Given the ubiquitous coverage of Joe Biden’s declining cognitive function while president, including attempts to cover up the problem, it’s safe to assume most Americans don’t want to see this happen again in the future. In fact, most of us may be ready to demand that presidents be tested for cognitive fitness. And we may also be ready to make it a crime for close associates to conceal a president’s inability to discharge the duties of office.
On the other hand, the old adage “look before you leap” reminds us to consider possible consequences or dangers before we act. In particular, how can we assure that any testing requirements we come up with are fair and feasible? And how can we keep candidates and political parties from usurping the new assessments and requirements to serve their hyper-partisan ends?
In this article I explore these questions. I do so by taking a broader perspective, looking at the three presidents in American history who were elected to a term of office after they turned 70. By taking a deep dive on the age and cognitive health concerns regarding Presidents Ronald Reagan, Joe Biden, and Donald Trump, I hope to bring some context to the discussion. To what extent was there cognitive decline, to what extent was there a coverup, and why wasn’t action taken to address these problems? After treating each president separately, I’ll proceed to offer eight takeaways that include why our current policies are failing us, why we are nonetheless unlikely to change these policies, and some frightening prospects regarding the future.
Ronald Reagan: Background and emergence of problems
Ronald Reagan was born February 11, 1911, and was 73 when campaigning for his second term. Reagan went out of office in January of 1989, when he was 77 years old.
Wikipedia documents that Reagan’s campaign managers started to reduce his public appearances starting early in 1984. He was never a detail person and was horrible at remembering names. But his fitness for office had not been questioned by the media or Democrats during his first term.
However, in the first presidential debate with Walter Mondale (October 1984), Reagan struggled to recall statistics and seemed thrown off his stride. For the first time his age was brought up by the media, and there were whispers regarding his decline. His strong performance in the second debate put these concerns to rest, and Reagan won a landslide victory.
By 1986, however, there was substantial evidence that Reagan’s cognitive functioning had seriously declined. That summer, CBS reporter, Lesley Stahl, in her 2000 book, Reporting Live, recounts a disturbing encounter she had with the president. As she finished up her stint as a White House correspondent, she was given a customary farewell audience with the president in the Oval Office. She was admonished by Press Secretary Larry Speakes not to ask any questions at all, about anything. Here’s how Stahl described the encounter:
“Reagan was as shriveled as a kumquat. He was so frail, his skin so paper-thin. I could almost see the sunlight through the back of his withered neck… His eyes were coated. Larry introduced us, but he had to shout. Had Reagan turned off his hearing aid? . . Reagan didn’t seem to know who I was. He gave me a distant look with those milky eyes and shook my hand weakly. Oh, my, he’s gonzo, I thought. I have to go out on the lawn tonight and tell my countrymen that the president of the United States is a doddering space cadet. My heart began to hammer with the import… I was aware of the delicacy with which I would have to write my script. But I was quite sure of my diagnosis.”
CBS reporter, Lesley Stahl, in her 2000 book, Reporting Live
Just a year later, in 1987, History.com accounts that Reagan’s aides raised the possibility of invoking the 25th Amendment to remove him. Howard Baker had just been appointed as Chief of Staff in February, and he asked aide James Cannon to confidentially investigate what had gone wrong in the White House, especially since the Iran-Contra scandal. Cannon interviewed numerous aides, who informed him of problems regarding Reagan’s fitness for office.
Cannon later recalled some of these problems to journalists Jane Mayer and Doyle McManus, in their book, Landslide: The Unmaking of the President, 1984-1988. Here are some of Cannon’s statements about what he learned from aides:
“They told stories about how inattentive and inept the president was. He was lazy; he wasn’t interested in the job. They said he wouldn’t read the papers they gave him—even short position papers and documents. They said he wouldn’t come over to work—all he wanted to do was to watch movies and television at the residence.”
Reagan aide James Cannon, as recounted in the book Landslide: The Unmaking of the President, 1984-1988.
Cannon and another aide, Thomas Griscomb, privately raised the possibility to Baker that it might be necessary to remove Reagan. Baker decided that before relying on accounts from staff, he needed to observe Reagan in action first hand. Soon thereafter, Baker dispensed with possibility of invoking the 25th Amendment, as he apparently found Reagan to be competent.
Ronald Reagan: Subsequent developments and evidence
Reagan was diagnosed with Alzheimer’s disease in August of 1994, and thus it’s possible he had this condition while in the White House. In fact, Ron Reagan, the President’s son, said he believed this to be the case in his 2011 book, My Father at 100: A Memoir. An article in Politico also recounts some of son Ron’s concerns. He began to suspect his father might have a problem three years into the first term. The presidential debate in October 1984 further fueled his concern. Then, in July 1989, when Reagan underwent brain surgery after falling off a horse, doctors revealed they saw the first signs of Alzheimer’s.
On the other hand, other of Reagan’s children deny seeing any signs of Alzheimer’s during the time he was president.
In December of 2019, an academic paper from the National Library of Medicine provided further evidence of Reagan’s cognitive decline while in office. The research compared press conferences of Reagan and George Herbert Walker Bush to assess the nature and extent of changes in their discourse during the time they served as president. The study involved statistical analysis of transcripts of press conferences. The Abstract states, in part:
“Key word counts previously associated with cognitive decline in Alzheimer’s disease were extracted and regression analyses were conducted. President Reagan showed a significant reduction in the number of unique words over time and a significant increase in conversational fillers and non-specific nouns over time. There was no significant trend in these features for President Bush.”
Tracking Discourse Complexity Preceding Alzheimer’s Disease Diagnosis: A Case Study Comparing the Press Conferences of Presidents Ronald Reagan and George Herbert Walker Bush, National Library of Medicine, December 2019
And here is a key statement from the Discussion:
“President Reagan was not diagnosed with AD until August of 1994, but the results of our analyses suggest that changes in speaking patterns were becoming detectable years prior to clinical diagnosis. Analysis of his transcripts revealed significant differences in variables known to be associated with the onset of dementia. We found that the use of unique words in the discourse of RR declined over time, and the use of non-specific nouns and fillers increased over time.”
Tracking Discourse Complexity Preceding Alzheimer’s Disease Diagnosis: A Case Study Comparing the Press Conferences of Presidents Ronald Reagan and George Herbert Walker Bush, National Library of Medicine, December 2019
Reagan held 46 press conferences during his presidency, with 19 during his second term of January 1985 to January 1989. Notably, he held far fewer press conferences during his second term. I went back and watched several of these 19 events, selected at random, and invite you to do the same. Overall, I found Reagan to be vigorous, focused, and in command.
Joe Biden: Background and emergence of problems
Joe Biden was just over 78 years old when he assumed the presidency in January of 2021. He was at that time the oldest person to be inaugurated as president and the oldest sitting president in US history.
While Biden campaigned for re-election in 2024, he ended his campaign in July 2024, after major pressure to withdraw due to electability concerns relating to his age and fitness for office.
Wikipedia provides a good overview of age and health concerns regarding Joe Biden. Given the extensive reporting regarding these concerns, I’ll just provide a summary.
Biden’s age was already an issue in 2018, when he was deciding whether to run for president. Notes Wikipedia: “By 2019, The New York Times, The Washington Post, Politico, CNN, The Atlantic, the Associated Press, and Slate all published articles on Biden’s age and fitness for office.”
During the primary campaign his Democratic opponents raised this issue of his age and fitness for office. During campaign events and other public appearances, there were frequent gaffes. And later his Republican opponent, Donald Trump, accused him of “hiding in the basement.” Trump and his allies also made claims that Biden was suffering from dementia.
After winning the presidency, Trump and conservative media outlets continued to make claims of dementia and cognitive decline. And Biden did, on occasion, fall asleep, stumble, trip, struggle with words, forget, and mumble incoherently. The Guardian documented these and other slips. On the other hand, he delivered some strong State of the Union speeches, and his Administration scored several major legislative victories.
By 2024, most public opinion polls revealed that most Americans believed Biden was too old to be an effective president. The final nail in the coffin was Biden’s disastrous performance in the presidential debate on June 27, 2024. He appeared confused and disoriented, and here is how Politico described his performance:
“The alarm bells for Democrats started ringing the second Biden started speaking in a haltingly hoarse voice. Minutes into the debate, he struggled to mount an effective defense of the economy on his watch and flubbed the description of key health initiatives he’s made central to his reelection bid… He repeatedly mixed up “billion” and “million,” and found himself stuck for long stretches of the 90-minute debate playing defense. . . And when he wasn’t speaking, he stood frozen behind his podium, mouth agape, his eyes wide and unblinking for long stretches of time.”
Less than a month later, on July 22, 2024, Biden ended his campaign for president.
Joe Biden: Subsequent developments and evidence
It didn’t take long before Biden’s health, mental fitness and the scandal of a coverup was back in the spotlight. On May 18, 2025, Biden’s office announced that he had been diagnosed with an aggressive form of prostate cancer. The official diagnosis from his doctors came a couple of days earlier showing a Gleason score of 9. This indicates a very aggressive cancer that is not curable, but treatable.
The spotlight on Biden’s mental fitness and a coverup during his presidency intensified a couple of days later. On May 20, 2025, Jake Tapper (CNN) and Alex Thompson (Axios) released their book, Original Sin: President Biden’s Decline, Its Cover-Up, and His Disastrous Choice to Run Again. The book became an instant bestseller, as it provided new detailed evidence of Biden’s cognitive decline and the coverup. Here’s how the publisher (Penguin Random House) describes the book:
“Now the full, unsettling truth is being told for the first time. Jake Tapper and Alex Thompson take us behind closed doors and into private conversations between the heaviest of hitters, revealing how big the problem was and how many people knew about it. From White House staffers at the highest to lowest levels, to leaders of Congress and the Cabinet, from governors to donors and Hollywood players, the truth is finally being told. What you will learn makes President Biden’s decision to run for reelection seem shockingly narcissistic, self-delusional, and reckless—a desperate bet that went bust—and part of a larger act of extended public deception that has few precedents. The story the authors tell raises fundamental issues of accountability and responsibility that will continue for decades.”
Publisher’s (Penguin Random House) description of Original Sin: President Biden’s Decline, Its Cover-Up, and His Disastrous Choice to Run Again
On the other hand, the notion that Biden avoided news conferences—“the fewest since Ronald Reagan” is misleading and inaccurate. The American Presidency Project examined Biden’s solo news conferences and compared them with five previous presidents going back to GHW Bush. The analysis found:
“In the first three years in office, all of the following are true concerning Biden’s performance in solo news conferences starting with George H. W. Bush:
- Presidents Trump and George W. Bush had fewer solo news conferences than Biden.
- Biden answered more questions on average than either Clinton or Obama.
- Media questions and Biden’s answers were shorter than for other Presidents except Trump.
- Presidents Clinton and Obama exceeded Biden’s linguistic sophistication
- Presidents Trump and Clinton exceeded Biden’s number of exchanges with reporters.
- The Biden Administration had more press briefings than any other.”
Donald Trump: Background and emergence of problems
Donald Trump was 70 years and 220 days old when inaugurated as the 45th President on January 20, 2017. And, when inaugurated as the 47th President on January 20, 2026, Trump was 78 years and 220 days old. This makes him the oldest President ever inaugurated.
Wikipedia provides a good overview of age and health concerns regarding Donald Trump. Given the extensive reporting regarding these concerns, I’ll just provide a summary.
Concerns about Trump’s health and mental fitness go back at least a decade. From the time he threw his hat in the ring for President in June of 2015, his detractors and some media outlets raised concerns. For instance, Jeb Bush, one of his opponents in the primaries, speculated that Trump had mental health issues.
Shortly after being sworn into office in 2017, there were numerous individuals and groups who called attention to mental health concerns, including a “Duty to Warn” movement, a warning from psychiatrists and clinical psychologists about a “dangerous mental illiness”, and a petition signed by 41,000 mental health professionals asserting serious mental illness. There was also a book, The Dangerous Case of Donald Trump, with 27 essays from psychologists, psychiatrists, and mental health professionals on the “clear and present danger” that Trump’s mental health posed to the nation.
There was controversy regarding these warnings about Trump’s mental illness because the “Goldwater rule” requires mental health professionals to refrain from diagnosing a condition of a public figure unless they have actually examined the individual and have consent to speak.
Similar to studies of Reagan’s speech patterns in press conferences over time, Trump’s speech patterns over time have been analyzed. In 2017, STAT (a health-oriented news website) published an article entitled, Trump wasn’t always so linguistically challenged. What could explain the change?
The article explained that studies show that linguistic and cognitive decline tend to go hand in hand. Fluency reflects the performance of the brain’s prefrontal cortex, including such cognitive functions as working memory, judgment, understanding, and planning. The temporal lobe searches for and retrieves the right words from memory. Neurologists thus use tests of verbal fluency, especially how it has changed over time, to assess cognitive status.
STAT asked experts in neurolinguistics and cognitive assessment to compare Trump’s speech from the 1980’s and 1990’s to his speech in 2017. They all agreed there had been a deterioration, and that some of it could be the result of changes in the health of Trump’s brain. They emphasized there could be other reasons for the deterioration. Let me quote a few key paragraphs of the findings:
“In interviews Trump gave in the 1980s and 1990s (with Tom Brokaw, David Letterman, Oprah Winfrey, Charlie Rose, and others), he spoke articulately, used sophisticated vocabulary, inserted dependent clauses into his sentences without losing his train of thought, and strung together sentences into a polished paragraph, which — and this is no mean feat — would have scanned just fine in print. . . .
Now, Trump’s vocabulary is simpler. He repeats himself over and over, and lurches from one subject to an unrelated one, as in this answer during an interview with the Associated Press last month:
“People want the border wall. My base definitely wants the border wall, my base really wants it — you’ve been to many of the rallies. OK, the thing they want more than anything is the wall. My base, which is a big base; I think my base is 45 percent. You know, it’s funny. The Democrats, they have a big advantage in the Electoral College. Big, big, big advantage. … The Electoral College is very difficult for a Republican to win, and I will tell you, the people want to see it. They want to see the wall.”
In 2020, Trump’s niece, Mary Trump, a clinical psychologist, wrote about the President in her book, Too Much and Never Enough: How My Family Created the World’s Most Dangerous Man. The book focuses on how Donald Trump’s family and upbringing shaped his personality and character. Fred Trump, Donald’s father, is described as a high-functioning sociopath who was authoritarian, manipulative, and tormenting. Donald’s mother, also named Mary, is presented as weak, entirely submissive to her husband, and unwell both physically and mentally. The author argues that Trump’s upbringing left him cruel, lacking in empathy, and sociopathic.
In the fall of 2024 and other occasions, Mary Trump has gone on to write about Donald’s diminished cognitive functioning and dementing. In a Newsweek article she talks about how he cut a Pennsylvania town hall meeting short to listen to songs from Cats and Shrek for 39 minutes. She also talked about his “rambling, incoherent performance” at the Economic Club of Chicago in an interview with Bloomberg editor-in-chief John Micklethwait. Here are some of her comments:
“If the town hall was the best example so far of his cognitive decline, the interview with Bloomberg Editor-in-Chief John Micklethwait at the Economic Club of Chicago was perhaps the best example I’ve seen of an interlocutor revealing both Donald’s inability to handle pushback and his stunning ignorance. . . it’s hard to see how anybody thinks my uncle is still tethered to reality.”
Mary Trump, as quoted in Newsweek, October 18, 2024
In this substack article, Mary Trump gives detailed examples of rambling and incoherent statements made by Donald that she says demonstrate his dementing status. She states: “On any given day, he is demonstrably untethered from reality—and it often seems that the reason the warning lights aren’t constantly flashing red is because nobody covering him expects otherwise.”
She also complains that instead of reporting his gibberish statements, the media is “imbuing them with meaning that is not there.”
Like Biden, Trump has, on various occasions, slipped, tripped, fallen asleep, spoken gibberish, and uttered statements that couldn’t possible be true. He has had difficulty drinking from a bottle of water, slipped on ramps, and said that during the Revolutionary War continental army troops took over airports from the British. During the course of the 2024 primaries, Trump made numerous gaffes, including confusing Nikki Haley for Nancy Pelosi, claiming he was running against Barack Obama (it was Biden), and fearing the nation could enter World War II.
Just as with Joe Biden, by 2024, most public opinion polls revealed that most Americans believed Trump was too old to be an effective president.
Donald Trump: Subsequent developments and evidence
Concerns about Trump’s cognitive decline continue since his re-election and the start of his second term. A May 28, 2025 Daily Beast article discussed how the President’s rambling speeches and stream-of-consciousness press briefings could be symptoms cognitive decline. Dr. Jennifer R. Mercieca, professor of Communication and Journalism at Texas A&M University, said: “His lack of focus makes it seem as though he’s experiencing cognitive decline, that his brain is not well-disciplined, and he’s unable to maintain a thought and carry it through to a logical conclusion.”
A May 26 article in The New Republic decribes numerous recent instances where Trump repeatly fumbled in weird rants. For instance, in a speech at West Point, he went on a long, rambling digression about real estate tycoon Bill Leavitt and his “trophy wife,” his yacht, and how he lost it all.
On May 4, 2025, USA Today published an opinion piece entitled, “Is Trump in mental decline? He sounds far worse than Biden ever did.” For instance, when Time Magazine asked Trump about the border wall, he said: “I built hundreds of miles of wall, and then (Biden) didn’t want to, and we had another, an extra hundred miles that I could have put up because I ordered it as extra. I completed the wall, what I was doing, but we have, I wanted to build additional because it was working so well.”
It also needs to be noted that Trump’s father, Fred, was diagnosed with dementia at age 86, and died with Alzheimer’s disease at age 93. His mind deteriorated rapidly after the initial diagnosis. Within a few months, he could not remember his birthday or age.
In summary, Trump has been dogged with concerns about his fitness for office, cognitive decline, and possible dementia going back to 2016 and his first year in office (2017). Many psychiatrists and clinical psychologists have expressed concerns, and studies have revealed cognitive decline. Still, Trump, soon to be 79, has never been diagnosed with dementia or Alzheimer’s disease.
Takeaway #1: We cannot say for certain whether Reagan, Biden, or Trump became unfit for office during their presidencies because there was no requirement for their cognitive functioning to be tested and reported.
What we have seen from our review is that while numerous psychiatrists and clinical psychologists expressed concerns regarding all three presidents, none of them were officially diagnosed as unfit. Mental health professionals are prohibited from diagnosing a condition unless they personally examine the president and have permission to reveal their findings. Presidents thus enjoy confidentiality regarding their medical condition, and they control what is released to the public.
Because their condition was never officially diagnosed, and because there is no requirement for their cognitive function to be assessed and reported, presidents and their administrations can keep the American people and the media in the dark. We simply don’t know whether any or all of these three presidents were either unfit or fit for office.
Perhaps just as bad, because there is no formal assessment and reporting of cognitive fitness, this opens the door for partisan attacks that use cherry-picked evidence to smear an opponent as unfit for office.
Takeaway #2: While Ronald Reagan’s potential unfitness for office received less media attention than Biden’s or Trump’s, the cognitive decline of all three presidents was covered (and continues to be covered) extensively by the media.
Especially with respect to Biden and Trump, the media has devoted a great deal of attention to reporting on concerns about declining cognitive abilities or lack of fitness to serve as president. The public has been informed regarding gibberish statements, slips, mental lapses, and irrational behavior. The media has addressed whether these individuals are too old or lack the fitness to be president.
Public opinion polls demonstrate the American people have concerns with respect to both Biden and Trump. Both were seen as too old to function effectively as president. For more public opinion on the fitness of Biden and Trump, see this EconomistYouGov poll (May 23-26).
Takeaway #3: Cognitive decline proceeds in different individuals at different rates, can be caused by numerous factors, some of which can be reversed, and doesn’t always result in dementia or loss of fitness to be president.
Consider this insight from an article in the Harvard Gazette:
“There are age-related changes that occur throughout our lifespan. As we age, there are some brain changes that occur as part of the normal aging process; white matter changes are the result of arteries that get narrowed or blocked by atherosclerotic plaque, this can begin around age 60. As that happens, there’s some associated slowing of processing, difficulty with being able to access information, pulling up that memory crisply, and efficiently finding words; some people identify those experiences as “senior moments.” We also have some cell loss and atrophy in the brain that occurs with normal aging. On neuroimaging, we see age-commensurate loss of volume in the cortex or gray matter, which plays a significant role in many functions including memory/learning and language. All of these changes are part of normal aging.”
Harvard Gazette, “Testing Fitness of an Aging Brain,” June 12, 2024
Thus, a president might be losing a step because of normal aging. The loss may be due to hypothyroidism, anemia, a vitamin deficiency, sleep apnea, low blood pressure, unstable blood sugar, or other medical issues that are reversible. This includes correction of vision and hearing problems, and addressing mental health issues such as depression and anxiety.
Remember, not one of the three presidents was formally diagnosed with dementia or declared unfit for office. All three clearly appear to have suffered cognitive decline; and we, the public, have been under a barrage of partisan messaging to influence our judgment regarding their fitness for office.
Takeaway #4: Especially with respect to Biden and Trump, the question of a president’s cognitive decline has been treated as a partisan issue by the political parties and their media allies.
Candidates and their political parties have cherry-picked examples of decline, including incoherent statements, slips, trips, forgetful moments, and falling asleep. Both Biden and Trump have been accused of covering up their lack of mental fitness to be president. The approach has been very partisan in nature.
For instance, consider Republican Senator John Cornyn’s statement on an upcoming (June 18) Senate hearing focusing on the coverup of Biden’s lack of mental fitness:
“This is about a constitutional crisis, where we basically have a mentally incompetent president who’s not in charge. . . For this conspiracy between mainstream media, Joe Biden’s family, and his inner circle to have hidden the impairment of the president of the United States for years, and lied consistently to the American people about his capacity to make decisions, which are solely vested by the Constitution, is unacceptable.”
U.S. Senator John Cornyn
In this political narrative, President Biden is declared “mentally incompetent” without a formal diagnosis. A conspiracy is alleged with the media when there was in fact considerable coverage of Biden’s decline. And insiders have “hidden the impairment of the president” when, in fact, the pubic clearly exhibits knowledge of Biden’s decline and believes he is too old to be an effective president.
In another instance, President Trump just ordered Attorney General Pam Bondi to investigate whether certain individuals conspired to deceive the public about Biden’s mental state and unconstitutionally exercise the authorities and responsibilities of the President (use of an Autopen). Trump sensationalized the investigation and revealed his true intentions by stating:
“This conspiracy marks one of the most dangerous and concerning scandals in American history. The American public was purposefully shielded from discovering who wielded the executive power, all while Biden’s signature was deployed across thousands of documents to effect radical policy shifts.”
President Donald Trump, writing about his recent order to investigate Joe Biden
Further evidence that issue of fitness for office has become politicized is revealed in public opinion polls. For instance, in a recent EconomistYouGov poll (May 23-26), 83% of Republicans believed Biden was “not very transparent” or “not at all transparent” about his physical health. When Democrats were asked the same about Trump, 77% said Trump was “not very transparent” or “not at all transparent” about his physical health. 86% of Republicans thought Democrats actively tried to cover up information about Biden’s health, while only 28% of Democrats thought this to be the case.
Finally, because of this barrage of political narratives, members of the public may not really care when presented with information that questions the cognitive abilities of the person they voted for. Thus, Trump can utter incomprehensible statements on a daily basis. The media may cover these statements, but his supporters simply shrug and view it as a partisan attack. Further, it happens so often that it’s no longer newsworthy. The media may even explain (“sanewash”) what Trump meant to say. Trump supporters think it’s “Trump being Trump”; while Biden supporters think of it as “Biden being Biden.” Many of us don’t really see a problem.
Takeaway #5: We can’t really hold staffers, family members, and close associates of a president accountable for covering up a lack of fitness unless they know, and it has been formally determined, that the president is unfit.
Without formal assessment and reporting regarding cognitive fitness, how can we hold staffers, family members, and other close associates responsible for “covering up”? After all, the opinions and petitions of psychiatrists and clinical psychologists don’t constitute a diagnosis. Studies of speech patterns don’t prove dimentia or lack of fitness. Finally, staffers, family members, and other close associates lack the expertise and authority to diagnose a condition.
Think about it. Suppose you are the spouse of a president who is being accused of being mentally unfit by the opposing political party, some media outlets, and some psychiatrists and clinical psychologists. You know the president is increasingly forgetful, sometimes confused, and sometimes speaks gibberish. And you see the opposing party cherry-picking the worst of these instances to make its case that the president is unfit for office. The opposing party also asserts that the president’s condition is being covered up, naming you as a prime offender. What should you have a duty to disclose, especially considering you aren’t qualified to determine whether the president’s behaviors constitute dementia or whether the president is unfit for office?
And, finally, recalling that the rate of cognitive decline is usually gradual and unpredictable, is it reasonable for those surrounding a president to be held accountable for knowing exactly when a president deteriorates from functional to dysfunctional?
Takeaway #6: Presidential candidates and the political parties will probably resist requirements to test and report cognitive functioning because it goes against their best interests.
If you are a president who is slipping mentally, you won’t want to have your cognitive functioning tested and reported to the American public. You will rely instead on your own doctor to give you a clean bill of health and choose what to disclose. And you can accuse opposing candidates and political parties of dirty campaign tactics.
If you are a presidential candidate, or plan to run in the future, you’ll be wary of having your cognitive functioning tested. Who will do the testing and reporting, and will it be valid and objective? And how might your results be exploited by the opposing candidates and political parties?
If you are the president’s political opponent or the opposing political party, you will not be able to attack a president as unfit if they have been officially assessed and determined to be fit. And, if a president is diagnosed as unfit, you can’t blame the president and close advisors for covering up the problem. The president will be replaced, but you lose the ability to cry “scandal” and attack the opposing party. Overall, there are advantages to not having a formal diagnosis. You retain the ability to build a case with cherry-picked evidence and accuse the other side of a coverup.
In my research I did not find a single country in the world that tests the cognitive fitness of their candidates for head of state. The Boston Globe editorialized that candidates for president should be tested for cognitive function. A March 2023, Morning Consult poll found that 74% of respondents support mental competency tests for all presidential candidates. But don’t count on it happening anytime soon.
Takeaway #7: If Reagan or Biden had experienced a sudden, profound and permanent loss of cognitive function, or if Trump suffers the same, removal under the provisions of the 25th Amendment will likely set off an unpredictable and potentially disastrous chain of events.
America has yet to have a president who suffered a sudden, profound, and permanent loss of cognitive function. When that happens we’ll have a president who will have to be removed from office, perhaps involuntarily, pursuant to the 25th Amendment. Under the seemingly straightforward provisions of Section 4, when a president is incapable of discharging the duties of office, but is unwilling or unable to recognize this incapacity, there are two options. First, the vice president and a majority of the cabinet can determine that the vice president should carry out the duties of the presidency until the president regains the ability. Or, second, the vice president and a “body” set up by Congress can make the determination.
An article in Psychology Today addresses how this could be unpredictable and lead to a crisis. The problem is that Congress never acted to create the “body” that works with the vice president to make the determination (option 2). Thus, the only option is for the vice president and the majority of the cabinet to make the decision that the president is unable to discharge the duties of office. Here a recalcitrant president could fire cabinet members and prevent a majority vote from occurring. In addition, the vice president and cabinet members don’t have the benefit of medical and psychiatric assessments to assist in making their decision. A recalcitrant president could argue the vice president and cabinet were illegally conspiring to empower the vice president. Finally, the vice president and cabinet might be pressured into covering up unfitness by deciding an unfit president is, in their view, fit. After all, there are no requirements for the president to be evaluated by medical professionals. Overall, it’s a sticky situation because Section 4 has never been tested. In my view it will be a nightmare if a cognitively-compromised president is unwilling to step down.
In the aftermath of such a nightmare, we can anticipate that Congress will finally get around to setting up the body that is to work with the vice president in determining whether the president is unable to discharge the duties of office (option 2). This would presumably involve a broad-based and neutral body that includes psychiatrists and medical experts. For instance, H.R.1987 (2017) attempted to establish an 11-member commission for this task, but the legislation went nowhere.
Takeaway #8: Sadly, until we go through the nightmare of removing an unwilling president, future candidates for president and presidents won’t be routinely assessed for cognitive fitness; instead, partisan politics will continue to drive our opinions as to who is fit and unfit.
If we go through the nightmare of removing an unwilling president, we can anticipate that Congress will also finally get serious about requiring presidential candidates and sitting presidents to be routinely assessed regarding their cognitive fitness. In voting for the most powerful person on earth, Americans deserve to have an accurate assessment of the cognitive functioning of candidates and the president in power. And, when it comes to removing a president, we want the vice president, along with a competent and neutral body, to be making the decision.
Until then, unfortunately, we’re going to see candidates and political parties pushing their views and largely controlling our thinking. Slip ups and flubs will be cherry-picked and offered as proof of unfitness. Candidates will avoid having their declining cognitive abilities from being diagnosed. Coverups will be described as historic scandals and constitutional crises.
We shouldn’t give up, however. Since we know that candidates and political parties are using the discussion of cognitive fitness to serve their own ends, we can account for this reality. We can gain perspective by reviewing a wide range of media accounts that cover the cognitive functioning of candidates and presidents. We can make our own judgments given the frequency and severity of instances that call a person’s cognitive functioning into question. We can recognize and discount partisan attempts to declare someone to be incompetent based on cherry-picked incidents and anecdotal evidence.
Conclusion
America should be routinely assessing our sitting presidents and candidates for president for cognitive functioning, and the results should be public. Because we don’t to this, we’re in a situation where partisan politics dominates the discussion of who is fit and unfit. This situation allows presidents to conceal what may be disqualifying cognitive function if they have not been actually examined and diagnosed by an expert with authority to report the results.
Most likely we won’t change our policies and practices until we face the removal of a sitting president who suffers a sudden, severe, and permanent loss of cognitive function. If the president resists removal under the 25th Amendment, under provisions yet untested, it will likely be a national crisis.
Given the evidence of cognitive decline in our current president, and given his unyielding propensity to never admit defeat, we should pray that he doesn’t suffer a major loss of cognitive function. And, for the good of the country, we should urge Congress to implement the 25th Amendment by establishing the body to work with the vice president in determining whether a president is unfit to discharge the duties of office.
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