Mental Acuity and the Presidency

Most Americans, and even many physicians, don’t understand the nuances of the various forms of dementia. Alzheimer’s Disease, for instance, is particularly highlighted by short term memory loss. There are other forms of dementia that demonstrate other types of mental impairment. Multi-infarct dementia is caused by multiple small strokes and can be represented by a variety of symptoms, memory loss being only one of them. Another form of dementia that is particularly bad and has no known treatment is called frontotemporal lobe dementia, or FTD.  There are three variants of FTD. The hallmark symptoms of the behavioral variant (https://pmc.ncbi.nlm.nih.gov/articles/PMC5619539/) include disinhibition, repetitive behavior, mental rigidity, blunting of affect, and loss of empathy. Disinhibition is often associated with making sexually inappropriate remarks. Blunting of affect can include a reduction in the range of emotional expression. There may also be a genetic component to FTD.

For the past couple of years, there has been much discussion about President Biden’s age and his mental acuity. I am a geriatrician and have spent over three decades caring for older adults, including many with cognitive impairment and various forms of dementia. I have been interviewed and quoted twice by the Washington Times regarding President Biden’s cognitive function. The first time I went into significant detail as to why the President had not demonstrated signs of dementia.  The second time my comments focused on acknowledging the fact that the President has had a decline in physical function, but again, no evidence of cognitive decline. Despite his dropping out of the race, this issue continues to garner press, with Vice President Harris being asked about it during her recent interview on Fox News. Her response, based on my observations, was appropriate. President Biden’s gaffes, stumbles and momentary lapses are most likely related to his physical decline and his lifelong stutter. In my opinion, no 82-year-old with cognitive impairment, much less dementia, could deliver President Biden’s highly effective State of the Union Address and Convention speech.

As I have not personally evaluated either President Biden or Trump, I am limited in my ability to do specific cognitive tests such as those for short term memory or language function. However, regarding the types of symptoms noted above, we have countless hours of footage of both interacting in front of various audiences. The media and President Biden’s opponents tend to cherry pick moments during speeches and press conferences. That is not how one performs a true assessment of mental acuity. On the other hand, observing either for longer periods of time gives one a better opportunity to look at the type of symptoms that one sees in FTD. I will leave it to the reader to decide if Donald Trump, particularly over the past year, has had a significant increase in the type of symptoms seen in FTD.

Over my career I’ve cared for patients with FTD. I’ve seen it occur in relatively younger individuals, which does tend to be more common. On the other hand, I’ve also seen it in older adults. People with FTD will demonstrate varying degrees of memory impairment and other aspects of mental acuity. That can make it difficult to diagnose in the early phases of the disease. Predominant behavioral symptoms can be quite disturbing and literally impossible to manage, the loss of impulse control being quite common. The unfortunate reality of FTD is that there are no effective treatments.

While I have not examined either President Biden or Trump, I am quite confident from observing them on video for prolonged periods of time that neither suffers from Alzheimer’s Disease. Regarding Donald Trump and the possibility of FTD, it would be unfair to make a diagnosis without a full and comprehensive evaluation. Nevertheless, I believe that the same scrutiny that has been applied to President Biden should be focused on Donald Trump.