Road to Dementia

We might as well call this presidential election “The Road to Dementia, 2024.”

Both candidates for the White House (and a large percentage of the US Congress) display the natural signs of cognitive decline that hit nearly everyone who reaches the so-called “golden years.”

photo by Michael Yuan

The Oxford Dictionary defines dementia as a “condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain.”

I doubt that any doctor would officially diagnose either President Joe Biden or Donald Trump, the former president and convicted felon trying to unseat Biden, with dementia yet. But both candidates display the creeping signs of cognitive decline characteristic of almost anyone who lives to be eighty-one or seventy-eight, the respective ages of the candidates. And they are running for a four-year term in which cognitive decline could easily slip into dementia.

Lest we forget, the deceased President Ronald Reagan, whose presidency ended when he was nearly seventy-eight, began displaying signs of dementia before he left the White House in 1989. One of his sons said he had dementia before his term ended but Reagan loyalists covered up the signs of the disease and the press didn’t pursue any of his demonstrated verbal miscues or mental slips. Reagan himself finally announced he’d been diagnosed with Alzheimer’s disease, a particularly severe form of dementia that progressively got worse, in 1994, about six years after he left office. He died of the disease in June 2004.

President Biden’s disastrous debate performance put on public display his obvious instances of cognitive decline. He confused names, was unable to finish sentences, and at times, seemed perpetually confused. He performed better in his recent news conference but not by enough to quell the calls for another candidate. Likewise, former President Trump often rambles and confuses names. He often makes no sense. He consistently displays an inability to distinguish between reality and lies. He refuses to accept his defeat in the last election. He rubs shoulders with notorious autocrats while denying he’s anti-democratic. His flawed economic policies seem conceived in some kind of fairy land for the sensory deprived. 

The news coverage of this mess has been disappointing at best and reflects a steep decline of the media that won’t ease. The New York Times has embraced an old-fashioned newspaper crusade to get Biden dumped from the Democratic ticket, and the rest of the media follows its lead like hungry dogs. Where is the scientific reporting on what the verbal flubs, miscues on names and titles, failure to face defeat, and tendency towards autocracy say about the neurological states of both candidates? Instead of the heavy focus on polls and speculative reports that don’t mean much at this stage of the game, we need something as old-fashioned as a crusade: Reporting.  

So far, we’ve seen references about neurological exams. Former President Trump says he passed his test. What does that mean? This isn’t high school. No one even followed up on that ridiculous claim. Likewise with President Biden. I’d like to see some reporting about whether the troubling signs we see with both candidates could be signals that worse is ahead for their mental health and consequently for the nation’s psyche. Are the gaffes and mistakes signposts on the road to dementia? It’s a fair question for candidates who want to occupy the most powerful job in the world.

Medical research on the impact of aging concludes there is ample evidence of predictable change in cognition that occurs with normal aging. In a paper he published long before the current elections on The Impact of Age on Cognition, Dr. Daniel L. Murman of the Department of Neurological Sciences at the University of Nebraska, divided cognitive abilities into several domains, including attention, memory, executive cognition function, language, and visuospatial abilities, such as the ability to use a map to get from one place to another.

“Each of these domains has measurable declines with age,” he wrote. “The most noticeable changes in attention are declines in performance on complex tasks,” such as the ability to separate relevant from irrelevant information, or to focus on multiple tasks simultaneously.      

“Some aspects of memory are stable with normal aging, but there are consistent declines in new learning abilities with increasing age and some decline in retrieval of newly learned material.” The most relevant aspect of natural declines that Murman detailed occurs in executive cognitive functions – decision-making, problem-solving, planning and sequencing of response, and multitasking, exactly the kind of skills that are crucial for anyone who sits at that desk in the Oval Office.  

“Each of these areas decline with advancing age,” Murman wrote. Novel or complex situations or those that require assessing the relevancy of information decline with age as does concept formation, abstraction, and mental flexibility “especially in subjects older than age seventy.”

It's important to recognize the signs of cognitive decline as we grow old, Murman says, but it is equally “important to understand what types of changes in cognition are expected and what type of changes might suggest the onset of a brain disease.” We are talking about cognitive changes that require sophisticated neurological exams, the results of which should be public. American voters should not be forced to rely on a candidate’s claim that he “passed his test.”

Although a decline in mental acuity doesn’t mean someone can’t do a job, and they can always take drugs designed to minimize any damage they might suffer. But even normal declines that are part of the aging process should sound alarm bells when we are talking about the presidency. Should we even be considering candidates for the highest office in the land if they are vulnerable to normal cognitive struggles such as making quick decisions or solving a thorny problem? Can’t the political parties give us better choices with their next generation of potential candidates?  

The controversy of Biden highlights more than the political mess the Democrat and Republican parties foisted upon voters in this election. It also reflects the decline in the media of good science writers, the kind of journalists that could routinely and regularly tackle stories about complex subjects such as the neurological conditions of elderly presidential candidates and their vulnerability to brain disease.

Political reporters can’t just observe a candidate and draw conclusions, although they often try to with superficial reports that lack credibility. A good science journalist could tap into sources and learn that scientists divide cognitive traits that change with age into crystallized and fluid abilities. Tests of general knowledge learned in the past, such as reading comprehension, math, science, history and vocabulary, are crystalized abilities that improve until about age sixty, Murman’s paper says, and then plateau until about eighty. Reporters watching a candidate might not detect much difference in crystalized abilities. The decline in fluid ability is another question and can be more noticeable, particularly to the trained eye. Tests of fluid ability require a subject to attend to one’s environment and process new information quickly to solve problems. “There is a steady decline in fluid abilities from age twenty to eighty,” the report says.

Unfortunately, there are not as many working science writers around. They proved to be a juicy target for budget cutters at newspapers across the country struggling to overcome financial problems. The Chicago Tribune, where I was once the managing editor, had a stable of Pulitzer Prize-winning science writers savaged by shortsighted budget cutters. National Geographic magazine last year laid off all of its staff reporters. Wired laid off twenty staff members, and Popular Science stopped publishing the magazine, according to Ira Flatow, the host of Science Friday on National Public Radio.

Flatow also questioned whether the layoffs contributed to America’s loss of trust in science writ large. He cited a Pew Research Center study that just fifty-seven percent of Americans think science has a mostly positive effect on society, down considerably since the start of the Covid pandemic.

Perhaps Americans cynicism about the media has grown more acute with the decline in the quality of political coverage, just as their faith in science fell with the decline in science writing. If there’s a lack of faith among existing voters, it hasn’t surfaced in Republicans ranks. The GOP will gather in Milwaukee next week to formally anoint Donald Trump as its White House candidate. President Biden, meanwhile, fiercely battles fellow Democrats who at least are considering coming up with a better choice.

I’m currently eighty years young, so I’m not some youngster picking on old guys. I know what it’s like to be the mature voice in the room. I also know there are many potholes on the road to dementia. One can avoid them with the right kind of driver at the wheel.

—James O’Shea

James O’Shea is a longtime Chicago author and journalist who now lives in North Carolina. He is the author of several books and is the former editor of the Los Angeles Times and managing editor of the Chicago Tribune. Follow Jim’s Five W’s Substack here.