Presidents Live Longer. Should We Test For Dementia?

As presidents live longer, one wonders if a test for dementia should be considered.

At 70, Trump is the oldest American president to ever take office. Couple his age with a family history of dementia — his father Fred developed Alzheimer’s disease in his 80s — and one could argue that the question of baseline cognitive testing for the U.S. head of state has taken on new relevance.

An assortment of fairly simple tests exist that can establish a reference point for cognitive capacity and detect early symptoms of mental decline. One of the most common such screens is the Mini-Mental Status Examination, a series of questions that gauges attention, orientation and short-term memory. It takes about five to 10 minutes to complete.

Yet admitting vulnerability of any kind isn’t something politicians have been keen to do. The true health of politicians has likely been cloaked in secrecy since the days of Mesopotamian kings, but definitely since the Wilson administration.  And FDR, disabled by polio, controlled his public image to deflect attention from his paraplegia.

In 1919, President Wilson suffered a debilitating stroke, the after effects of which were covered up by his wife, doctor and cabinet. Franklin Delano Roosevelt’s disability related to polio and John F. Kennedy’s various ailments were minimized. And it’s possible, some have speculated, that Reagan developed dementia while still in office that was also concealed.  But until Reagan, septuagenarian presidents at risk for dementia weren’t a concern.

“Donald Trump at the time of his inauguration was older than half of our deceased former presidents at the age when they died,” says Dr. Jacob Appel, a Mt. Sinai School of Medicine psychiatrist who has studied the health of politicians and presidents. “Only a generation ago, our political leaders — like the rest of us — were likely to die of heart disease or cancer in their 60s and 70s, what we now think of as late middle age.”
Teddy Roosevelt died at 60, FDR at 63, and Lyndon Johnson at 64, all before dementia usually sets in.

It is a cruel Darwinian yin to the yang of medical progress that as we live longer and longer, new health problems like mental deterioration can emerge.

“This is a relatively recent problem that may call for a novel solution,” says Appel.
Arthur Caplan, a bioethicist at New York University’s Langone Medical Center, took issue with revelations in The New York Times, saying that anyone’s personal physician shouldn’t divulge health information without permission — even if that person is the president. Yet Caplan says there needs to be greater transparency when it comes to presidential health.

“I think we’re about 50 years overdue for having some sort of annual physical for the president and vice president, the results of which should be reported publicly,” he says. “Part of this should be psychiatric and cognitive testing.”

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