Biden age debate: Experts explain normal aging vs. cognitive decline

In the days following Thursday’s presidential debate, one of the questions The question posed on stage seems to be lingering in the public debate: How would the candidates handle concerns about their ability to do the job in their 80s?

Both candidates — Joe Biden, now 81, and Donald Trump, 78 — would set a record for oldest president in office, and both have faced speculation about their cognitive abilities. On the debate stage, Biden and Trump both exhibited behavior that raised red flags among their audiences: the current president had a slurred speech, some garbled answers, a pause that ended in a non sequitur; his opponent came up with answers that often sidestepped logical reasoning, and lied about easily verifiable facts.

Between the two, it is Biden who has been subjected to more scrutiny, possibly because of his overall performance, in which he also looked weak.

But was the president’s attitude a manifestation of troubling symptoms or simply regular aging, perhaps on a particularly bad day? Medical experts, who are averse to any form of armchair diagnosis, repeatedly told STAT that it is essentially impossible to tell much about the president’s cognitive health without an in-person assessment. Several declined to comment, concerned about the escalating level of political exploitation of a medical problem, real or perceived. However, a few shared insights into what “normal aging” looks like and what should be a cause for concern.

Sharon Sha, chief of Stanford University’s Division of Memory Disorders, said cognition is a broad term that includes several functions, such as executive functioning (the ability to plan, multitask, organize), memory, paying attention and language functions. These all tend to change with age, but not always in ways that worsen or irreparably compromise them. “What we often see as we get older is that processing speed [change]. So the speed at which we come up with and analyze information may slow down,” Sha said. “But that doesn’t mean there aren’t things that can compensate for that.”

Research has shown that although older people take longer to process information, they often still do it correctly. But they have also shown that experience and judgment often improve with age. “With normal aging, there is some decline in cognitive function, and in fact there is some increase,” says John Rowe, professor of health policy and aging at Columbia University Mailman School of Public Health. For example, vocabulary increases with age, as does the ability to resolve conflicts and emotional stability.

“The decline we see with normal aging, in the absence of disease, is usually associated with the speed at which information is processed and retrieved,” says Rowe, noting, for example, that a person may encounter a friend or acquaintance on the street and have difficulty remembering their name quickly. “That’s normal aging. That is not dementia,” he said. Sha agreed, adding that it’s a matter of degrees. We may become slower at remembering things like phone numbers, and remembering them may become more challenging, but that doesn’t mean we no longer have memory capacity.

“The processing speed is one that we see decreasing, but not to zero,” Sha said. Likewise, she said, we may have trouble remembering a long string of numbers or an entire shopping list, but that doesn’t mean we don’t remember numbers, or that we come home from the store with an empty bag.

The situation is different when it comes to mild cognitive impairment (MCI), a condition in which patients experience more severe forgetfulness – misplacing or misplacing things, missing appointments – in a way that interferes with their daily activities. About 10% to 20% of people age 65 and older will develop MCI, and about 10% to 15% of them will develop dementia, often Alzheimer’s disease, Rowe said. “But most of them won’t. And in fact, some of them even improve with age, as they get used to dealing with this. And they use memory tricks and aids and things like that to deal with those problems,” he said.

When someone presents with symptoms of MCI, doctors should assess the severity of the problems, and whether they are intermittent or consistent, Rowe said. Isolated incidents may be linked to external factors – for example, in the case of the debate, a cold that Biden said he had may have had an impact, or perhaps cold medicine. “A lot of times it’s intermittent and just associated with the fact that they’ve had a few drinks, or they’re on medication or they’re having certain stress or a certain procedure,” he said. And unless it turns into something more serious, Rowe says, MCI doesn’t really interfere with what you might consider a president’s responsibilities: making decisions, processing complex information, applying wisdom or experience.

“We tend to see in our clinics that there may be people who have cognitive problems or even formal cognitive impairment when we do testing, but the person can still work and function and live independently and do all the things that they used to do. . ” said Sha.

But not all experts STAT spoke to agree. While emphasizing the caveat that without personal assessments it is impossible to get a reliable diagnosis, one expert (who asked not to be named for fear of attacks) pointed out other signs that should raise concerns in older patients : a gait that does not sway the arms, lack of blinking, and an overall “masked” expression that does not show much facial movement are all signs of someone who is not aging well at best, or could have a progressive disorder. And while such symptoms do not necessarily indicate irreversible causes, they still require medical attention.

For his part, Biden, as well as his team, appear to be writing off his debate performance as a bad day. This, according to Sha, points to another important element to consider when trying to determine the health of an older person, as there are indeed bad days. That said, though, it’s critical to understand how those bad days compare to the baseline – whether they’re the norm or the exception. “When I see a patient in my clinic, I often ask family and close friends and whoever is coming… to provide some additional history to understand compared to baseline: Is this a change?” Sha said.

Fundamentally, she said, it is essential to stop viewing aging as a problem – whether for presidents or anyone else – and understand that just as our bodies age and are still able to to function, which also applies to our brains. “What we see in other cultures [is] that people at that age contribute much more than we normally see in this country, and maybe not as president, but certainly to a family unit or other parts of society,” Sha said.