What is the relationship between aging, memory loss, and overall cognition. That is a topic of heated controversy in the aftermath of special counsel Robert Hur's report on President Biden's alleged mishandling of confidential documents.
While the report does not recommend filing criminal charges against Biden, it has received a lot of attention for its emphasis on the president's age, with prosecutors describing him as "a sympathetic, well-meaning, elderly man with a poor memory" and citing instances of the president forgetting dates, names, or details of events. Biden has disputed these claims: "My memory is fine," he told a reporter Thursday. Democrats have also spoken up, noting Donald Trump's memory failures.
Medical practitioners avoid making armchair diagnosis of prominent people. However, the current discourse provides an opportunity to reflect on what we know about memory and the aging brain. To learn more, STAT spoke with Joel Kramer, a neuropsychology professor at the University of California, San Francisco Medical Center who runs the UCSF Memory and Aging Center and studies the relationship between the central nervous system and behavior. The interview below has been reduced and edited for clarity.
Is there a link between aging and memory loss?
There are no hard and fast rules for how our memories alter with aging. Some people's recollections deteriorate significantly, while others' memories remain constant throughout time. So memory deterioration with aging is not inevitable.
So, why do we have the feeling that memory decreases with age?
It's because the brain functions similarly to other parts of the body. And as we get older, we become more vulnerable to a variety of illnesses that are not caused by our age but are associated with it. I just got back from seeing an orthopedist this morning because I have arthritis in one of my hands. It is certainly prevalent as you become older, however my wrist problem is caused by arthritis rather than aging. The same is true for memory. There are 30 potential issues with our brains as we age. Changes that you notice that you are more likely to experience as you age, but are not unavoidable.
On average, an 80-year-old will remember less than a 60-year-old, who will not remember as much as a 40-year-old. But these are only broad trends. And you can't assume that this 80-year-old will remember less than the typical 40-year-old, or any 40-year-old.
Do memory lapses and losses in elderly adults necessarily imply underlying conditions? Do they also suggest other cognitive impairments?
When there is a significant degree of sickness, you might expect a more general deterioration in memory and other [mental] functions. But they are actually quite dissociable. In reality, one of the ways that many older adults compensate for their memory impairments is by superior reasoning, planning, and judgment. Some think that as we age, we gain more wisdom and judgment.
A excellent study of airline pilots few years ago found that senior pilots have slower reaction times, without a doubt, but they have greater experience and better judgment. So the concept that just because someone is 80 years old, they must have memory and other cognitive issues is simply false.
So, as a doctor, when do you get concerned that memory lapses could be more serious?
There are various factors that would cause concern: We become concerned when the family comments on changes, when we notice problems with our cognitive tests, or when we find biological markers of impending sickness while examining someone.
Returning to memory loss, is everything the same? Or are certain types more suggestive of larger problems than others?
There are various types of memory, and each memory system is based on a particular neuroanatomy or neural networks. It depends depend on the sort of condition you have: memory symptoms can differ fairly significantly. You can have a patient who is severely damaged in one memory system but does well in another, and another patient who exhibits the exact opposite pattern. We detect patterns that can often assist us diagnose.
Do you believe that in the case of Biden, our prejudice against aging is showing?
In some cultures, where the old are more revered and respected, the problem we've encountered clinically is that the family fails to perceive that the person is disabled. But in our country, I'm not sure if it's a cultural bias or just the lowest form of political bullshit. Criticizing Biden's memory and cognitive capacity has political implications.
