April 24, 2024

Our aging candidates spark a valuable discussion about brain health

When is someone too old to work? How do we assess competence?

These questions are now being asked with a greater sense of urgency to two men who will be in their 80s if they are elected to a second presidential term. This is a time when people are well into retirement and focusing on quality time with their families and communities while strengthening their legacies, offering wisdom to the next generation, and enjoying the fruits of their labor.

We show photos of how the presidency can age a person: new strands or even loss of white hair, wrinkles in shrunken faces and dark circles under tired eyes. The ultimate example of this accelerated aging process is no better reflected than in the death mask of President Abraham Lincoln, a 56-year-old man who took on the burden of a young country at war with itself.

The presidency is often declared the toughest job in the world. Yet we have never really determined what the physical and psychological requirements are to do this work successfully. Political experts debate these issues. The audience jokes about it. Doctors write articles about possible pathology visible in candidates. However, no formal attempts have been made to determine the metrics to be used.

Presidents end their oath of service with “to the best of my ability.” But what is that ability? Should there be age-specific ranges? American presidents have dealt with a plethora of health problems ranging from paralysis, endocrinopathies, heart defects, malignancies, gunshot wounds and even dementia.

It is believed that President Ronald Reagan began showing signs of Alzheimer’s disease during his second term. He shared his diagnosis with the nation in his moving farewell letter after leaving the presidency.

Many were shocked to learn that he had this disease, as he performed well, especially in scripted moments that matched a previous acting career, and this was before the onslaught of social media to monitor every comment. But did this decline in cognitive skills, even if mild, affect his understanding of complex situations and decision-making?

Recently, this issue has come to the fore with the release of Special Counsel Robert Hur’s report, which commented on President Biden’s age and his poor memory regarding dates, including the death of his son. It makes you wonder how many people cannot remember the dates of their loved one’s death, but can remember every detail of their surroundings and the despair that filled their hearts during this tragic time. Failure to remember dates surrounding highly emotional events is a weak indicator of disability.

What was worrying about this report was the connotation that age is a medical condition and that people without any medical training are diagnosing others like regular doctors, which can have a detrimental impact on lives and careers. In this case, statements and questions are often used to discriminate.

It is not unreasonable to ask whether a surgeon can operate, a pilot can fly, a person can drive a car, or whether a president can make convincing decisions in old age. Their actions can affect safety. But we must ask whether these abilities are chronologically age-dependent or biologically age-dependent and whether there is a correlation between the two.

In addition, we know that hand-eye coordination, muscle strength and bone mass can decrease and that blood vessels harden with age. But knowing what actually influences human performance and how we quantify it are complex questions that need unbiased and apolitical experts to answer.

A positive outcome of this report is that we can have an honest discussion about brain health, just as we do about other health issues that affect us all. The brain is a crucial organ that determines how we live our lives. Everything depends on it, including how we determine whether a person is alive or dead (brain dead).

Prevention, diagnosis and treatment of brain disorders are often accompanied by a sense of fear and anxiety that there is very little we can do about. We try to make light of it and assuage our anxiety by viewing a decline in brain or cognitive function as the epitome of aging – the ‘senior moment’ when you forget, but with a smile.

Yet we now know that our environment, genes, behavior and lifestyle can have a significant impact on the way our brains change over time. Ironically, while the public fears dementia or neurocognitive disorders, one of the main risk factors for it is spreading freely through society: the SARS-CoV-2 virus that causes COVID-19.

This isn’t a horror movie plot. We see a build-up of “zombie” or senescent cells in infected brains, which accelerate brain aging. These cells are damaged but refuse to ‘die’ or be removed – they build up in the brain and cause more inflammation and damage.

Studies show that this coronavirus, like viruses such as HIV, is neurotrophic and infects and damages brain and nerve cells. This can lead to premature dementia and other neurological disorders. Even mild infections throughout life, including in childhood, can lead to cellular damage and the effect of multiple infections is cumulative.

After the acute infection, many patients complain of brain fog, memory and attention loss, difficulty finding words and multitasking, and even personality changes. Some recover from this form of long COVID over time; however, the long-term impact is unknown.

In healthcare we monitor vital functions as indicators of well-being. We obtain laboratory tests to assess conditions that can lead to disease and we teach patients how to modify behavior for better outcomes.

One area that needs more attention is brain health. We need more sensitive, cheaper and easy-to-administer tools to screen and diagnose brain disorders at an early stage, and treatments to slow or reverse the findings. Research into microgravity in space has shown that the brain can adapt to a changing environment – ​​a form of neuroplasticity. We must investigate how we can maximize this potential on Earth.

Most importantly, we must prevent injury and protect our brains at every stage of life. We are never too old to start.

Saralyn Mark, MD is a geriatrician and endocrinologist and former senior medical advisor to the White House, the Department of Health and Human Services, and NASA. She is the American Medical Women’s Association-Covid-19 Lead and Strategic Advisor for Human Health and Performance for the Charles F. Bolden Group.

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