Whispers regarding Joe Biden’s cognitive decline have been orbiting the beltway for some time now, but as the battle for the White House moves into high gear, both campaigns have decided to make their candidate’s gray matter a central issue. It is more than a bit bizarre that the question of who has the most marbles might supersede matters like the economy, but this has been an odd election year, to say the least.
Seventy-four Plus Three Equals?
There is reason for concern in this area with President Trump clocking in at age 74 and Mr. Biden at 77. Cognitive deterioration is normal after the age of 65, according to the National Institutes of Health, and “is associated with declines in certain cognitive abilities, such as processing speed and certain memory, language, visuospatial, and executive function abilities.”
This week, President Trump challenged the former vice president to take a test that would measure his mental fitness. Mr. Biden countered that he is eagerly looking forward to going head to head (so to speak) with the president in three scheduled debates. “I’ve been tested, I’m constantly tested,” Biden responded when asked about his cognitive health. “Look, all you’ve got to do is watch me and I can hardly wait to compare my cognitive capability to the cognitive capability of the man I’m running against.”
Game on. So, where do both men stand regarding these four crucial cognitive domains? Since proper neurological function can be divided into specific categories, it seems apropos to look at how Biden and Trump have performed publicly in each of these areas. Here is a quick primer:
Processing Speed: The first area of concern is what neurologists call processing speed. According to a neurological health website, processing speed “is related to the speed in which a person can understand and react to the information they receive.” For example, when Mr. Biden appeared confused by a question from George Stephanopoulos regarding knowledge of the Michael Flynn affair, the Delaware politician said, “I know nothing about those moves to investigate Michael Flynn.” Stephanopoulos proceeded to press the issue. That is when Biden responded with, “No, I thought you asked me whether or not I had anything to do with him being prosecuted,” Biden said. “I’m sorry,” he then continued, “I was aware that there was—that they asked for an investigation, but that’s all I know about it, and I don’t think anything else ...”
This is a classic example of a processing speed deficit because it demonstrates that Mr. Biden had difficulty comprehending the ABC newsman’s question. He was unable to process Stephanopoulos’ query fast enough to respond appropriately.
During the height of the Coronavirus crisis, President Trump fielded dozens of questions at a rapid pace. Whether you agreed with his answers or not, he did not exhibit anything close to a deficit in processing speed.
Memory: According to NIH, memory cognition can be broken down into three parts: acquisition, retention, and retrieval. Everyone experiences a drop in acquisition as they age. But for those with cognitive decline, retention and retrieval are where things can get dicey. As well, there are three types of memory that should remain stable in adults who age normally: recognition memory – the ability to retrieve information with a cue, temporal order memory – the ability to recall the sequence of events in order, and procedural memory – remembering how something is put together. Recalling how to ride a bicycle is another example of procedural memory.
Forgetting the words of the Declaration of Independence and saying “the thing” when you are searching for the word “God,” as Mr. Biden did this spring, is a classic example of a deficit in recognition memory. Often called “senior moments,” a loss of recognition memory can leave someone bewildered and fearful.
Language: In general, language should remain intact with age, and one’s vocabulary should remain stable until age 70. Cognitive deficits can be identified when someone over 70 has difficulty naming things or when he or she loses verbal fluency, which is the ability to retrieve words from a specific category. Again, Biden’s Declaration of Independence moment is instructive here. Substituting “the thing” for “God” demonstrates a deficit in verbal fluency. Had the former vice president used "higher power" or “deity,” it would have at least shown that he could pull from the same linguistic category. But replacing “God” with “the thing” is revealing of a cognitive deficit in the area of language.
Visuospatial: A National Institutes of Health study defines visuospatial abilities as follows: “These abilities include object perception, the ability to recognize familiar objects such as household items or faces, and spatial perception, the ability to appreciate the physical location of objects either alone or in relation to other objects.”
Super Tuesday, when Joe Biden confused his wife, Jill, with his sister, falls within the area of visuospatial orientation. The presumptive Democratic nominee quickly recovered with, “They switched on me,” but this was after he glanced at his wife and grabbed her hand while announcing her as his little sister. The normal aging process does not include this type of spatial confusion.
Executive Function: This is a rather broad neurological area that includes the ability to reason, plan, and problem-solve, and it does include motor function. So, for instance, when President Trump walked down a metal ramp recently and took small steps, the media blamed it on declining executive function. While this could be true, both Trump’s explanation (that he didn’t want to fall on a slippery surface because he wasn't wearing rubber soled shoes) and, more importantly, the lack of repetition on the president’s part likely do not add up to an executive function problem. In other words, if Trump's gait changes significantly and repeatedly then there is reason to worry. If not then it is likely much ado about nothing.
One final but crucial part of a healthy executive function is the ability to respond to someone with appropriate behavior. Thus when Mr. Biden calls a student on the campaign trail “a lying dog-faced pony soldier” or a farmer from Iowa “a damn liar” and challenges the man to a “push-up contest” – or when tells a voter he’s full of “sh--,” he is demonstrating a deficit in the area of executive function.
The presidency is an arduous job and requires a leader who can function in all these cognitive areas. Just by virtue of their age, both Trump and Biden will have times when they are not running on all pistons. The question that voters must ask, after having watched both men closely for years, is which one comes to the table with the most marbles intact.
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Read more by Leesa K. Donner.
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