Are our senior presidential candidates mentally fit?

Did you know, one in four people over 65 have abnormal memory impairment? This is the finding from screening with an objective test.  In half of those who test abnormal, there were common conditions – such as depression and medication interactions – which can be addressed and even reverse the memory problem.  But for the other half, the memory problem is a sign of mild cognitive impairment, which can be the early stage of Alzheimer’s, a 14-year-long disease.

Presidential candidate Bernie Sanders’ recent coronary adds a superimposed risk factor.  When the heart pump begins to falter, and inadequate blood delivery to the brain results, cognition can suffer.

Many have already speculated that President Trump is impaired, given his erratic temperament – or disinhibition.  Appropriate behavior lives in the frontal lobes, important for maintaining one’s “cool.”   Frontotemporal dementia is another neurodegenerative disorder that particularly affects the frontal lobes.  Frontal lobe function may also be diminished from traumatic or other causes such as tumors, infections, and alcohol abuse.

As Joe Biden is vying for the presidency, his being a part of a fortunate minority – old white guys – has already come up.  But he is part of another fortunate minority: Survivor of a ruptured brain aneurysm, as described in his book. The majority of folks with aneurysm rupture die, and many survivors suffer some type of brain damage with residual impairment.  Joe Biden presumably escaped that fate despite major neurosurgery.

Though many seniors age normally without cognitive issues, as seemingly our senior candidates demonstrate today, with aging, the risk goes up. Mild cognitive impairment can be outwardly silent. Hence the question:  Should we screen for cognitive impairment in senior professions where lives depend on normal cognition, like airline pilots, doctors, even presidential candidates?

Ten thousand people in the U.S. turn 65 every day: an important health policy question looms.  Should we routinely screen seniors for abnormal memory and mild cognitive impairment as we do for diabetes?  Given that those who have the cognitive impairment cost Medicare three times as much as those seniors who don’t, and that half of those who test abnormal may have reversible conditions, it would make sense. Studies show that early medical and behavioral intervention (exercise, proper diet, new learning) can slow the progression of the neurodegenerative conditions that lead to dementia. Thus, improving the cognitive life quality of seniors and can reduce medical costs.  Future presidents who will shape health policy, please remember this – if you can.  It’s a no brainer.

Michael Brant-Zawadzki is senior physician executive, and endowed chair, Pickup Family Neurosciences Institute, Hoag Hospital, Newport Beach, CA.

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