Questions about Joe Biden’s fitness to serve as president have been swirling for some time, with concerns about his mental acuity growing louder after his debate performance against Donald Trump on June 27th. Observers noted Biden’s struggle to maintain focus and clarity during the debate, raising worries among even Democrats. This incident isn’t an isolated one, as the 81-year-old leader has frequently been in the headlines for verbal gaffes and incoherent speeches. Reports of a Parkinson’s expert visiting the White House eight times in eight months have further fueled these concerns, adding pressure for Biden to undergo cognitive testing.
Cognitive tests, designed to assess cognitive impairment, evaluate various aspects of mental function, including memory, awareness, reasoning, attention, and language comprehension. These assessments are typically conducted when mental decline or impairment is suspected. The Montreal Cognitive Assessment (MoCA), Mini-Mental State Exam, and Mini-Cog are among the most commonly used tests. The MoCA, a 15-minute assessment, involves tasks like memorizing word lists, identifying objects in pictures, and copying shapes. The Mini-Mental State Exam, taking about 10 minutes, includes activities like counting backward, identifying objects, and stating the date. The Mini-Cog, the shortest and simplest test, requires memorizing and recalling a three-word list, drawing a clock with time points, and setting the hands for a specific time.
The results of these tests can help diagnose cognitive impairment, dementia, or pseudo-dementia, and provide a basis for further evaluation for Alzheimer’s. Early detection of potential cognitive impairment is crucial for determining the need for additional tests and treatment. While age is a risk factor for cognitive impairment, calls for cognitive tests have extended beyond Biden to include Donald Trump, the oldest major presidential candidate in US history.
Following the debate, neurosurgeon Dr. Sanjay Gupta, along with other brain specialists, urged Biden to undergo neurological testing and publicly release the results. Lawrence K Altman, a physician and former medical correspondent, echoed this sentiment, advocating for Biden to take the MoCA test. Jamie Reilley, a professor of speech-language neuroscience, cautioned that judging someone’s mental fitness for office is complex, adding that accusations of dementia could worsen stigma against older individuals and discourage those with memory concerns from seeking help.
In response to the growing concerns, Biden attributed his poor performance in the debate to a cold and exhaustion, stating that he undergoes regular medical assessments. While he initially denied taking specific cognitive tests, he later claimed to take a cognitive test every day, emphasizing his daily responsibilities. However, Biden’s aides confirmed that he has never taken a cognitive test as president, despite three annual physical examinations.
Donald Trump, in January, boasted about acing a cognitive test that included identifying animal shapes and solving math problems. He claimed to be cognitively better than he was 20 years ago. While the details of when he last took the test remain unclear, he previously asserted his excellent performance on a screening test in 2020. In 2018, Trump scored a perfect 30 on the MoCA. The ongoing debate about cognitive testing highlights the complexities of assessing mental fitness, particularly for individuals in high-profile positions. While the calls for testing raise legitimate concerns about mental health and transparency, they also underscore the need for sensitive and informed approaches to addressing these issues.
