Joe Biden and Donald Trump are the oldest and second-oldest presidents in US history, respectively, and their ages have prompted calls for cognitive testing as they attack each other’s intellectual abilities in the 2024 election.
Concerns have been raised about Biden’s age and mental health after he performed poorly in the debates, stumbling, struggling to understand and losing his train of thought.
In an interview with ABC’s George Stephanopoulos on Friday night, the 81-year-old Biden declined to say whether he would take cognitive tests. “I take cognitive tests every day,” said Biden, who will be 86 when he leaves office if he is re-elected in November.
Trump, 78, has also faced questions about his cognitive abilities during his presidency. In 2018, White House physician and now Republican congressman Ronny Jackson said Trump had undergone the Montreal Cognitive Assessment (MoCA), a common, rapid test used by medical professionals to identify dementia and cognitive decline. Jackson said Trump scored “30/30,” which was “normal.” Trump said he “performed at his best.”
In January, Trump, who will be 82 by the time he leaves office, bragged that he’d again gotten a perfect score on the MoCA test, adding that he had to point out a whale among a group of increasingly difficult animals as the questions progressed. But there are no whales on the test, Dr. Ziad Nasreddine, the creator of MoCA, told The Washington Post.
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The MoCA test looks at minimal cognitive ability, not precision — in other words, the MoCA should be easy for people without cognitive disabilities, Nasreddin previously told MarketWatch.
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What happens during cognitive testing?
Cognitive tests can assess mental awareness, reasoning and memory. They are not designed to catch the kinds of gaffes Biden and Trump are known for. Biden has had a lifelong stutter that affects his public speaking but not his cognitive abilities.
According to the Cleveland Clinic, the test is typically administered when a person, family member or friend shows signs of mental decline or disability. It requires no preparation or study and is a quick, basic test.
According to the Alzheimer’s Association, early detection of cognitive decline makes it easier to identify treatments and lifestyle changes that can slow the decline.
What types of tests are there?
The 15-minute test that Trump reportedly performed well on, MoCA, involves memorizing a short list of words, naming pictures of objects, and copying their shapes. In addition to MoCA, there is the 10-minute Mini-Mental State Exam, which requires test-takers to count backwards, identify objects in a room, and state dates and other “common, commonly known facts,” according to the Cleveland Clinic.
Mini-Cog is the shortest and easiest game, taking just three minutes to complete. The task is to memorize and recall a list of three unrelated words, draw a circular clock showing the time, and then display the hands at a particular time.
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What are they not telling us?
It is important to note that the brains of older people work differently than the brains of younger people.ofDr. Alvaro Pascual-Leone, a professor of neurology at Harvard Medical School, previously told USA Today, “While the risk of brain disease increases with age, each age has its advantages and disadvantages,” he said. For example, younger people can learn new facts more quickly, but older people can put those facts into perspective, something commonly referred to as “wisdom,” he said.
Moreover, we should not rely on a single snapshot that may miss declines in high-functioning people.
Cognitive tests like the MoCA have results available online so you can study in advance, which is why it’s important to get regular brain health screening tests starting in midlife., Several experts told USA Today:, This is because even people who perform “top” on tests show changes that could be signs of decline.
But publicly available summaries of annual medical examinations of presidents and former presidentss Cognitive testing is not included.
This reflects the situation in the general population: Most doctors do not perform cognitive testing on their elderly patients., Pascual Leone said that even though most people say they would like to be tested to detect brain disease early, that is not the case.
“There is a big gap between the expressed aspirations and needs, clinician perceptions and what is actually being done,” he said.
Are cognitive tests a good test of presidential fitness?
Experts told USA Today that readily available cognitive tests are not a good gauge of suitability for the rigors of the presidency.
Jamie Riley, a professor of speech-language pathology and neuroscience at Temple University School of Public Health in Philadelphia, previously told USA Today that there is no perfect way to determine whether someone is mentally fit to hold public office.
In an interview with ABC, Biden said he is proving every day that he is fit for the presidency.
Accusing either candidate of having dementia or lacking mental capacity may garner political support with some voters, but it could exacerbate existing prejudices against older people and discourage people with legitimate concerns about memory or language from seeking help, he said.
USA TODAY’s Karen Weintraub and Janine Santucci contributed to this report.
