Public moments of confusion by Donald Trump and Joe Biden worry some Americans, but neurologist Andrew Budson says he doesn’t detect cognitive impairmen in either. Biden photo by Kyle Mazza/SOPA Images/Sipa USA, Trump by AP/Matt Rourke
Politics
BU neurologist Andrew Budson says voters should adjust expectations and accept campaign-trail confusions from tired older candidates
January 25, 2024
22
- Rich Barlow
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When is a verbal flub just a normal innocent slip? And when is it cause for genuine cognitive concern?
This is the question Americans have to begin considering in all seriousness as they brace for what many say they don’t want—a presidential rematch between 81-year-old Joe Biden and 77-year-old Donald Trump. Most recently, the cognitive question landed on Trump, when he repeatedly confused Nikki Haley for Nancy Pelosi, and also appeared to slur a number of words at a campaign rally. Trump has also referred a number of times recently to former President Barack Obama when it was clear he meant Biden.
Fear of age-related unfitness hasn’t hampered either candidate from becoming his party’s presumptive nominee for the November election. After voters elected Biden, the oldest-ever president, in 2020, Andrew Budson, a Chobanian & Avedisian School of Medicine professor of neurology, gave BU Today a primer on aging and cognition, concluding with this observation: “For most people who are working at a cognitively demanding job, job performance may be a highly sensitive measure of cognitive decline.”
Now that both Trump and Biden have had time in the Oval Office under their belt, Budson says it’s important for voters to set the right expectations for their commander-in-chief and ask for an overarching vision of where the country needs to go. “We don’t want a president who is going to be micromanaging details at high speed,” says Budson, whose many other roles include chief of cognitive behavioral neurology at the Veterans Affairs Boston Healthcare System.
In the wake of Trump’s recent gaffe, and with increasing questions about how old is too old when it comes to being president, BU Todayreturned to Budson with some new questions about the “old” issue.
Q&A
With Andrew Budson
BU Today: Nikki Haley has made references along the lines of, “This is what happens when you reach 80.” Can you talk about what does happen to the brain around that age, and are voters right to be concerned about cognition?
Budson: There are a number of changes that happen to the brain as we age. For most people, as part of normal healthy aging, there are alterations of chemical receptors in the brain. These alterations make it more difficult for an older adult to learn completely new information, such as a new computer program, but easier to understand and synthesize previously learned information. Similarly, these receptor alterations make it more difficult for older adults to perform high-speed mental arithmetic and other cognitive activities in their head, but make it easier to slow down, double-check their work, and make sure it is done correctly. Healthy older adults can also usually incorporate new facts into their preexisting knowledge as well as younger adults, and because older adults generally have more preexisting knowledge than younger adults, this is another one of their strengths. Of course, as people get into their 70s and 80s, diseases that affect the brain and cognition, such as strokes, Alzheimer’s disease, and other causes of dementia, become more common.
BU Today: How can the lay public tell the difference between a simple slip of the tongue by an older candidate—especially during the fatigue of a campaign—versus something that might indicate a cognitive problem? Are there hints of such a problem to look for?
When one is talking spontaneously in public, it uses that type of high-speed cognitive ability that is done in their head. As mentioned, older adults are just not as good at this type of activity, and are therefore more likely to make errors. And yes, fatigue is one of many factors that make this type of cognitive activity more difficult. It really isn’t possible to diagnose someone with a brain disorder of cognition by watching them on the campaign trail. Anyone who does so, whether a doctor or a layperson, really shouldn’t be trusted. Any normal individual of any age can show cognitive problems when, for example, they are under the influence of alcohol, sick with a high fever, taking cold medicine, or simply sleep-deprived.
It really isn’t possible to diagnose someone with a brain disorder of cognition by watching them on the campaign trail. Anyone who does so, whether a doctor or a layperson, really shouldn’t be trusted.
BU Today: Without asking for a diagnosis, of course, has your trained eye seen anything in Trump or Biden—behavior, speech, etc.—that worries you about their mental acuity to be president?
No; see my answer above. We want a president who can see the big picture and know which direction the country should be going in. The changes that occur in normal aging, including being good at slowing down and not rushing to conclusions, are actually beneficial in that regard. So, I’m optimistic that our next president will have the wisdom to take their time, lead a good team, and make good choices.
Explore Related Topics:
- Aging
- Politics
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Rich Barlow
Senior Writer
Rich Barlowis a senior writer at BU Today andBostoniamagazine. Perhaps the only native of Trenton, N.J., who will volunteer his birthplace without police interrogation, he graduated from Dartmouth College, spent 20 years as a small-town newspaper reporter, and is a formerBoston Globereligion columnist, book reviewer, and occasional op-ed contributor.Profile
Boston University moderates comments to facilitate an informed, substantive, civil conversation. Abusive, profane, self-promotional, misleading, incoherent or off-topic comments will be rejected. Moderators are staffed during regular business hours (EST) and can only accept comments written in English. Statistics or facts must include a citation or a link to the citation.
There are 22 comments on Are Verbal Flubs by Trump or Biden Signs of Cognitive Decline or Innocent Mistakes?
I love the misdirection with the following quote from the article: “Most recently, the cognitive question landed on Trump, when he repeatedly confused Nikki Haley for Nancy Pelosi, and also appeared to slur a number of words at a campaign rally. Trump has also referred a number of times recently to former President Barack Obama when it was clear he meant Biden.”
Disingenuous at best on your part or you don’t understand politics and where candidates stand on the issue? Stick to doctoring.
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He also didn’t address the falling down several times by biden nor the published napping biden next to other leaders nor the nonsense said on the podium biden has done on many occasions.
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I don’t think that Trump’s multiple references to Obama is unintended. We all know that Biden is not running the show.
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No, we don’t “all know that.” We don’t all belong to the low IQAnon conspiracy club.
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This article is laughable .. you note a couple instances where Trump may have been confused, but without anymore context – cause I can see a scenario where Trump would compare Haley to Pelosi (as he’s basically called Haley a D), and you fail to note that Trump IS in the public eye every day, several times a day, doing rally after rally in front of THOUSANDS .. buuuuuuut, then you conveniently skip over the basic fact that Biden has been relegated to the second set of stairs on Air Force One as he’s fallen three or four times, that he never seems to know where he is when he finishes a speech and is often turning circles before Jill or someone else bails him out and helps him off the stage, that he can’t complete many sentences, that he’s skipped overseas meetings because he’s tired, his relentless ‘vacation’ schedule while the world is at war, or that he’s not given anything but a small handful of softball interviews (what’s your favorite flavor of ice cream), etc etc etc .. The World sees that he’s exhausted and not really physically fit for the job (I mean, just go back and listen to Biden speak in 2016), and as a result ‘bad things’ are happening in lots of places
One guy is generally very spry for his age, can bounce from campaign rally to rally to rally without a break, speaks from a podium and often without script (something the other guy CAN’T do anymore), is very entertaining and engaging .. the other guy has been in politics for half a century and really should be retired
Do better BU .. at least ‘try’ to show both sides to a story .. STOP carrying water for the one party (you’re fooling nobody) .. we don’t all ‘love Trump’ but we are each quite capable of assessing who it is that needs the cognitive test vs the other .. honestly, you’re making BU Today into a nothing more than a sad joke anytime you go towards politics
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See AlsoBiden promised unity, but State of the Union speech was loud, angry, partisan | OpinionIs This Meandering Quote From Biden Real?WATCH: In surprise appearance, Biden angrily pushes back at special counsel's reportRepublicans Distort Facts on Special Counsel Decision Not to Charge Biden - FactCheck.orgLink
The difference between Trump and Biden is that if you mention Biden’s latest gaffe people ask “which one?”. This article is essentially defending Biden’s cognition while simultaneously dragging Trump into the front and center of the dementia conversation. It’s so obviously worse with Biden it’s not even close. Only one of them has had 2 emergency brain surgeries.
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It’s equally accurate to say the difference between Trump and Biden is that if you mention Donald Trump’s latest lie people ask, “Which one?”
Likewise, if you mention Donald Trump’s latest incomprehensible statement many people ask which one — while others insist they understood it.
Who among us can interpret, “Republicans eat their young”, for example? What did he mean?
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Clearly you love biden, however if you send a specialist the list of how many falls published on biden, how many times he has been published napping next to another leader, how many times he walked off and the secret service have to follow him behind a bush and how many time he was shown falling the specialist would say it is time to check his brain for dementia. I hope for his sake they are checking as those holes get bigger, his face is showing the look people with dementia.Its not at the beginning of dementia.
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Nobody can know by looking who has “dementia” and who doesn’t. Even a specialist would not diagnose this without further tests of various types.
But. would you agree that nominees should nowadays have to take identical tests under neutral doctors to determine cognitive abilities including memory, regardless of age, so voters could compare and make informed decisions?
As for just physical health, does it matter whether a person can walk or see or hear so long as they acknowledge the issue and are using appropriate measures to compensate?
In such cases we would want to choose someone who was an excellent judge of character and expertise, so we could be sure that their ideas and obligations were being expressed and carried out true to the potential president’s intent by their assistants.
President Reagan was dealing with Alzheimer’s while president.
Many noted his sudden blank looks and how others (notably his wife, feeding him his lines in a whisper on one videoed occasion) would have to prompt his replies. It seemed obvious to many that he had a mental problem, yet no influential Republican or Democratic legislator dared point it out — probably because he was so popular.
Errors and “holes” are one thing. However, repeating wrong information even when told by a spectrum of others it’s wrong, is the sign of the repeating person being a liar — repeating what they now know to be wrong — or suffering severe short term memory loss, or in the throes of a recurring delusion.
None of those are problems confined to an age group or party (as for lying politicians, the propensity of politicians to lie has been lamented for thousands of years, going back to ancient Greece).
Finally, I note you preface your comment with unsupported guesswork about me personally, as if it were a valid argument responding to my comment: “Clearly you love biden”
I do not know how you came to that conclusion nor why you consider it relevant, except you might think that, if it were true, it would counter my argument or reflect poorly on my character. Can you enlighten me?
Do your comments “clearly” prove that you “love” Trump?
No. If I wanted to know that, I would ask you, not presume. But it would be irrelevant.Thank you for your attention to these questions.
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HAHA, so many words to post so much BS with a straight face. Trump didn’t compare Haley to Pelosi, he went on a lengthy rant about how Haley, his primary opponent who he was attacking in the moment, was responsible for security on January 6th. This is not a gaffe, this is a guy whose brain is mush….
“By the way, they never report the crowd on Jan. 6. You know Nikki Haley, Nikki Haley, Nikki Haley, you know, they — do you know they destroyed all of the information, all of the evidence, everything, deleted and destroyed all of it. All of it, Because of lots of things … like Nikki Haley is in charge of security — we offered her 10,000 people, soldiers, National Guards, whatever they want. They turned it down. They don’t want to talk about that. These are very dishonest people.”
Oh and the story, even if you sub in Pelosi for Haley here, is a figment of his imagination, just pulled from his rather large behind. I realize most trump supporters are low IQ and will swallow anything the carnival barker tells them to, but trying to sell this ridiculousness with a straight face is why you people get accused of being in a cult, which you are.
Did you know you need to show ID to buy a loaf of bread? Windmills cause cancer? Tim Apple was Apple’s CEO? Biden’s leading us into WW2? Sioux Falls, Sioux City (where am I? who cares, here’s some more dopes I can fleece). We’re just scratching the surface here. His personal appearance makes Tan Mom look normal, he looks like he got shot in the face with orange paint. Of course, when you see what he looks like without it, well let’s just say I’ve seen corpses with better color. Also sports the world’s worst combover and blonde dye job. A literal clown.
Vacations you say? donnie spent his presidency going to safe-space rallies and then running off to his clubs, where he could funnel taxpayer money into his own pocket regularly, because thieving is like breathing for him.
I do think Biden is also too old for this job and is in cognitive decline, but your attempt to rationalize donnie’s comments is disconnected from reality.
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Yah for the wonderful comeback with true words.
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Maybe you find him entertaining and engaging because he is often closing? He calls women horrible names, talks about birds,windmills,toilets and whales an inordinate amount of the time, and insults people to an infinite degree. He MAY be more cognitively aware but, my God, he is a MEAN mofo.
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I am 86 years old and in those many years. I have seen thousands of verbal flubs by people of all ages especially parents with two or more children. When calling their children’s names they sometimes use the wrong name. The same with people who own multiple pets. In my 22 years as a student in class rooms I have seen it there by teachers/professors. It is not age. It is a human condition. A week ago I completed a cognitive examination and scored 28 ot a possible 30.
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This is comically biased. You mention Trumps most recent gaffe as if Biden hasn’t been repetitively getting confused and forgetting what he is saying for the last few years. The campaign trial does not mark the beginning of these instances. People have been concerned with Biden’s cognitive health for his entire presidency. Falling down stairs, getting lost, and inaudible mumbling has become expected at this point. It’s funny that you didn’t mention the multiple brain aneurysms that Biden had neurosurgeries for either. Personally I don’t like either candidate but for the sake of unbiased reporting, let’s be honest.
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The question is whether a person will a) acknowledge the mistake and correct it, or b) instead stand by it, become angry it was pointed out, insist it was right, blame and harass whoever pointed it out and threaten revenge, say it was an intended joke, repeat it, deny it was ever said…or all do all of those things in rapid succession, possibly in the same sentence…or have said it intentionally to mislead/influence people but pass it off as a “mistake” when called on it.
That it is the question and the choice here today. Not age.
Any adult of any age who consistently follows the latter pattern is not mentally or emotionally fit to be a leader, not as a kindergarten teacher, a military officer, a volunteer coach, an office manager, or government official.
The Big Truth, when ignored, can be as damaging as The Big Lie.
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Well, what’s worse- mild cognitive impairment or being a mean-spirited, hateful, narcissist who is addicted to lying?
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What I do know is that Biden has passed more legislation that anyone since FDR. He’s also given us stability, lowered inflation, brought NATO together, defended Ukraine, and brought respectability back to the United States. As for Trump, an entertainer is not anyone I’d like in the White House. Notice the soft ball questions of reporters to Trump. He has obvious no knowledge about anything, and couldn’t answer a single question about our government beyond platitudes and generalities. He knows zero, and has no curiosity to learn, in self-introspection, is totally unaware – and let’s not even begin to discuss his immorality and attempt to overthrow our government. Trump supporters actually know that Trump is ignorant of how the government works and has not a clue about legislation. It is not up to me whether a gaffe about Meterrand on the grueling campaign trail speaks volumes about his cognitive ability, or is a simple mistake we all occasionally make. The job of president is thankless and grueling. I don’t think that I would want it. What I do hope is that Biden looks out for what is best for America. Trump: I’m sure it’s only what is best for Trump and beating the rap. Sad times…
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All you folks complaining about Biden falling asleep during meetings need to do a fact check.
factcheck+ did Biden fall asleep in a meeting
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They are both too old to be president of the United States. If these two are allegedly the best of the best we are doomed. As an independent I am truly saddened by this country being two party, seeing people being uncivil to one another, the name calling, and constant bickering. Aside from the flubs these two make there are other reasons to worry about it as we have a congress that refuses to get any work done why are we paying them? The doctor should have wrote his article on why do candidates lie, or when should people really retire. Washington warned the nation of political parties in his Farewell Address, published in newspapers across the country in 1796. He feared that partisanship would lead to a “spirit of revenge” in which party members would not govern for the good of the people, but for power. We see this happening today. His all farewell address is a great read. Google it.
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Whatever his mental state, Biden has had a far more successful administration than Putin wannabe Trump. Trump sucks up to dictators because that is what he’d like to be. He’s an enemy of democracy. He’s also a dunce. Trump or Trump and his family were willing to sue anyone who released any information about his academic achievements, or lack there of.
Thats not the behavior of anyone who’s proud of or confident in his academic achievements.Search the comments of his Whitehouse staff from his Presidency ; they basically think he’s a dunce.
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If Trumps cognitive decline gets much worse, he’ll match his supporter’s cognitive ability.
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It is time for a thorough evaluation of Donald J Trump. I base this on the many mis steps he made yesterday. It is no longer early this or that. Something more advanced is occuring.
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