In a special council report released last week, President Biden was described as an “elderly man with a poor memory,” but doctors say it’s impossible to use isolated examples to diagnose a memory problem, as memories can be impacted by more than aging, and memories don’t solely determine a person’s cognitive fitness. The President has a team of medical professionals from a number of subspecialties including neurology who evaluated him last year and deemed him “fit to successfully execute the duties of the Presidency.”
“There are different variables that have to be taken into account when you try and understand whether a slip up is worrisome or not,” Dr. Leah Croll, board-certified neurologist, and assistant professor of neurology at Temple University, told ABC News.
This report has since sparked criticism of Biden’s memory, to which Biden has responded in an interview that, “my memory is fine.” Adding that the most recent interviews with the special council were also in the immediate aftermath of the Oct. 7 Hamas terror attack in Israel when Biden said he was “in the middle of handling an international crisis.”
ABC News spoke to several doctors in the field of medicine, neurology and psychiatry to understand how memory, aging and executive functioning relate, and they all agree that simply forgetting dates or timelines in the past does not imply anything specific about a person’s level of cognitive fitness, decision-making, judgement or executive functioning.
Doctors say a number of factors influence memory, independent of aging
“There are so many different factors that affect how well your memory and cognition are working in any given moment,” Croll said. These include things like stress, sleep, hunger, multi-tasking and situational circumstances that can act against someone’s memory, independent of their age.
“When we think about how someone’s memory and cognition function in any given moment, the reality is that they don’t function at a constant level,” Croll said. “They’re always changing and fluctuating depending on what factors or variables are on board at that time.”
Dr. Louise Aronson, board-certified geriatrician, and professor of medicine at UCSF, told ABC News that internal processing functions like recalling specific memories naturally decline to an extent with age but can also be impaired by high-pressure situations.
Dr. Yalda Safai, a board-certified psychiatrist, told ABC News that memory lapses are different that memory problems and even in cases where memory problems exist, this cannot be used alone to determine cognitive fitness. “Just because somebody has problems remembering things from the past, it doesn’t mean they don’t have the ability to make good decisions or it doesn’t mean that their executive function is impaired with aging,” Safai said.
Memory and cognitive evaluation require more extensive assessments
Doctors say isolated examples of memory lapses can’t replace more in-depth assessments of memory and cognitive functioning, and it’s more than just one assessment at one point in time and there is no one test to determine if a person is fit to hold office.
“If we could [just use isolated examples] we wouldn’t need the detailed neurocognitive testing,” Aronson said. These assessments are extensive, may take multiple visits to fully complete and require a detailed history to fully understand and assess someone’s level of function.
Dr. Richard Isaacson, a preventive neurologist at the Institute of Neurodegenerative Diseases Florida, told ABC News, “it’s impossible to accurately judge whether a brain change may be due to the normal aging process versus compared to a neurodegenerative disease or just due to a disease without a formal evaluation, examination, cognitive assessments, and when needed, brain imaging.”
In these assessments, doctors are evaluating for any warning signs that show patterns of behavior or memory lapses that prevent them from carrying out their daily responsibilities. “Things like being unable to do your finances and stay on top of your monthly bills or consistently having a pattern of memory problems that pose safety concerns,” Croll said.
Doctors say there are some cognitive benefits of aging
“When people are younger, [in their] 20s and 30s, they often have worse impulse control and ability to integrate information,” Aronson said. Doctors say as people age, impulse control tends to improve, and they may better integrate more information into their decision-making.
“As we age, there are aspects of cognitive function, specifically related to judgment and wisdom that actually improve over time. And you know, when a person is seasoned and has experience dealing with complex problems, that experience may come in handy when either dealing under pressure or having to make a decision,” Isaacson said.
“These [traits] can manifest as having a better handle on your reactions to various situations and being able to think before you act which can be extremely useful as we get older,” Croll said. “Having wisdom from many lived experiences, of course, is another form of knowledge and cognitive fitness.”
Dr. Jade A Cobern, MD, MPH, board-certified physician in pediatrics and general preventive medicine, is a fellow of the ABC News Medical Unit.