Donald Trump and Joe Biden at the debate on June 27, 2024 in Atlanta.

Two American presidents walk into a bar to order a drink. One says, "I'll have a... uh... what do you call it?" The other one interrupts, “So tell me, do I come here often?”

Welcome to the 2024 U.S. Presidential Election. It is incredible to me that in a country filled with some of the brightest minds and a politically engaged public, America’s best candidates for the highest office are two elderly men who have both shown alarming cognitive slip-ups. Joe Biden has had frequent word finding issues, word mispronunciation, memory lapses regarding significant events and incoherent statements. Donald Trump has had many moments where his speech has become incoherent, often mispronounces words, and confuses people and names. If you can not recall these cognitive slip-ups you only have to look at YouTube for Biden and Trump’s “cognitive-gaff mashups” to be reminded that neither candidate is at their peak anymore.

Both Biden and Trump have had long careers, and at their age, shouldn’t they be focusing on learning pickleball, arguing about golf scores on a patio (not during a presidential debate) or just enjoying a good afternoon nap—like the rest of us dream about when we’re slogging through our 20s to 60s, balancing careers and family.

Some may accuse me of ageism but I assure you that’s not the case. In my job as an Alzheimer’s Health Coach, I have worked with many seniors who are sharp as tacks, score well on their neurocognitive exams and are still working. Seniors should work for as long as they want but only if they are up to the task. I have also worked with many seniors who have very advanced cognitive decline but they have no awareness of it and their families downplay the severity - much like some of the Democrats are doing. As someone who works with Alzheimer’s patients regularly, I am not hesitant to say I have concerns about both Biden and Trump's cognition and I doubt if I am alone.

But, we are where we are—a world superpower has two men, aged 78 and 81, who want to lead their country, leaving many American citizens and the rest of the world concerned about their ability to meet the relentless cognitive demands that the Oval Office requires.

Calls For Cognitive Testing

Joe Biden’s debate performance has reignited discussions about his cognitive health, with suggestions that he should take a Montreal Cognitive Assessment (MoCA). But I assert that a MoCA test is not enough. Many neurologists agree and including Sangay Gupta, a neurosurgeon and the Chief Medical Correspondent for CNN, who has called for Biden to get in depth cognitive testing and have the results revealed to the public. This should be a requirement given his debate performance but let's not stop there—Trump should take one too. This is not just about individual leaders; it is about ensuring older politicians are mentally fit to govern.

With media pundits, political opponents and even some of Biden’s supporters calling for cognitive testing I thought we should break down 3 of the most common cognitive tests and the pros and cons of each.

The MoCA Test: Quick and Handy, but Not Foolproof

The MoCA is like the Swiss Army knife of cognitive tests. It takes about 10 minutes and evaluates attention, memory, language, visuospatial skills and more. It’s a handy tool, highly sensitive in detecting mild cognitive impairment. But here’s the kicker: it’s not perfect. Here are the pros and cons of the MoCA:

Quick Administration: Takes only about 10 minutes.

Sensitivity: Great at detecting mild cognitive impairment.

Subjectivity: Scoring can be subjective and can vary depending on who is administering it.

Manipulation: The test can be viewed ahead of time and a person may be coached on the answers which skews the results.

Enter the CNS Vital Signs Test: The Objective Analysis

This is where the CNS Vital Signs test comes in—a computerized assessment that offers a thorough analysis of cognitive function. It measures:

verbal memory
visual memory
executive function
complex attention
processing speed
psychomotor speed
cognitive flexibility
reaction time

Think of the CNS Vital Signs cognitive test as the comprehensive annual check-up for your brain that anyone can do and only takes 30-ish minutes. Unlike the MoCA, it’s objective and precise, tracking answers to the millisecond and comparing results to people of the same age and gender.

A Neuropsychological Evaluation: The Deep Dive

The most comprehensive cognitive evaluation is the four to eight-hour neuropsychological evaluation conducted by an neuropsychologist. A comprehensive neuropsychological evaluation provides an in-depth analysis of various cognitive domains, such as memory, executive function, attention, and language, through objective and standardized tests. It is the gold standard.

The downside of a neuropsychological evaluations are that it is time-consuming and costly, often requiring four to eight hours and the expertise of a trained neuropsychologist. Additionally, they can be less accessible and more complex to interpret compared to simpler tests like the MoCA and CNS Vital Signs and because it is not computerized the interpretation is somewhat subjective.

Why Multiple Neurocognitive Tests Are Essential

Having both Biden and Trump undergo the MoCA, CNS Vital Signs test and a comprehensive neuropsychological examination by a neuropsychologist would provide a thorough and multi-faceted evaluation of their cognitive health, ensuring any potential impairments are identified and addressed.

The MoCA offers a quick screening for mild cognitive impairment, while the CNS Vital Signs test provides objective, detailed analysis of various cognitive functions through precise, computerized testing. The neuropsychological examination delves deeper into cognitive strengths and weaknesses through standardized assessments. This combination ensures a balanced approach, blending objective and subjective insights, and allows for detection and intervention, which is crucial for high-stakes leadership roles.

Regular assessments establish a cognitive baseline, track changes over time and enhance public confidence through transparency, demonstrating the candidates' commitment to mental fitness. This non-partisan approach removes bias, informs decision-making, and sets a precedent for future elections, promoting the importance of cognitive health in leadership and encouraging ongoing assessment and transparency.

Testing For Regular Folks

For the rest of us regular folks who do not have our fingers hovering above a nuclear button, the four to eight-hour neuropsychological evaluation is overkill. A comprehensive snapshot of brain health can be achieved with just a MoCA and the CNS Vital Signs test.

The Business Angle

All this talk about political leaders’ cognition led me to think about all the men and women who run companies, big and small, and who make important decisions every day. Imagine a world where business leaders also underwent both the MoCA and a CNS Vital Signs cognitive testing periodically. It’s not such a crazy idea, after all, they are responsible for making strategic decisions, managing large teams and ensuring the company’s success.

A sharp mind is essential for navigating the complexities of today’s business world. Regular cognitive testing for business leaders could not only reduce the stigma associated with such assessments but also lower business leader’s risk of developing dementia/Alzheimer’s by identifying cognitive changes early. Early detection would enable timely interventions to improve brain health. Additionally, if leaders supported cognitive testing, they could significantly help de-stigmatize cognitive health issues.

The Business Case for Employee Cognitive Testing

Moreover, let’s imagine businesses offering optional, confidential, neurocognitive testing to employees as a progressive move that could significantly enhance workplace productivity and the well being of its employees. The ability of employees to focus, think clearly, remember details and process information swiftly is crucial for the success of any business.

When cognitive health is prioritized, employees are happier, more engaged and more productive—key ingredients for a thriving company. Imagine the potential if all your employees were operating at peak cognitive performance, driving your business to new heights of innovation and efficiency. By investing in employee cognitive optimization, you foster a culture of proactive health management, ensuring a robust and dynamic workforce ready to tackle any challenge.

Where To Get Tested

There are a variety of places you can have cognitive testing done such as your family doctor’s office, a neuropsychologist office and private cognitive testing businesses. At Health Uncovered Inc., we offer neurocognitive testing as a cornerstone of our practice and as a starting point when working with new clients. Using both the MoCA and the CNS Vital Signs tests, we help families and individuals get a comprehensive view of their cognitive health. Whether you are caring for a loved one in cognitive decline or looking to reduce your own risk of Alzheimer's, these tests are the first step in a proactive approach to brain health.

The Importance of Regular Testing

As an Alzheimer’s Health Coach, I believe everyone over the age of 50 should have neurocognitive testing (MoCA and CNS Vital Signs). This provides a snapshot of brain health and establishes a baseline. Furthermore, I would like to see politicians tested at 50 years of age and then have regularly testing every five years until they are 65 and every two years after that. Remember, cognitive decline typically starts 15 to 20 years before a diagnosis is given. Regular retesting allows us to catch even the smallest changes in cognition before it become a significant and irreversible problem. Fifteen to 20 years is a lot of time to right the ship.

Proactive Steps for Brain Health

Once you have your cognition tested you can either breathe a sigh of relief and stay the course or if the results are not as you hoped you can take action now to ensure your brain is healthy in retirement. We know that there are many things a person can do to improve their memory and cognition.

Inflammation, infection, and loss of nutrient support to the brain are the three big categories driving cognitive decline and addressing these can make a significant difference. From reducing overall inflammation (know your homocysteine level), to taking targeted supplements (citicoline, lion’s mane and bacopa monnieri to name a few), to checking for underlying chronic infections and doing daily brain training - we can take significant action to improve our brain health.

Conclusion: Take Charge of Your Brain Health

People are living longer than ever before but that does not mean that their brain is aging well and is up to the job of leading a nation. Cognitive testing should be mandatory for our political leaders to ensure the public has faith in their ability to make good decisions for the country and the world. Similarly, business leaders who to take proactive steps to ensure that they and their team are cognitively sharp will gain a competitive edge.

By taking the initiative to understand and monitor our cognitive health, we can ensure not only the well-being of our leaders but the well being of ourselves and our loved ones. Let's not wait for a crisis to take action—let's be proactive about our brain health today.

The Political Debate on Cognitive Health