A lengthy Justice Department report on President Biden’s handling of classified documents contained stunning assessments of his well-being and mental health.
Mr. Biden, 81, was an “elderly man with a poor memory” and “diminished faculties” who “did not remember his time as vice president,” special counsel Robert K. Hur said .
In conversations recorded in 2017, Mr. Biden was “often painfully slow” and “had difficulty remembering events and sometimes struggled to read and relay notes from his own notebook.” Mr. Biden was so weakened that a jury was unlikely to convict him, Mr. Hur said.
The Republicans were quick to pounce, some calling the president unfit for office and demanding its removal.
But while the report disparaged Mr. Biden’s mental health, medical experts noted Friday that his judgments were not based on science and that his methods bore no resemblance to those doctors use to evaluate possible cognitive disorders.
In its simplest form, the problem is one that doctors and family members have faced for decades: How do you know if an episode of confusion or memory lapse is part of a serious decline?
The answer: “No,” said David Loewenstein, director of the Center for Cognitive Neuroscience and Aging at the University of Miami Miller School of Medicine.
The diagnosis requires a battery of sophisticated, objective tests that probe several areas: different types of memory, language, executive function, problem solving, as well as spatial and attention skills.
The tests, he explained, determine whether there is a health problem and, if so, its nature and extent. Verbal stumbles are not evidence, Dr. Loewenstein and other experts said.
“Forgetting an event doesn’t necessarily mean there’s a problem,” said Dr. John Morris, a professor of neurology at Washington University in St. Louis.
Mr. Hur, the special counsel, based his findings on a five-hour interview conducted over two days — the two days following Hamas’ surprise attack on Israel — and a review of recorded ghostwriter interviews. in 2017.
But to scientifically identify a memory problem requires doctors to assess how a person’s cognitive function changes over time and ensure that its magnitude is sufficient to reduce the patient’s ability to perform usual activities. , said Dr. Morris.
The best way to determine whether such a change has occurred is to compare the results of a memory test today with the results of a test taken five or 10 years ago, he added. Failing that, doctors can interview someone who knows the patient well — usually a close family member — to determine if there has been a decline.
Recall is just one aspect of cognition, noted Dr. Mary Ganguli, a professor of psychiatry, neurology and epidemiology at the University of Pittsburgh.
To make an accurate diagnosis, a geriatric psychiatrist may ask how long the patient has had problems with their ability to plan and organize, or express themselves. If the person forgets, what do they forget and when?
“We want to know what specific losses were observed, not just ‘memory,’” Dr. Ganguli said. “Was it one-offs when the person was tired or sick, or does it happen constantly and increase in frequency?
It’s important to rule out other possible causes that could affect cognitive function, such as stroke or head trauma, or even the use of certain common medications, Dr. Ganguli added.
For example, diphenhydramine (sold as Benadryl and other brands) is often responsible for memory loss. As a result, people who chronically take time to fall asleep often end up forgetting. (Patients often tell her they take Tylenol at night, she says, but Tylenol PM actually contains diphenhydramine.)
Dementia presents a distinctive pattern of memory loss, not to be confused with routine forgetfulness, Dr. Ganguli added. A person with dementia will usually forget recent events, such as what they ate for breakfast, but will remember things from the distant past, such as a wedding day.
A detailed examination can take an hour, Dr. Ganguli explained, and may additionally involve interviews with family members. A family doctor can perform a more abbreviated assessment, including quick memory tests like the Mini Mental State Exam or the Montreal Cognitive Assessment, known as the MoCA.
During these tests, patients are asked for the date and time as well as the location of the doctor’s office. They may be asked to draw a clock showing a specific time. We say a few words to them and, shortly after, ask them to repeat them.
To assess cognitive status, Dr. Loewenstein often administers a much longer and more probing series of objective tests. It’s a fundamental principle in the field to never diagnose a patient you haven’t seen in a medical setting, he said.
Dr. Loewenstein said he was outraged by experts “who would have the audacity to make diagnoses by saying, ‘Oh, this person went to the refrigerator and forgot why,’ or ‘Oh, they substituted someone’s name one to another name while they have another.” things in mind.