OPINION | Just How Good is Biden’s Memory?
By Alec Pruchnicki, MD
I normally don’t make medical evaluations on patients I’ve never examined in person. However, when Robert Hur’s report on Biden’s retention of classified materials contained gratuitous remarks about his supposed faulty memory, I had to say something. This unnecessary comment follows in the tradition of another Department of Justice (DOJ) Republican lawyer, James Comey, sliming another Democratic presidential candidate, Hillary Clinton, and possibly costing her the election. I can’t tell you exactly the state of Biden’s mind (although I might do better than a DOJ lawyer), but I have seen plenty of 81-year-old men with cognitive deficits. So, I can describe what might be going on and the consequences.
When people get past the age of 65, they often experience problems with recall. They have a word or a name on the tip of their tongue but just can’t state it explicitly. Later on, the word will come to them when they are doing something else. These are sometimes called “senior moments.” This is usually a problem of immediately recollecting what you already know and not a significant memory deficit.
To break it down, the mildest type of deficit is called “Age Associated Memory Impairment (AAMI)” and it exists in about 40 – 45% of people over the age of 65. There is a 1% chance of it developing to dementia but most of the time, it does not worsen. If the problem increases, it’s described as a “Mid Cognitive Impairment (MCI)” which occurs in 10% of people over 65 and has a 15% probability of advancing to dementia. Although annoying, neither of these deficiencies (at these levels) are serious nor do they prevent the person from functioning normally in family, work, or day to day interactions.
Further, even people with actual diagnosed mild dementia can still function at activities they always performed. Motor functions can persist in playing an instrument, driving a car, or using a sewing machine or typewriter (if anybody still uses a sewing machine or typewriter). I’ve had patients who were doctors and became mildly demented but were still able to adequately discuss medication decisions. I’ve had lawyers with dementia who still were able to recount points of law. People can function well in activities they’ve performed all their lives. The actual diagnosis of dementia is usually performed by a trained healthcare professional (psychologist, psychiatrist, neurologist, or geriatrician) and not a DOJ lawyer with a grudge.
That brings us to Biden. For many years he has been described as someone who makes a “gaffe” here or there—so minor lapses, word finding problems, or malapropisms are nothing new. Yet, he’s not being criticized by opponents because he failed a mental status test but because his occasional blunders supposedly imply that he can’t perform as president. As laid out previously, what AAMI, MCI, and even some mild dementia have in common is that the person can still perform normal activities. I don’t know if the DOJ report commented on his abilities to perform his presidential duties along with the gratuitous negative comments, but it certainly seems like he’s been capable.
Thus, despite Biden’s “poor memory,” he’s been able to out-maneuver the Republicans on the debt limit, continue to fund resolutions, and trick his opponents into publicly proclaiming that Social Security and Medicaid are off the table in budget negotiations. He also got trillions of dollars of spending legislation passed despite opposition from almost all Republicans—and even a few Democrats. Actions speak louder than words, or even slanted DOJ reports.
