What a doctor sees when Joe Biden hesitates

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What a doctor sees when Joe Biden hesitates

Op-ed, Elections 2024, Mental health

Daniel J. Stone

March 7, 2024

As a geriatrician, I discuss the consequences of aging with patients every day. I wish I had the chance to give my usual speech to anyone singing or tearing their hair out about President Biden’s suitability for the job.

Remember first. I explain to patients that there are three components to consider. One of them is formation. Then storage. And finally: remembering. The most common problem among seniors is slow recall. This is the well-known tip-of-the-tongue phenomenon, where a word seems to hide itself or a name does not come to mind. You know the name, it’s in your memory bank, it’s just not quickly accessible. With time it usually comes around.

This problem, called age-related memory impairment, often starts in people in their thirties and gradually worsens. It’s annoying, but not disabling. If, like me, you find yourself using the term whatchamacallit, you probably have it. Don’t worry, you’ll be fine.

Alzheimer’s disease, the most common cause of dementia, is a different story. Those affected lose the ability to store new memories. They can still access old memories in their memory bank and can recount events that happened decades ago. But they can’t tell you what they had for breakfast because it was never recorded in the memory bank. (I reassure my patients with age-related memory disorders by asking if they remember their breakfast. They do.)

Alzheimer’s disease is cognitively crippling. Losing the ability to form new memories freezes time. Those affected cannot make new friends or tackle new situations without new memories. In addition, the disease gradually impairs other domains, including behavior and ultimately physical skills.

Fortunately, President Biden is not showing any signs of Alzheimer’s disease. Bee

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At conferences he refers to new events and of course creates new memories efficiently. He speaks slowly and pauses to find words that sound like others with benign age-related memory impairment. These problems are exacerbated by a chronic speech impediment. Biden has struggled with stuttering since childhood


and vestiges of the condition have long been evident in his speech.

Unfortunately, word hesitations combined with the mild stuttering cannot help but affect his public speaking. Biden’s political opponents and the uninformed are exploiting it, along with stereotypes about the elderly, to create a false narrative about intellectual disabilities.

I care for many high-functioning seniors like President Biden in my practice. One I know, who is not a patient of mine, has been my family’s attorney for fifty years. Melvin Spears, at age 96,

recently responded to a legal question by email with concise and targeted advice, as he always has. When I spoke to him, he acknowledged some concessions to his age. He speaks more slowly and transportation is a challenge because he no longer drives. (He thinks Uber and Lyft are a hassle.) Like Biden, Spears focuses on his work and lets others worry about his age if they want to.

Research shows that high-functioning seniors like Mel Spears and the president compensate for slower reaction times by applying superior knowledge and judgment. The presidency is not a job that requires lightning-fast reflexes. For example, firsthand experience with the successes and failures of American foreign policy over decades, combined with proven judgment, provides much more than just speed in speaking or making decisions.

Actuarial tables show that the life expectancy of the 81-year-old president is almost eight years, much longer than a second term. He receives excellent health care, has no major chronic illnesses and recently underwent a physical at Walter Reed Military Medical Center


was declared healthy, active and fit for duty. All that means Biden will likely beat the actuarial estimate. Given his overall health and the absence of current cognitive impairment, he would likely complete a second term with stable cognition.

All candidates for political office in the United States deserve to be judged based on their performance and abilities, not their age. Seniors may be the last minority whose natural attributes are ridiculed and stereotyped. If the American people disagree with President Biden’s policies and prefer change, they should support their opponent. But in the absence of valid evidence of true cognitive impairment, their judgment should not be influenced by age-related social stereotypes. Biden and the American political process deserve better.

Dr. Daniel J. Stone is an internist and geriatrician in Beverly Hills.


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