Should Biden be screened for dementia? What neurologists say

By | March 5, 2024

President Joe Biden was declared fit for duty by his physician following his annual physical on February 28, the same month a special counsel report raised concerns about his memory. However, the 81-year-old did not undergo cognitive testing because both his doctor and neurologist said it was unnecessary, White House press secretary Karine Jean-Pierre said.

Neurologists told NBC News that the memory problems the president has recently shown — namely forgetting dates and mixing up names — do not indicate Biden has dementia, but could simply be a normal part of aging.

Still, Biden’s age and suitability for the presidency are top priorities for many voters heading into the 2024 election. A Feb. 6 national NBC poll found that three-quarters of respondents, including half of Democrats, are concerned about their mental and physical health.

Fewer than half of respondents felt the same way about former Republican President Donald Trump, who also had memory problems and recently confused fellow presidential candidate and former governor Nikki Haley and former House Speaker Nancy Pelosi. Trump has also confused Biden and former President Barack Obama at least seven times, Forbes reported.

At the press conference after Biden’s physical meeting, Jean-Pierre said he “passes a cognitive test every day” because he is constantly “moving from one topic to another and understanding the detailed level of these topics.” And within hours of the release of the special counsel’s report, Biden staunchly defended his knowledge, telling reporters, “My memory is fine,” although later in his speech he repeated the names of two heads of state for the third time that week got each other.

So, what are the signs that a person, especially an older adult, needs a cognitive assessment or screening for dementia? This is what experts say. (These experts have not treated Biden or Trump and emphasize that only their medical teams can provide an assessment of their cognition.)

What is dementia?

According to the National Institutes of Health (NIH), dementia is a decline in cognitive function that by definition interferes with people’s daily activities. This includes memory, reasoning and general thinking, and some people experience personality changes.

According to the NIH, about one-third of people age 85 and older have some form of dementia.

“Dementia becomes more common as people get older, but not all adults will develop dementia with age,” says Dr. Audrey Chun, professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City, told TODAY.com.

The NIH emphasized that dementia is “not a normal part of aging,” as many people live into their 90s and beyond without any signs of it.

What causes dementia?

Dementia is caused by changes in the brain that affect the cells’ ability to communicate with each other. Different parts of the brain have different functions, from memory to movement to reasoning, so symptoms depend on which part of the brain is damaged.

The risk of dementia increases as you get older and if you have a family history, according to Mayo Clinic. However, leading a healthy lifestyle can reduce the risk of developing dementia, such as eating a balanced diet, exercising regularly, not drinking alcohol, sleeping well and maintaining healthy weight, blood pressure and cholesterol levels.

Types of dementia include:

  • Alzheimer’s disease (the most common)

  • Frontotemporal dementia (what Bruce Willis has)

  • Lewy body dementia

  • Vascular dementia (caused by strokes)

  • Huntington’s disease (hereditary condition that causes uncontrollable dance-like movements)

  • HIV-associated dementia

  • Creutzfeldt-Jacob disease (rare brain disorder)

  • Dementia in Parkinson’s disease

What are the signs someone needs to be tested for dementia?

“It is critical that people realize that it is common as they grow older to occasionally forget names or misplace items,” says Dr. Michael S. Okun, director of the Norman Fixel Institute for Neurological Diseases at University of Florida Health and medical advisor to the Parkinson Foundation, tells TODAY.com.

Another normal memory change with age is not being able to remember memories from many years ago.

But forgetting recent events is more of a warning sign, because dementia tends to affect the part of the brain where short-term memory resides first, says Dr. Paul Newhouse, core clinical leader of the Vanderbilt Alzheimer’s Disease Research Center.

For example, it would be worrisome if you didn’t remember a recent shopping trip. “What I’m more concerned about is, can you remember what happened yesterday or an hour ago?” said Nieuwhuis.

Another sign that someone’s memory loss is greater than normal aging is when they don’t realize they’re forgetting things, says Dr. Thomas Wisniewski, director of NYU Langone Health’s Alzheimer’s Disease Research Center and the Center for Cognitive Neurology.

And if a patient has noticed cognitive deficits or if the people around them have, that should merit evaluation as well, Chun explains.

Other indications to consult a doctor for a possible diagnosis of dementia are:

  • A disability that affects important activities of daily living (such as filing taxes, managing personal finances, or driving)

  • Consistently having difficulty completing familiar tasks

  • Struggling with visual images or spatial representations

  • Social withdrawal

  • Getting lost in a familiar neighborhood

  • Hallucinating

  • Losing balance

Does age matter when testing for dementia?

“While age is always a consideration… we must recognize that different forms of dementia can occur in all age groups,” Okun says. He advocates changing the perception that dementia is “just a disease of the elderly”.

For example, compared to other forms of dementia, a rare form of dementia known as frontotemporal dementia often develops at a younger age. Former talk show host Wendy Williams, 59, was recently diagnosed.

The U.S. Preventive Services Taskforce, which makes evidence-based recommendations for preventive health care, does not have definitive guidance on whether older adults should be screened for cognitive impairment because there is insufficient evidence.

However, Medicare does suggest that beneficiaries’ annual wellness visits should include cognitive evaluation, Chun says.

Why is it important to test for dementia?

“Normally we screen for conditions where we can cure or mitigate the condition if we detect it early,” notes Chun. “While there is no cure for dementia, there are important conversations and preparations that need to take place in the early stages of the disease.”

Experts say early testing for dementia helps to:

  • Confirm the diagnosis

  • Rate the severity

  • Determine the underlying cause, including reversible conditions, such as vitamin B12 deficiency or thyroid disease

  • Help the family and doctor understand the prognosis and plan for the future

  • Offer treatment options specific to the diagnosis

  • Let doctors and patients take advantage of available treatments, if they exist

“When it comes to considering a diagnosis of dementia, it is important that we test and monitor people closely over time as lifestyle changes or medications may be recommended,” Okun emphasizes.

What is the most effective way to test for dementia?

“There is no single clinical test for dementia, as dementia is a large category of neurological disorders that affect cognition,” Chun explains.

The first step is to see a doctor who can review a person’s medical and family history and perform a complete neurological exam to determine possible causes.

Testing often starts with a cognitive screening, Chun adds.

A highly regarded and validated screening test is the Montreal Cognitive Assessment, known as MoCA, which takes approximately 10 minutes to complete. Another example is the mini-mental state exam, which lasts five to ten minutes.

Okun says it’s especially helpful to detect suspected cases of dementia by administering these tests multiple times over an extended period of time to see if scores decrease, which can be a sign of worsening cognition.

If a doctor is concerned about cognitive impairment, they will then perform blood tests and special imaging to examine the brain, Chun says.

“An abnormal MoCA should prompt the physician to consider the next step, which could potentially be an MRI,” Okun adds.

Blood tests can look for reversible conditions that can lead to cognitive impairment, such as B12 deficiency, electrolyte imbalances, infections, thyroid abnormalities, and sometimes test for syphilis in the appropriate clinical setting.

“Depending on the suspected cause, a doctor may perform (additional) blood tests, such as (for Alzheimer’s disease), or an advanced neuroimaging examination, a so-called PET scan,” Okun explains.

If you or a loved one is experiencing signs of cognitive decline, your first step should be to see your doctor.

This article was originally published on TODAY.com

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