The Forward Lean


We recently had four inches of snow in Washington, not much, actually, but enough to bring the city to a halt. Record-breaking cold weather, down into the teens and even single digits, has accompanied the snow, so it has stuck around for a while.

True, we would hardly have noticed this weather when we lived in northeastern Minnesota, but it brings up a longing for the winters there. My memories of cross-country skiing through the forest near our house are among my happiest.

The city was beautiful, however. Marja and I stretched our regular evening walk to about an hour, enjoying the snow hats on the front-lawn bushes, the empty streets, the wind swirling down the main corridor of our local business area, one house with Christmas-tree lights still on the pine tree in its front yard, and the occasional person struggling against the wind and the cold.

When the temperature is this low, the snow gets crunchy underfoot, evoking memories of walks in Finnish winters where we also lived for some time. When it's this cold, the snow is no longer slippery, nice for an old man whose balance ain't what it used to be. It was absolutely glorious to be out in the quiet city.

As we walked, however, I noticed that I kept leaning forward. Marja noticed it to.

We always walk quickly to get the exercise as well as our nightly togetherness, but Tuesday evening, I almost couldn't help speeding up. Unintentionally I kept leaning forward, and my legs seemed to be hurrying up to catch up to my upper body, which seemed to be dragging my legs along. I stepped off a curb and almost tumbled forward into the street. I didn't fall but only because Marja and I often hold hands, as much for balance as for tenderness.

Before I was aware of my cognitive decline, I would hardly have noted an isolated instance like this. With my impairment, however, my medical mind switched on, and I thought immediately about Parkinson's disease. One of its signs is a "festinating gait," which is one image I have from medical school: a guy pulled faster and faster by his upper body. Parkinson's is often a cause of dementia, too.

Naturally, I googled it when we got home. It turns out, however, that my gait didn't really meet the criteria to be festinating. I'd forgotten the other elements it comprises: stooped position; short, shuffling stride; absence of an arm swing; difficulty starting and stopping; and so on. It also turns out that a festinating gait doesn't show up until late in Parkinson's when many other symptoms would have become obvious.

The mental jump to thinking about my impairment is understandable, I suppose. My diagnosis is uncertain, different diseases have different prognoses, and I'm a doctor with a natural curiosity.

But I also wonder if it's an unhealthy preoccupation with the future.

In the months following my diagnosis, I felt a wonderful freedom from concern about the future. I lived more in the present, more in tune to others and the world in general.

It was wonderful.

Some of that remains. On the other hand, I find myself now, twelve months later, a little less in tune with the others, more often preoccupied with past and future.

Is this thinking about Parkinson's a "preoccupation" or something less neurotic?

I don't feel worried about the future, mostly interested in it. It's a mental challenge to put together all of my symptoms and test results, and wonder about the different futures. So I don't really feel worried.

In any case, this is my present moment. Wondering about what's happening now, even wondering about my future is what I'm doing in this present moment. And the present moment is where I want to live.

Editor's note: David's journey with Mild Cognitive Impairment was chronicled in "Fade to Blank: Life Inside Alzheimer's," an in-depth look at the real lives of families impacted by the Alzheimer's epidemic. His story continues on his personal blog on

An author and former physician, Dr. David Hilfiker was diagnosed in 2012 with a progressive mild cognitive impairment. His doctor thought it was Alzheimer's but additional testing proved this initial diagnosis to be wrong. Now David must learn how to come to terms with the reality of worsening cognitive issues that appear to have no cause.

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The title of this caught my attention... and held it as I read because it described EXACTLY an odd (and isolated) incident that occurred with my mom once last summer when we were out walking. [Which, sadly, we seemed to do less and less after that time, even in gorgeous weather, until such strolls pretty much ceased altogether.]

She had slowed down significantly in general at that point in time, but that day, when we were were just about back to the house (about 3 doors down), she started a forward lean, such as you noted - and began moving oddly rapidly. I could not have described it better than you did - to say that it seemed her lower body was trying to keep up with her upper body, as if in an attempt to prevent her from falling forward on her face. I was walking beside her, our arms hooked, and I could hardly keep up with this sudden burst in her gait. It continued right up the driveway until she put her hands out in front of her as if to allow the closed garage door to "break" this action, and then leaned against it, panting heavily, as if she'd just run a marathon or something. I questioned her, but she was unable to explain what any of that was about. And I never saw it again - nor did any of my siblings ever experience this with her. To this day, I have no idea what was happening there, but I still recall it vividly and how odd it was. Until your article, I had never seen/heard any mention of such a thing by anyone else, either.

By the way, my mom has dementia (vascular), but not Alzheimer's. She has had several falls/breaks, and each incident throws her deeper into the dementia - but somehow she manages to heal quite miraculously from each injury (by doing the bare minimum of physical therapy until someone signs off on it, then no longer moves a muscle to try and maintain/improve her strength/balance/circulation), though she is less steady on her feet and again, therefore, less active.

Very interesting of you to note this incident, and even while being aware of it, not be able to explain it causally or medically.

Please know that this is a brave and wonderful thing you are doing, documenting your experiences. You may never know how many others such a venture will benefit. You have my admiration, gratitude, and prayers.
Lovely read. Just out of curiosity, did the additional testing determine that you perhaps had Lewy Body Dementia?
God bless you David, I will keep you in my prayers.