Are Verbal Flubs by Trump or Biden Signs of Cognitive Decline or Innocent Mistakes?
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
Are Verbal Flubs by Trump or Biden Signs of Cognitive Decline or Innocent Mistakes?
BU neurologist Andrew Budson says voters should adjust expectations and accept campaign-trail confusions from tired older candidates
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 Today returned 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.
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