stroke. At the time of Yalta, these 3 men were the leaders of the most powerful countries in the world. The subsequent deterioration of their health and eventual death had varying degrees of historical significance. Churchill's illness forced him to resign as British prime minister, and the events that unfolded immediately after his resignation included Britain's mismanagement of the Egyptian Suez Crisis and also a period of mistrust with the United States. Furthermore, Roosevelt was still president and Stalin was still premier at their times of passing, so their deaths carried huge political ramifications not only for their respective countries but also for international relations. The early death of Roosevelt, in particular, may have exacerbated post-WWII miscommunication between America and the Soviet Union-miscommunication that may have helped precipitate the Cold War.
neurosurgical
focus Neurosurg Focus 41 (1):E7, 2016
By February of 1945, it had become strongly appar-
ent to the Allied Powers, which included the United
States, Great Britain, and the Soviet Union, that
Nazi Germany was crumbling and on its way to defeat.45
On the eastern front, Soviet Union troops had recaptured
Poland and seemed virtually unstoppable in their march
toward Berlin; in the west, the successful completion of
Operation D-Day had allowed millions of Allied troops
to begin their own campaign of recapturing France and
pressuring Germany’s western front.4,16 The close of a war
that had left tens of millions dead on continental Europe
seemed rmly within reach.11
What was less clear was how post–World War II
(WWII) Europe should be organized and how the Allied
Powers would deal with the still grave threat of Imperial
Japan in the Pacic.45 Thus, a conference was organized for
February 4 to 11, 1945, near Yalta in Crimea to be attend-
ed by the leaders of the 3 major Allied Powers: President
Franklin D. Roosevelt of the United States, British Prime
Minister Winston Churchill, and Soviet Union Premier Jo-
seph Stalin (Fig. 1).22 At this point in the war, the Soviet
Union was largely uninvolved in the Pacic theater; to en-
list the Soviet Union’s assistance against Japan, Roosevelt
guaranteed tracts of land in Northeast Asia to the Soviets.45
Additionally, Joseph Stalin conceded that in exchange for
a sphere of inuence over Eastern Europe, the countries
there would be able to exercise self-determination via free
and fair democratic elections following the war.13,25,45
Within 20 years after this historic agreement, all 3 ma-
jor participants had died of a stroke.15,26,43 The rst of these
deadly strokes—that of Roosevelt—would prove to be
among the most consequential in human history, as sub-
sequent interactions between the succeeding Truman ad-
ministration and Stalin’s Soviet Union were acrimonious.45
This tension would eventually develop into a decades-long
conict known as the Cold War. The strokes that killed
Stalin and Churchill also proved to have varying degrees
of historical signicance. In the subsequent sections, we
intend to examine the interaction of domestic politics and
international geopolitics with the deteriorating health and
ultimate death due to the strokes of Roosevelt, Stalin, and
Churchill.
ABBREVIATIONS WWII = World War II.
SUBMITTED February 26, 2015. ACCEPTED April 26, 2016.
INCLUDE WHEN CITING DOI: 10.3171/2016.4.FOCUS1575.
The strokes that killed Churchill, Roosevelt, and Stalin
Rohaid Ali, BA, Ian D. Connolly, MS, Amy Li, BA, Omar A. Choudhri, MD,
Arjun V. Pendharkar, MD, and Gary K. Steinberg, MD, PhD
Department of Neurosurgery and Stanford Stroke Center, Stanford University School of Medicine, Stanford, California
From February 4 to 11, 1945, President Franklin D. Roosevelt of the United States, Soviet Union Premier Joseph Stalin,
and British Prime Minister Winston Churchill met near Yalta in Crimea to discuss how post–World War II (WWII) Europe
should be organized. Within 2 decades of this conference, all 3 men had died. President Roosevelt died 2 months after
the Yalta Conference due to a hemorrhagic stroke. Premier Stalin died 8 years later, also due to a hemorrhagic stroke.
Finally, Prime Minister Churchill died 20 years after the conference because of complications due to stroke. At the time
of Yalta, these 3 men were the leaders of the most powerful countries in the world. The subsequent deterioration of their
health and eventual death had varying degrees of historical signicance. Churchill’s illness forced him to resign as British
prime minister, and the events that unfolded immediately after his resignation included Britain’s mismanagement of the
Egyptian Suez Crisis and also a period of mistrust with the United States. Furthermore, Roosevelt was still president
and Stalin was still premier at their times of passing, so their deaths carried huge political ramications not only for their
respective countries but also for international relations. The early death of Roosevelt, in particular, may have exacer-
bated post-WWII miscommunication between America and the Soviet Union—miscommunication that may have helped
precipitate the Cold War.
http://thejns.org/doi/abs/10.3171/2016.4.FOCUS1575
KEY WORDS stroke; Franklin D. Roosevelt; Winston Churchill; Joseph Stalin
©AANS, 2016 Neurosurg Focus Volume 41 • July 2016 1
R. Ali et al.
Neurosurg Focus Volume 41 • July 20162
Franklin D. Roosevelt
President Franklin Roosevelts death came on April 12,
1945, just 2 months after the Yalta Conference, when he
was sitting for a portrait in Warm Springs, Georgia. Mid-
way through the artist’s work (Fig. 2), he proclaimed “I
have a terric headache,” and he collapsed to the oor.36
His primary cardiologist, Dr. Howard G. Bruenn, rushed to
evaluate him; the presidents blood pressure was 300/190
mm Hg.7 Within a few hours, Roosevelt was pronounced
dead; the cause: an occipital hemorrhagic stroke.7
The death of Roosevelt shocked a public that widely
pictured him to be in excellent shape, but the reality was
that he had been in declining health for many years.35,42
In 1937 he had hypertension, with a blood pressure of
162/98 mm Hg.7 In April 1944, about 1 year before his
death, Roosevelt’s blood pressure had climbed to 230/126
mm Hg.7 Radiographs showed cholesterol gallstones, and
an electrocardiogram indicated an enlarged heart.2 Later
that year in November, the month he was reelected to his
fourth term as president, his blood pressure was 250/150
mm Hg.7 He began complaining of a loss of appetite.2 By
January of the following year, his hands shook uncontrol-
lably, and he had lost a considerable amount of weight.2
During the Yalta Conference the following month, Roo-
sevelt’s blood pressure reached 260/150 mm Hg.7 This
was when Dr. Lord Moran, personal physician to Winston
Churchill, uttered the prophetic prognosis, “I give him
only a few months to live.”8
Roosevelt’s compromised health during the Yalta Con-
ference may have weakened his mental capacity and, in
turn, negotiating ability with Stalin. William Harriman,
the American special envoy to Europe, noted, “At Yalta,
FIG. 1. From left, Prime Minister Churchill, President Roosevelt, and Premier Stalin at the 1945 Yalta Conference to discuss plans
for a post-WWII planet. Within 20 years of this conference, all of these men had died. Source: http://en.wikipedia.org/wiki/Yalta_
Conference#mediaviewer/File:Yalta_Conference_(Churchill,_Roosevelt,_Stalin)_(B%26W).jpg. Public domain.
FIG. 2. This is the Unnished Portrait by Elizabeth Shoumatoff. On
April 12, 1945, Shoumatoff was painting this portrait of Roosevelt when
he suffered a fatal hemorrhagic stroke, leaving the rest of the artwork
incomplete. Source: http://en.wikipedia.org/wiki/Unnished_portrait_
of_Franklin_D._Roosevelt#mediaviewer/File:FDR_unnished.jpg.
Photograph CC BY 2.0 (http://creativecommons.org/licenses/by/2.0/).
Courtesy of the FDR Presidential Library & Museum. Painting courtesy
of Roosevelt’s Little White House.
The strokes that killed Churchill, Roosevelt, and Stalin
Neurosurg Focus Volume 41 • July 2016 3
I believe, [Roosevelt] didn’t have the strength to be quite
as stubborn as he liked to be. I suppose that if FDR has
been in better health, he might have held out longer and
got his way on a number of detailed points.”23 When Roo-
sevelt returned to the United States, he delivered a speech
to Congress exalting the successes of the Yalta Confer-
ence, describing how the Allied Powers were united on
the principle that all nations deserve the right to exercise
self-determination.41 However, shortly thereafter, Stalin
reneged on this agreement. He falsely accused the United
States and United Kingdom of creating an exclusive peace
with Germany, and he raised tensions further when he
started disallowing Eastern European countries from par-
ticipating in free elections.2 On March 23, 1945, Roosevelt
said to an aid, “We can’t do business with Stalin. He has
broken every one of the promises he made at Yalta.”23
Roosevelt began working to normalize relations with
Stalin, but the cerebral hemorrhage would take his life be-
fore he could succeed.2 Three days after Roosevelt’s pass-
ing, Nazi Germany celebrated by describing the fatal stroke
as a miracle.1 Meanwhile, newly appointed President Harry
Truman began settling himself into the job. Truman over-
saw American military operations in Europe until Ger-
many’s surrender on May 8, 1945, and he effectively led
the Allies to victory against Imperial Japan in the Pacic.
However, the Truman administration was never success-
ful in normalizing relations with Moscow; left unchecked,
the Soviet Union continued to exert—in discordance with
internationally agreed-upon principles—a dominating in-
uence over newly liberated Eastern European nations.45
Given the magnitude of Roosevelt’s poor health in the
months preceding his death, the fact that the American
public was not made aware raises important ethical ques-
tions. Roosevelt’s personal cardiologist, Dr. Bruenn, was
familiar with the rapidly declining health of the president
during his last year of life. However, another of his physi-
cians made public statements during this same time peri-
od that Roosevelt’s health was “excellent.35 Furthermore,
when Roosevelt was delivering his speech to Congress in
1945 following the Yalta Conference, he needed to remain
seated the entire time; rather than attributing his inability
to deliver a standing speech as being due to his failing
health, he blamed it instead on fatigue from travel (Fig.
3).41 This lack of transparency toward the American public
and to other groups in government may have lulled every-
one into thinking that Roosevelt was healthy and foreign
policy was under control, when in reality Roosevelt was
deathly sick and American relations with the Soviet Union
were rapidly deteriorating. One analyst wrote that the po-
tent mix of Roosevelt’s poor mental and physical health,
and also the ignorance of those around him of the Soviet
Unions rise, caused a “hiatus” in effective American lead-
ership.24 While certainly debatable, this analyst went on to
state that this hiatus created the conditions that allowed
“the betrayal of the Poles, the imposition of Communist
governments in Eastern Europe, the Czechoslovak coup,
and, on the other side of the world, the loss of China and
the invasion of South Korea.”24
Joseph Stalin
Both his contemporaries and subsequent historians
have described Joseph Stalin as being unquestionably
competent around the time of WWII. In 1937 his doctor
wrote that Stalin had “devilish, cunning, and slyness as
well as an astonishing knowledge of the human mind with
all its weaknesses. He was headstrong, consistent, and had
extraordinary willpower and nerves of iron.”40 In 1945 a
contemporary said that his “Russian vocabulary was rich
and his manner of expression very vivid and plastic, and
replete with Russian proverbs and sayings.12 Stalin was
famously blindsided by Germany’s offensive early in
WWII, but his subsequent management of Red Army af-
fairs and his success at the Yalta Conference and other
international meetings in advancing Soviet interests dem-
onstrated his shrewdness. Russian historian Roy Medve-
dev wrote of Stalin that he “was without a doubt mentally
competent and fully aware of what he was doing.32
Stalin experienced an array of health problems through-
out his life, and eventually these came to seriously affect
his physical and mental abilities. In 1922 he started experi-
encing headaches.39 In 1934 he might have developed high
blood pressure, and in 1937 he might have experienced
a transient ischemic attack that disrupted his speech.32,38
Stalin, a heavy smoker, suffered from atherosclerosis; on
June 24, 1945, he experienced a mild stroke during the
WWII victory parade in Moscow, and in October he suf-
fered a major heart attack.34 In 1947 he experienced an-
other mild stroke, and in 1948 a severe heart attack left
him physically incapacitated for half a year (Fig. 4).29,32
Stalin’s cerebrovascular health problems came to a head
in 1953 when he experienced a fatal hemorrhagic stroke.
On the night of February 28, Stalin invited members of his
inner circle for dinner in a private residence near Moscow.
After a night of heavy drinking, the party disbanded at 4
am. However, the next day Stalin did not leave his quar-
ters. Fear prevented his aides from entering his room, but
as the day wore on, they became increasingly concerned.
Finally, at 11 pm members of the Politburo entered Stalin’s
quarters to nd him on the oor, incoherent and drenched
in his own urine. His right arm and leg were paralyzed,
FIG. 3. Roosevelt appears seated as he delivers a speech before Con-
gress following the Yalta Conference. Photographer Bettman/Bettman
Collection/Getty Images.
R. Ali et al.
Neurosurg Focus Volume 41 • July 20164
and he had a right Babinski reex.14 Over the next day his
blood pressure climbed to 210/120 mm Hg.14 Doctors were
summoned, but his condition continued to deteriorate over
the subsequent days. On March 3 he lost consciousness
permanently, on March 4 he vomited blood, and on March
5 he died with an ofcial time of death of 9:50 pm.14
Stalin’s death changed the course of Russian history. His
regimen was murderous; a major Soviet paper declared in
1989 that, under it, “20 million died in labor camps, forced
collectivization, famine, and executions.”28 Stalin was no-
toriously paranoid, murdering many Red Army generals
and members of his inner circle whom he perceived to be a
threat. Some have attributed these actions to a psychiatric
paranoid personality disorder, perhaps exacerbated by his
declining cerebrovascular health.21 Indeed, the fact that it
took so long for members of Stalin’s Politburo to enter his
room following his stroke is a reection of this fear that he
had instilled in them. Because Stalin had not designated
a successor, the immediate aftermath of his death was
an internal struggle for power.20 The Council of Minis-
ters and the Presidium of the Supreme Soviet had initially
announced the formation of collective leadership and im-
mediately released anyone arrested in Stalin’s last days as
well as thousands of political prisoners from gulag labor
camps.33,34 Hence, it appeared that Moscow was instantly
ready to turn away from the harsh policies and repression
characteristic of Stalin’s rule, although it was also possible
that the leadership was persuaded to do so because the
high number of prisoners represented a wasteful and inef-
cient use of resources.30
Nikita Khrushchev, who maneuvered his way to become
Stalin’s successor, continued to reinforce the concept of
“de-Stalinization.” On February 25, 1956, during a closed
session of the 20th Party Congress of the Communist Par-
ty of the Soviet Union, Premier Nikita Khrushchev (Fig.
5) boldly delivered his famed speech titled “On the Cult
of Personality and Its Consequences,in which he criti-
cized Stalin’s purges and personality cult and called for a
return to the traditional ideals of communism.34 Khrush-
chev may have only delivered this speech to consolidate
his own power. Nevertheless, the ofcial denouncement
of Stalin’s purges offered great relief to those living in the
Soviet Union. The death of Stalin therefore marked the
end of an era of a hyper-repressive regimen and allowed
opportunities for domestic change characterized by less
oppressive policies and increased emphasis on consumer
industries.31 A domestic de-Stalinization, however, was
not necessarily accompanied by a de-Stalinization in for-
eign policy, as foreign policy patterns were arguably more
a continuation than a change after Stalin’s death.17
Winston Churchill
Winston Churchill was both the last of the 3 major
participants at Yalta to pass away and the only one to do
so while not holding public ofce. He lost reelection as
prime minister in July 1945, shortly after the conclusion of
WWII. Churchill remained active in British politics for a
number of years, however. From 1945 until 1951 he served
as the leader of the opposition party. In 1951 he won elec-
tion again as prime minister, and he held this post until
his resignation in April 1955 (Fig. 6). He continued on in
Parliament, but in 1964 he ofcially left public ofce for
good and spent his last year at his home in Hyde Park Gate
in London.5
As was the case with Stalin and Roosevelt, Churchill
suffered from hypertension for a number of years before
his death. After a mild stroke in 1949, his blood pressure
was recorded to be about 160/90 mm Hg.6 In consulting
a physician, he admitted to smoking about 13 cigars per
day and having 3 brandies after dinner.6 Four years later
on June 24, 1953, Churchill suffered a more serious stroke,
which caused his face to slightly droop and his speech
to become somewhat slurred.6 His blood pressure rose to
170/90 mm Hg.6 His health problems would continue to
worsen, and because he no longer trusted his own physi-
cal abilities, Churchill stepped down as prime minister on
April 5, 1955.5 In 1959 Churchill lost consciousness while
taking a bath in his home in Hyde Park Gate. By 1961 he
admitted to his doctor that he lost some emotional self-con-
FIG. 4. Joseph Stalin and Mao Zedong at a ceremony arranged for
Stalin’s 71st birthday in Moscow in December 1949. Source: http://
commons.wikimedia.org/wiki/File:Mao,_Bulganin,_Stalin,_Ulbricht_
Tsedenbal.jpeg. Public domain.
FIG. 5. Joseph Stalin meeting with Nikita Khrushchev in 1936. Two
decades later, Khrushchev delivered a speech called “On the Cult of
Personality and Its Consequences” that denounced the purges that
Stalin conducted during his reign and also the personality cult with
which he surrounded himself. Source: http://commons.wikimedia.org/
wiki/File:Joseph_Stalin_and_Nikita_Khrushchev,_1936.jpg. Public
domain.
The strokes that killed Churchill, Roosevelt, and Stalin
Neurosurg Focus Volume 41 • July 2016 5
trol and had moments of extreme anger and rage toward his
assistants.6 He developed depression, and sensing himself
no longer t to hold any public ofce, Churchill left Par-
liament in 1964 (Fig. 7).5 On January 11, 1965, his health
took a rapid downward trajectory. He was unable to feed
himself or swallow solid foods. His doctor described him
as “someone in deep sleep” and diagnosed him as having a
terminal episode of cerebral ischemia.6 Churchill’s family
declined nasal feedings, so he went without nourishment
for 13 days until January 24, the day he died.6
Given the stepwise departure from government be-
fore his death, Churchill’s resignation from his position
as prime minister is perhaps the most abrupt and inuen-
tial event in his gradual decline. Anthony Eden, deputy of
Churchill, was chosen to be his successor. Considered by
some to be one of Britain’s least successful prime minis-
ters,3 Eden held the position for less than 2 years (1955–
1957). His term in ofce is most widely known for the Suez
Crisis in which Britain colluded with French and Israeli
allies to invade Egypt without the approval of the United
States. The deceptive maneuvers to disguise the invasion
severely hurt Eden’s reputation as well as foreign relations
with the United States, led at the time by President Eisen-
hower. The crisis eventually led to Eden’s resignation in
1957. Evidence points toward Churchill’s disapproval of
the manner in which the Suez Crisis was managed. He
privately expressed his disappointment in a letter to a pub-
lisher, and his wife believed that his subsequent trips to the
United States were made partially in an attempt to repair
relations with the United States.9,18 Having been wartime
colleagues with Eisenhower, Churchill most likely would
not have employed the same deception as Eden. Indeed, it
was Churchill who in 1946 coined the term “special rela-
tionship,a phrase still in use today to describe the close
connection and cooperativeness between the two nations.
In addition to fueling a period of mistrust with the Unit-
ed States, Britain’s handling of the Egyptian Suez Crisis
fueled chaos in the region, which may have beneted the
Soviet Union. Siding with Egypt, the Soviet Union threat-
ened to send troops and launch attacks against Britain,
France, and Israel if their invasion was not stopped. At the
same time, Khrushchev hinted at the nuclear capabilities
of the Soviet Union. Although the crisis eventually came
to a close due to both political and economic pressures, the
Soviet Union perceived the role it had played as a triumph.
Khrushchev further realized the utility of nuclear black-
mail in imposing foreign policy.19 While arguable, the dis-
orderly resolution of the crisis that followed allowed the
Soviet Union to secure additional inuence in the Middle
East.
Conclusions
The Yalta Conference ranks among the most impor-
FIG. 6. Churchill’s letter of resignation as prime minister. Source: http://www.businessinsider.com.au/winston-churchill-resignation-
letter-2014-3. Public domain.
R. Ali et al.
Neurosurg Focus Volume 41 • July 20166
tant meetings of the past century, as it laid the groundwork
for not only the end of WWII but also for a new style of
cooperative international diplomacy, a model that exists
to this day. Its participants—Franklin Roosevelt, Win-
ston Churchill, and Joseph Stalin—are among the most
inuential men of the modern era. The illnesses that so
greatly affected them, thus, had a major effect on history
and should not be ignored when examining the course of
human events in the later part of the 20th century. Stalin’s
stroke marked the end of a brutally murderous regimen,
and Churchill’s deteriorating physical condition forced
hi m to step out of public ofce premat urely, which in hind-
sight appears to have been detrimental to British foreign
relations. Additionally, Roosevelt’s worsening cerebro-
vascular health dulled his cognitive ability at the critical
closing period of WWII, exactly when strong American
leadership was needed to effectively help rebuild war-torn
Europe and East Asia.
Interestingly, there was great secrecy that surrounded
these leaders’ health, as all 3 men acted to hide their physi-
cal condition from the media and general public. Premier
Stalin killed physicians who evaluated his health and
wrote negatively of it; during his last few years of life, his
distrust of the medical community grew such that at the
time of his death he was on the cusp of executing a plan to
massacre doctors in Moscow.10,37 When Churchill experi-
enced a severe stroke as prime minister in 1963, he did not
disclose his stroke to either the media or Parliament, blam-
ing exhaustion instead for his fatigue and brief period of
absence.5 Lastly and perhaps most consequently, the fact
that Roosevelt did not disclose his poor health despite be-
ing a democratically elected leader of a nation at war rais-
es important ethical questions.27 Perhaps doing so would
have helped smooth over communication challenges that
occurred between the succeeding Truman administration
and the Soviet Union following Roosevelt’s abrupt passing.
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Disclosures
The authors report no conflict of interest concerning the materi-
als or methods used in this study or the findings specified in this
paper.
Author Contributions
Conception and design: Steinberg, Ali, Connolly. Critically revis-
ing the article: all authors. Reviewed submitted version of manu-
script: all authors.
Correspondence
Gary K. Steinberg, Department of Neurosurgery, Stanford
University School of Medicine, 300 Pasteur Dr., Stanford, CA
94305-5327. email: gsteinberg@stanford.edu.
... Roosevelt succumbed to a major stroke a few weeks after the conference [19,20]. Churchill produced symptoms and signs of cerebrovascular disease in the 1950s [21,22]. Stalin became a victim of his own paranoia when he suffered a fatal stroke in 1953, and none of the medical specialists he had prosecuted was available [21,23]. ...
... Churchill produced symptoms and signs of cerebrovascular disease in the 1950s [21,22]. Stalin became a victim of his own paranoia when he suffered a fatal stroke in 1953, and none of the medical specialists he had prosecuted was available [21,23]. ...
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Background: Increasing life expectancy may explain why more elderly candidates appear to be running for office. This raises general questions regarding the specific risks of old age and frailty in demanding political positions. Therefore, I tried to give important contemporary examples of elderly leaders, study the mean age of leading political figures over the last 3 decades and present historical examples of heads of state with age-associated brain diseases and cognitive deficits. I reviewed the literature on mental illness and politics and analyzed the ages of international political leaders in 1990, 2000, 2010 and 2020. Summary: There are several impressive contemporary examples of elderly politicians. The mean age of political leaders has not increased significantly in most parts of the world over the last 3 decades with the exception of the Gulf States and sub-Saharan Africa. Health problems of heads of state in earlier centuries had not been primarily age associated. After 1900, dementia but also mild cognitive and mild behavioral impairment became important issues in politically critical situations, for example international peace negotiations, the rise of Nazi Germany, the breakup of communism, the Arab Spring and others. Key Messages: This paper collects anecdotal evidence of cognitive frailty in ageing politicians; it is not an in-depth analysis of political history. Observations confirm that a very long time in power may obviously increase the risk of age-associated problems; dynamic revolutionary or entrepreneurial idols may be misled to rely on their irreplaceable charisma for too long. However, caution must be exercised against ageism on one side versus silent acquiescence towards leaders with failing mental powers on the other, who may become victims of obscure parties and their decompensating personality disorders.
... Another potential explanation for the increase in politicians' survival advantage in the second half of the twentieth century is the expanded range of therapies to treat cardiovascular disease. For example, President Franklin Roosevelt suffered hypertension (with his blood pressure recorded as 230/126 mm Hg in 1944), as did Prime Minister Winston Churchill (recorded as 160/90 mm Hg in 1949) [40]. Both of these political leaders died of stroke. ...
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This study aims to compare the mortality rate and life expectancy of politicians with those of the age and gender-matched general populations. This was an observational analysis of mortality rates of politicians (i.e. members of national parliaments with available data on dates of birth, death and election, gender, and life tables) in 11 developed countries. Politicians were followed from date of first election until either death or the last available year with life table data. Relative mortality differences were estimated using standardised mortality ratios (SMRs). Absolute inequalities were quantified as the difference in survival by deducting a population’s remaining life expectancy from politicians’ remaining life expectancy at age 45, estimated using Gompertz parametric proportional hazards models. We included 57,561 politicians (with follow-up ranging from 1816–2016 for France to 1949–2017 for Germany). In almost all countries politicians had similar rates of mortality to the general population in the early part of the twentieth century. Relative mortality and survival differences (favouring politicians) increased considerably over the course of the twentieth century, with recent SMRs ranging from 0.45 (95%CI 0.41–0.50) in Italy to 0.82 (95%CI 0.69–0.95) in New Zealand. The peak life expectancy gaps ranged from 4.4 (95% CI, 3.5–5.4) years in the Netherlands to 7.8 (95% CI, 7.2–8.4) years in the US. Our results show large relative and absolute inequalities favouring politicians in every country. In some countries, such as the US, relative inequalities are at the greatest level in over 150 years.
... Stalin moriría en marzo de 1953 de complicaciones de una hemorragia intracerebral probablemente hipertensiva, después de ser encontrado inconsciente en su alcoba con hemiplejía derecha, signo de Babinski ipsilateral, y una tensión arterial de 210/120 mmHg. 40 ...
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El Dr. Vladimir Hachinski es uno de los contribuyentes más importantes de la neurología y la neurología vascular a nivel mundial. Ha dedicado su vida a estudiar distintas áreas entre las cuales destacan la enfermedad cerebro-vascular, el deterioro cognitivo y el control cardiaco a nivel cerebral. El presente texto pretende difundir una pizca de la vida y obra de este gran personaje.
... Er war ein erfolgreicher und beliebter Präsident, dessen körperliche Fitness und geistige Spannkraft allerdings während seiner letzten Amtszeit so deutlich nachließen, dass dies für die Teilnehmer der Yalta-Konferenz unübersehbar wurde. Wichtige Ursachen waren unter anderem ein viele Jahre unbehandelter, ausgeprägter Hypertonus und Nikotinismus [7,8]. Analysen seiner Reden zeigten eine deutliche inhaltliche Verarmung und formale Vereinfachung bereits zu Beginn seiner letzten Amtszeit, ähnlich wie bei Ronald Reagan, dessen Vergesslichkeit in den letzten Amtsjahren zu einem spürbaren Handicap wurde [9]. ...
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Intellectually challenged heads of state have had a remarkable impact on the course of history and the problem of age-associated impairment in politicians appears to increase with growing life expectancy. Lenin, Paul Deschanel, Woodrow Wilson, Franklin D. Roosevelt, Heinrich Lübke, Urho Kekkonen, Mao tse tung, Ronald Reagan, Pope John Paul II., and Robert Mugabe were still in power while showing signs of cognitive impairment. Margaret Thatcher, Walter Scheel, Helmut Kohl and many others developed dementia after their resignation. Mild cognitive impairment in Paul von Hindenburg and in communist sclerocrats (Andropow, Breshnew, Ceausescu, Honecker, Mielke and others) may have contributed to the rise of Adolf Hitler and the downfall of communist regimes, respectively. Two prototypes of presidential dementia have to be distinguished: the tragic senile King-Lear-form with cognitive deficits and the buffalo- and buffoon-like King-Ubu-type with predominant behavioral disturbances.
... Dem durch exzessive Verhaltensweisen charakterisierten Prototyp des König Ubu entsprechen Tiberius (Regierungszeit: 14 -37), Caligula (37 -41), Nero (54 -68), Domitian (81 -96), Commodus (180 -192), Elagabalus (218 -222) -wenngleich ihr Bild sowohl in alten Texten als auch in der weiteren Geschichtsschreibung nicht als zuverlässig und authentisch gelten kann [3]. [7,8]. Analysen seiner Reden zeigten eine deutliche inhaltliche Verarmung und formale Vereinfachung bereits zu Beginn seiner letzten Amtszeit, ähnlich wie bei Ronald Reagan, dessen Vergesslichkeit in den letzten Amtsjahren zu einem spürbaren Handicap wurde [9]. ...
Article
Intellectually challenged heads of state have had a remarkable impact on the course of history and the problem of age-associated impairment in politicians appears to increase with growing life expectancy. Lenin, Paul Deschanel, Woodrow Wilson, Franklin D. Roosevelt, Heinrich Lübke, Urho Kekkonen, Mao tse tung, Ronald Reagan, Pope John Paul II., and Robert Mugabe were still in power while showing signs of cognitive impairment. Margaret Thatcher, Walter Scheel, Helmut Kohl and many others developed dementia after their resignation. Mild cognitive impairment in Paul von Hindenburg and in communist sclerocrats (Andropow, Breshnew, Ceausescu, Honecker, Mielke and others) may have contributed to the rise of Adolf Hitler and the downfall of communist regimes, respectively. Two prototypes of presidential dementia have to be distinguished: the tragic senile King-Lear-form with cognitive deficits and the buffalo- and buffoon-like King-Ubu-type with predominant behavioral disturbances. Die tragische Gestalt des senilen König Lear einerseits [1] und die surreale Dreistigkeit des verhaltensauffälligen König Ubu andererseits [2] repräsentieren die beiden Extreme des Demenzspektrums. Sie finden sich in der Klinik ebenso wie in der Politik.
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Purpose of review: Universally lowering blood pressure (BP) may adversely affect some populations especially in the older population. Recent landmark trials revealed cardiovascular benefits of tight controlling systolic BP (SBP) more than several recent BP targets. Implementing the evidence from the studies and guidelines in some populations is reviewed. Recent findings: Eighth Joint National Commission (JNC-8) on hypertension issued conservative guidelines that provided an evolutionary change to BPcontrol in the elderly. However, intensive BP control with SBP < 120 mmHg in Systolic Blood Pressure Intervention Trial (SPRINT) focuses on the improvement of cardiovascular and cerebrovascular outcomes. Although increasingly guidelines are trending toward the SPRINT results, it is noteworthy that not all populations show a favorable outcome with intensive BP control given hypotensive risks to memory, kidney function, orthostasis, and morbidity risks. Summary: Some populations may benefit from implementing the more intensive SBP target, whereas others such as elderly hypertensive patients may benefit from a more liberal SBP target. In the spirit of 'Primum non Nocere', we call for and suggest that a marriage of both SPRINT and JNC-8 recommendations be undertaken to champion the most cardiovascular protections for the greatest number of patients possible whereas preventing complications in vulnerable populations such as the elderly. Among the chronic kidney disease (CKD) population, SBP < 120 mmHg may not necessarily lead to favorable CKD outcomes.
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Joseph Stalin was one of the most important world leaders during the first half of the 20th century. He died suddenly in early March 1953 after a short illness, which was described in a series of medical bulletins in the Soviet newspaper Pravda. Based on both the clinical history and autopsy findings, it was concluded that Stalin had died of a massive hemorrhagic stroke involving his left cerebral hemisphere. However, almost 50 years later, a counter-narrative developed suggesting a more nefarious explanation for his sudden death, namely, that a “poison,” warfarin, a potent anticoagulant, had been administered surreptitiously by one or more of his close associates during the early morning hours prior to the onset of his stroke. In the present report, we will examine this counter-narrative and suggest that his death was not due to the administration of warfarin but rather to a hypertension-related cerebrovascular accident resulting in a massive hemorrhagic stroke involving his left cerebral hemisphere. The counter-narrative was based on the misunderstanding of certain specific autopsy findings, namely, the presence of focal myocardial and petechial hemorrhages in the gastric and intestinal mucosa, which could be attributed to the extracranial pathophysiologic changes that can occur as a consequence of a stroke rather than the highly speculative counter-narrative that Stalin was “poisoned” by the administration of warfarin.
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This retrospective review focuses on some illustrious personalities of history, who have suffered from neurological illnesses. Neurological diseases represent about 10% of all illnesses, and therefore do not spare anyone, much less, famous people. In this review, we discuss the neurological disorders that have struck some celebrities throughout history. We briefly examine the lives of emperors, writers, poets, and musicians that have suffered from neurological diseases such as epilepsy, stroke, tumors, and other illnesses, and which caused death or disability. From a historical point of view, recollection of the lives of famous people afflicted by neurological disorders holds important lessons for future generations.