The Mental Fitness Debate: Should Public Officials Disclose Their Cognitive Scores?

This November, Americans will face a choice between 81-year-old Joe Biden and 78-year-old Donald Trump. These are the oldest Presidential candidates in our nation's history, and a majority of Americans think that both candidates are too old to be Commander in Chief.

Pundits look at the way Biden walks and the way Trump talks, and major newspapers are running stories about the aging brain. Two psychologists started a podcast this year to declare Trump mentally unfit, and Biden's mental fitness made the Wall Street Journal front page.

After Thursday's Presidential debate, concern about President Biden has reached a fever pitch—with multiple news outlets even reporting that Democratic party leaders would like to replace Biden on the ballot.

As a law professor who is leading the charge to integrate neuroscience into law and public policy, I am happy to see public debate about the brain. The motto of my Neurolaw Lab is "Every story is a brain story," and this applies to politics. How a politician's brain processes information determines how they will lead, negotiate, and make decisions.

Concern over Presidential age is thus well placed. Living longer is the number one risk factor for developing Dementia, and a broken brain in the Oval Office puts the nation at risk.

But such concern is also overblown. The reason we shouldn't jump to conclusions about the cognitive abilities of older adults is that while age is a risk factor for cognitive impairment, it's just that—a risk.

Compared to baseline performance at thirty-five years old, there are roughly four paths we can expect to travel as we age:

• A small percentage of us (no one knows how many) will experience Super Aging, with little to no cognitive decline.
• Most will experience Normal Aging, where there is some decline but not enough to affect daily life.
• Some will experience Mild Cognitive Impairment (MCI), which is more accelerated than normal agers but not reaching the level of Dementia.
• And some will experience Dementia (of which Alzheimer's disease is the most common), which can significantly affect daily life.

Of particular importance is the distinction between "fluid intelligence" and "crystallized intelligence." Fluid intelligence might be thought of as processing speed and the ability to learn new tasks, while crystallized intelligence is something more akin to wisdom. In general, older adults are wiser but have slower processing speed. This is why you seek out an adult for investment advice but go to your teenage child for help installing the latest smartphone app.

It's worth emphasizing that a decline in one area of information processing should not disqualify a candidate but rather should lead to a system for supported decision-making. In short, the idea of supported decision-making is that one surrounds oneself with a team to help with those decisions that may be harder to make with an aging brain. It's the strategy the law routinely uses to facilitate independence for older adults who are experiencing some, but not total, mental decline.

The question facing the nation is: Which paths are Biden and Trump's brains taking? Are they aging normally, or are they veering toward dementia? 

Many armchair experts and cable news talking heads think they have an answer, especially after the debate. But they don't. 

The public is in the dark because the candidates have disclosed such limited information about their cognitive ability. 

It doesn't have to be this way. Outside of the political stream, physicians routinely use individualized neurological, neuroimaging, and neuropsychological assessments to make determinations about their patients' cognitive health. The tools are available to those who wish to use them.

But our two Presidential candidates apparently do not.

When I organized a Dementia and Democracy event at Harvard Law School back in 2017, I made a plea: We have to do better than speculation. I've since written extensively about how we can better address the concern about aging public servants.

My proposal is straightforward: In the same way that we mandate financial reporting, we should mandate disclosure of objective cognitive testing for Members of Congress and Presidential candidates. 

Former President Trump was right to demand cognitive testing, though we'd need to hear the results from an objective expert, and not rely on the candidates' own reporting.

The reason we require financial disclosures is that we're concerned about how a politician's brain will process information—will they vote favorably on legislation in order to reap financial gain?

The reason we should require cognitive testing is the same—we need to know how they'll decide when learning about nuclear threats. No one wants to cast a vote for someone whose brain circuitry is deteriorating and whose decisions are no longer aligned with the public interest.

Just as financial disclosures don't disqualify candidates, neither would cognitive testing. Both give the public crucial information to inform their vote, and of course, avoiding the politicization of such exams would be critical (and challenging). 

For future elections mandated disclosure of cognitive testing is promising. But it isn't happening this election cycle. Instead, our airwaves and inboxes will be deluged from now until November with so-called experts claiming to know the inner workings of Biden and Trump's brains.

So what can be done?

Voters should remember three things: 

First, rather than focus on disability, it's worth noting that both candidates are the oldest candidates to weather the storms of the most strenuous political campaign in the world. Could you do that? At any age?

Second, it would be wise to ignore those whose pronouncements about mental fitness aren't based on objective data and individualized assessment. Can a clinician make a conclusive judgment about Biden or Trump based on what they see on TV? No way. As bad as Biden's debate performance might have been, it could have been a bad day. We need an actual assessment.

Third, scrutinize both candidates. Listen to what they say and watch what they do. Just don't let the age narrative bias your evaluations.

The 2024 election won't be the last time we debate about aging politicians. In 2017 the public was concerned about Nancy Pelosi and Mitch McConnell, then it was Dianne Feinstein. Today it's Trump and Biden. Future election cycles will bring more concern, as lifespans extend and politicians don't retire.

A proposal for mandated cognitive testing for politicians should be started now, so that we aren't having this same debate next election cycle. 

In the meantime, there's nothing stopping President Biden and Former President Trump from voluntarily sharing with the public their cognitive testing results and objective data about their brains.  

If they don't, the public is right to ask: What are they hiding?

Francis X. Shen, JD, PhD directs the Shen Neurolaw Lab, teaches at the University of Minnesota Law School and Harvard Medical School, and serves as Chief Innovation Officer for the MGH Center for Law, Brain & Behavior.