Wow you people getting defensive about Biden are completely missing the point here. Dr McBride is - drum roll please - a doctor, and starting a conversation about cognitive decline after the entire nation just witnessed a glaring example of such on live television makes perfect sense.
It sounds like you're the type of people that think any criticism of the president, no matter how factual, is going to help Trump and is therefore irresponsible to being up. It's that exact mode of thinking that has resulted in Biden's handlers working overtime to project the vibe of nothing to see here, trying to tell people they shouldn't trust what they see with their own eyes and critical thinking skills. Seems like you're the ones deluding yourselves.
Thank you, Daniel! As you say, I’m drawing attention to the subject of cognitive impairment because it is so difficult to discuss. Denying its existence is a huge part of the problem. I see this all the time in my patients and in families, and it’s sad because it only delays the patient getting the help they need.
And you are right - this is not a political statement! ☺️
Thank you for bringing up an important topic. My husband is a Family physician and felt the same way you did regarding the president. This is NOT a political statement just an observation, so please be kind, everyone.
Having watched my parents cognition slowly decline in their 70’s due to diabetes and other ailments. The decline is very subtle at first. You don’t notice it for a while and when it becomes obvious it’s quite a shock.
What I learned from this experience is to have patience and compassion for them. At the time, many of my siblings and I had a family meeting to discuss what to do next. We all had a schedule and stuck to it. My dad’s parents were from Ireland, and he was always searching for his family of origin. I would tell him not to worry that they’ll be back shortly. We hired caregivers with brogue’s so he would feel comfort. He was an Irish tenor, so when he got agitated we would turn on Mario Lanza or a CD of my dad singing the Ave Maria. We were fortunate to keep them at home until they died. My dad died first and then my mother. I think she missed him.
Cognitive decline appears to be inevitable in most humans. Our DNA and health choices play a role for sure.
I agree. “A shell of his former self”?? Tossing around Parkinson’s, Alzheimer’s, as if they are potential diagnoses, while claiming not to diagnose? In the most generous explanation I can come up with, this was extremely poorly worded. I too have unsubscribed.
My wife died from frontal Temporal dementia about 18 months ago. It was diagnosed about 12 years ago and her neurologist at Columbia Medical said people usually lived another 5 to 10 years after diagnosis and she made it about another 10. Six of those years were spent in a nursing home with many others suffering from dementia. All I can say is anyone who has had a loved one in a nursing home with dementia patients would easily recognize Biden's behavior to be identical to so many of those patients. The facial expressions, the inability to finish a sentence or fully articulate thoughts, the walk. His family should be seeking help for him instead of praising him for answering questions as his wife did. It's very sad but as an old history professor said, power corrupts
Having had a career as a surgeon, I, and most surgeons believe your time in the OR doing complex cases should end around age 70, realizing, it’s about the patient, not the doctor. Mistakes at that age might likely be construed as age related decline. Even if Biden or Trump could get by this year, what about in 3-4 years? If they love the country, both should withdraw. We can honor our elderly (I’m one of them), but the world is no longer ours to manage, beyond managing ourselves.
I wish Dr. McBride were my doc. Knowledgeable, compassionate, and sees the WHOLE patient, not just the test results. And has the courage to directly address difficult situations!
I am honestly baffled by the comments on my post today. To me it shows how denialism about cognitive decline is so pervasive - and also how politicized we have become when we cannot talk about things we see in plain sight without being blamed for having an agenda 🤷♀️
I think it was totally inappropriate and unprofessional for you to comment on President Biden’s debate performance. Very surprised and disappointed to see this in your blog.
Honest question: If medical doctors with *zero* political agenda aren’t allowed to make observations about a medical situation that is shrouded in shame and denialism, who should?
This reminds me of the letter from more than four dozen psychiatrists before Trump was elected, providing caution to the country that he was a classic and severe narcissist. The country did not listen then. Physicians are entitled to their opinions, since we see so many different conditions develop in our patients over the years. Our opinions from afar are not diagnoses. Thank you Lucy for this helpful, factual post. ❤️
In our current climate of hyperbole and denialism, it seems that any unfavorable commentary about one’s political opponent is deemed virtuous - whereas anything unfavorable about one’s political ally is deemed in bad faith (even if it’s true).
That's very brave of you, Dr. Lucy, to tackle the President's debate performance in this context, and to do it in a caring, non-political, and non-judgmental way. Thank you!
I want to mention, however, a related but often overlooked point, which is relevant both to the President and aging people in general.
Someone who has some of the symptoms of cognitive decline - has a harder time with words, is less eloquent and articulate than they used to be - might actually be far wiser then us younger folks who run around the world thinking they are God's gift to mankind.
They've got many more decades of experience living on earth. They are more settled and sober in their thinking, and their decision-making isn't as corrupted by temptations, desires, and distractions of youth.
It's not for nothing that in all traditional societies (including my own, Orthodox Judaism), the elders were always turned to for advice, and respected as the heads of the community.
It seems that we've lost our appreciation for age in the modern world - and our societies are suffering deeply as a result.
Of course, I'm not referring to someone who has become senile or has real dementia, that's obviously another story. I'm talking about most folks in their 80's - for example, I would say (and am fine if someone would respectfully disagree), the President.
My husband has Alzheimer's Disease. So I know dementia fairly well. And while I know that one with dementia can have good days and bad days, I've never seen the type of swing in mental capacity as I saw in Biden from his Thursday night debate performance to his rally in North Carolina the very next day where he was sharp, cogent and lively. I have come to wonder if his Thursday night state had more to do with his cold (and possibly the effect of cold medications), lack of sleep over intense preparations for the debate, and nerves - who would not feel nervous about facing such an unpredictable person as Trump? No other time have I seen Biden like that, so I do not think that significant cognitive decline is the issue.
Point taken and not devaluing your experience. He needs a Neuropsychology assessment for us to know if there is really below average cognitive functioning. In my opinion, we might have been looking at the unappealing combined effects of fatigue, anxiety or stress, slowness and a dreadful vocal quality. His predisposition toward less fluent speech doesn't help. We also have no information on whether he is being affected by any meds or hearing loss.
Lucy, it’s a great post - informative, compassionate, wishing to share knowledge and good advice, as well as creating an important and urgent context. I’m reading the comments here, and I must confess that I envy your politeness and good nature. You are a real angel, so let me be a little impatient devil by your side.
I think some people here already pointed out this perspective - there are certain things that we loose as we age. It’s an inevitable process in the end of which we die. The eternal motion of the cosmos. It’s an unpleasant fact, but that’s life. And just as in any other aspect - some people are blessed with grace, self awareness, modesty and an understanding how the river of life flows. Others are not as wise, or sensitive or noble. They want to stay in the game whatever it takes, refusing to face the music. It can be perceived as a harmless blindness to reality, unless we’re talking about a man who is in charge of wellbeing and safety of hundreds of millions of human beings. The only honorable and responsible thing to do is to say farewell and to move on. Just as there is a right age to be a ballerina, or a solider or a rock star or climb the Cilimanjaro, there’s a rather wide, and yet limited span of years in which you are competent enough to function as this grand and complicated entity - a capo di tutti capi - the Leader of the Free World. I mean no disrespect but just as none of us would like a very elderly neurosurgeon to perform a 12 hours procedure on our beloved child. Yes it’s sad, yes it’s unfair, I know. I don’t want to die either. I want to stay in the game. I want to climb the Cilimanjaro, I want to seduce Brad Pitt and I want to resolve the global climate crisis. But hey - please show some responsibility.
Funny, I live in a war zone and I come to realize again and again that these are the painfully young who are willing to part from life so wildly and so easily. Twenty years old boys and girls throw themselves into combat, passionately, romantically , for their friends, for their country, for their fragile and fiery courage, for the unsure victory, for life.
On the other hand, elderly people don’t want to die. But really. They are even more desperate to hold on to life than the young soldiers to courage and heroism.
And it is so even when the life they have left is that of illness, dependency, decay of the body and of the mind. There are no conclusions I can draw. I’m thinking aloud. The unstoppable ambition of men is on one hand the engine that created the world as we know it, but on the other hand there’s so much danger in this elderly gentlemen who insist that it isn’t over until the fat lady sings.
I appreciate learning from a doctor about Biden’s cognitive decline. All Americans are concerned about the president after the debate. We have seen bits and pieces of this for a while but now it’s a real question if he is capable of serving out his term.
While this issue is in every media outlet, I haven’t seen any medical information to explain it. Thank you for sharing your expert knowledge and recommendations for prevention.
It appeared Biden adjusted a hearing aid at one point. Is hearing loss a cause of cognitive decline or a symptom of it?
Your article is thoughtful, helpful, and well written. Thank you.
One question I'm asking people is "What are you doing to grow your good mental health, including your cognitive abilities?"
You and I both know that when Trump says he succeeded in the two cognitive tests he was given, that the test was measuring Mental Status, not cognition. It's also apparent from all of Trump's behaviors, words, threats and ramblings that he is NOT MENTALLY HEALTHY. President Biden is, although his mental acuity may not be as sharp as it was four years ago.
Wow you people getting defensive about Biden are completely missing the point here. Dr McBride is - drum roll please - a doctor, and starting a conversation about cognitive decline after the entire nation just witnessed a glaring example of such on live television makes perfect sense.
It sounds like you're the type of people that think any criticism of the president, no matter how factual, is going to help Trump and is therefore irresponsible to being up. It's that exact mode of thinking that has resulted in Biden's handlers working overtime to project the vibe of nothing to see here, trying to tell people they shouldn't trust what they see with their own eyes and critical thinking skills. Seems like you're the ones deluding yourselves.
Thank you, Daniel! As you say, I’m drawing attention to the subject of cognitive impairment because it is so difficult to discuss. Denying its existence is a huge part of the problem. I see this all the time in my patients and in families, and it’s sad because it only delays the patient getting the help they need.
And you are right - this is not a political statement! ☺️
Thank you for bringing up an important topic. My husband is a Family physician and felt the same way you did regarding the president. This is NOT a political statement just an observation, so please be kind, everyone.
Having watched my parents cognition slowly decline in their 70’s due to diabetes and other ailments. The decline is very subtle at first. You don’t notice it for a while and when it becomes obvious it’s quite a shock.
What I learned from this experience is to have patience and compassion for them. At the time, many of my siblings and I had a family meeting to discuss what to do next. We all had a schedule and stuck to it. My dad’s parents were from Ireland, and he was always searching for his family of origin. I would tell him not to worry that they’ll be back shortly. We hired caregivers with brogue’s so he would feel comfort. He was an Irish tenor, so when he got agitated we would turn on Mario Lanza or a CD of my dad singing the Ave Maria. We were fortunate to keep them at home until they died. My dad died first and then my mother. I think she missed him.
Cognitive decline appears to be inevitable in most humans. Our DNA and health choices play a role for sure.
Thank you, Elaine! This is not a political statement whatsoever! :)
I am honestly quite shocked at the comments here. I appreciate yours. ❤️
Reckless and seems unprofessional to make these sweeping claims from one debate. Time for me to unsubscribe.
I am curious as to what claims you think I am making?
I am talking about my observations and sadness about a man who is clearly struggling - and about cognitive decline in general. 😌
As if one debate were the only signs we've seen....
I totally agree with you Sarah.
I was thinking the exact same thing!!
I agree. “A shell of his former self”?? Tossing around Parkinson’s, Alzheimer’s, as if they are potential diagnoses, while claiming not to diagnose? In the most generous explanation I can come up with, this was extremely poorly worded. I too have unsubscribed.
My wife died from frontal Temporal dementia about 18 months ago. It was diagnosed about 12 years ago and her neurologist at Columbia Medical said people usually lived another 5 to 10 years after diagnosis and she made it about another 10. Six of those years were spent in a nursing home with many others suffering from dementia. All I can say is anyone who has had a loved one in a nursing home with dementia patients would easily recognize Biden's behavior to be identical to so many of those patients. The facial expressions, the inability to finish a sentence or fully articulate thoughts, the walk. His family should be seeking help for him instead of praising him for answering questions as his wife did. It's very sad but as an old history professor said, power corrupts
I am so sorry for your loss. ❤️
Thank you for your comments.
Cognitive testing for Mr. Biden please.
Having had a career as a surgeon, I, and most surgeons believe your time in the OR doing complex cases should end around age 70, realizing, it’s about the patient, not the doctor. Mistakes at that age might likely be construed as age related decline. Even if Biden or Trump could get by this year, what about in 3-4 years? If they love the country, both should withdraw. We can honor our elderly (I’m one of them), but the world is no longer ours to manage, beyond managing ourselves.
Thank you, Ron. I appreciate your realism!
I wish Dr. McBride were my doc. Knowledgeable, compassionate, and sees the WHOLE patient, not just the test results. And has the courage to directly address difficult situations!
Awww.. thank you, Cindy.
I am honestly baffled by the comments on my post today. To me it shows how denialism about cognitive decline is so pervasive - and also how politicized we have become when we cannot talk about things we see in plain sight without being blamed for having an agenda 🤷♀️
It’s very sad to me that this is where we are.
Perhaps another post is needed about narcissism and pathological lying and how insidious - and dangerous - those qualities can be.
Indeed!
I think it was totally inappropriate and unprofessional for you to comment on President Biden’s debate performance. Very surprised and disappointed to see this in your blog.
Honest question: If medical doctors with *zero* political agenda aren’t allowed to make observations about a medical situation that is shrouded in shame and denialism, who should?
This reminds me of the letter from more than four dozen psychiatrists before Trump was elected, providing caution to the country that he was a classic and severe narcissist. The country did not listen then. Physicians are entitled to their opinions, since we see so many different conditions develop in our patients over the years. Our opinions from afar are not diagnoses. Thank you Lucy for this helpful, factual post. ❤️
Exactly!
In our current climate of hyperbole and denialism, it seems that any unfavorable commentary about one’s political opponent is deemed virtuous - whereas anything unfavorable about one’s political ally is deemed in bad faith (even if it’s true).
Make it make sense, Dr. Landers!
😭
That's very brave of you, Dr. Lucy, to tackle the President's debate performance in this context, and to do it in a caring, non-political, and non-judgmental way. Thank you!
I want to mention, however, a related but often overlooked point, which is relevant both to the President and aging people in general.
Someone who has some of the symptoms of cognitive decline - has a harder time with words, is less eloquent and articulate than they used to be - might actually be far wiser then us younger folks who run around the world thinking they are God's gift to mankind.
They've got many more decades of experience living on earth. They are more settled and sober in their thinking, and their decision-making isn't as corrupted by temptations, desires, and distractions of youth.
It's not for nothing that in all traditional societies (including my own, Orthodox Judaism), the elders were always turned to for advice, and respected as the heads of the community.
It seems that we've lost our appreciation for age in the modern world - and our societies are suffering deeply as a result.
Of course, I'm not referring to someone who has become senile or has real dementia, that's obviously another story. I'm talking about most folks in their 80's - for example, I would say (and am fine if someone would respectfully disagree), the President.
I couldn't agree with you more... that with age comes wisdom!
My last post about the beauty of aging is here:
https://open.substack.com/pub/lucymcbride/p/is-aging-bad-for-you?r=1p5bs4&utm_campaign=post&utm_medium=web ) 😉
Nice post! So strange, I must have missed it.
Yeah I'm also no fan of the words anti-aging.
My husband has Alzheimer's Disease. So I know dementia fairly well. And while I know that one with dementia can have good days and bad days, I've never seen the type of swing in mental capacity as I saw in Biden from his Thursday night debate performance to his rally in North Carolina the very next day where he was sharp, cogent and lively. I have come to wonder if his Thursday night state had more to do with his cold (and possibly the effect of cold medications), lack of sleep over intense preparations for the debate, and nerves - who would not feel nervous about facing such an unpredictable person as Trump? No other time have I seen Biden like that, so I do not think that significant cognitive decline is the issue.
Point taken and not devaluing your experience. He needs a Neuropsychology assessment for us to know if there is really below average cognitive functioning. In my opinion, we might have been looking at the unappealing combined effects of fatigue, anxiety or stress, slowness and a dreadful vocal quality. His predisposition toward less fluent speech doesn't help. We also have no information on whether he is being affected by any meds or hearing loss.
Yep. Agree on all
GREAT sober factual unbiased.as usual
Lucy, it’s a great post - informative, compassionate, wishing to share knowledge and good advice, as well as creating an important and urgent context. I’m reading the comments here, and I must confess that I envy your politeness and good nature. You are a real angel, so let me be a little impatient devil by your side.
I think some people here already pointed out this perspective - there are certain things that we loose as we age. It’s an inevitable process in the end of which we die. The eternal motion of the cosmos. It’s an unpleasant fact, but that’s life. And just as in any other aspect - some people are blessed with grace, self awareness, modesty and an understanding how the river of life flows. Others are not as wise, or sensitive or noble. They want to stay in the game whatever it takes, refusing to face the music. It can be perceived as a harmless blindness to reality, unless we’re talking about a man who is in charge of wellbeing and safety of hundreds of millions of human beings. The only honorable and responsible thing to do is to say farewell and to move on. Just as there is a right age to be a ballerina, or a solider or a rock star or climb the Cilimanjaro, there’s a rather wide, and yet limited span of years in which you are competent enough to function as this grand and complicated entity - a capo di tutti capi - the Leader of the Free World. I mean no disrespect but just as none of us would like a very elderly neurosurgeon to perform a 12 hours procedure on our beloved child. Yes it’s sad, yes it’s unfair, I know. I don’t want to die either. I want to stay in the game. I want to climb the Cilimanjaro, I want to seduce Brad Pitt and I want to resolve the global climate crisis. But hey - please show some responsibility.
Funny, I live in a war zone and I come to realize again and again that these are the painfully young who are willing to part from life so wildly and so easily. Twenty years old boys and girls throw themselves into combat, passionately, romantically , for their friends, for their country, for their fragile and fiery courage, for the unsure victory, for life.
On the other hand, elderly people don’t want to die. But really. They are even more desperate to hold on to life than the young soldiers to courage and heroism.
And it is so even when the life they have left is that of illness, dependency, decay of the body and of the mind. There are no conclusions I can draw. I’m thinking aloud. The unstoppable ambition of men is on one hand the engine that created the world as we know it, but on the other hand there’s so much danger in this elderly gentlemen who insist that it isn’t over until the fat lady sings.
I always love your perspective. Thank you for taking the time to write this and for being an impatient devilish ally ❤️
Thank you for all you do. It is very much appreciated.
Is there any research on how anesthesia affects cognitivr health? A loved one started showing signs of early onset Alzheimer's after surgery.
Can you cover in the future is pathological lying a mental illness?
Yes, anesthesia is known to elicit cognitive symptoms in certain older patients and patients who are at risk for cognitive decline.
As for the latter question, I will ponder! ☺️
I appreciate learning from a doctor about Biden’s cognitive decline. All Americans are concerned about the president after the debate. We have seen bits and pieces of this for a while but now it’s a real question if he is capable of serving out his term.
While this issue is in every media outlet, I haven’t seen any medical information to explain it. Thank you for sharing your expert knowledge and recommendations for prevention.
It appeared Biden adjusted a hearing aid at one point. Is hearing loss a cause of cognitive decline or a symptom of it?
Thanks Emily. In this case I just don’t know. I suspect his hearing loss is part of the issue but it doubt it explains the whole situation.
Your article is thoughtful, helpful, and well written. Thank you.
One question I'm asking people is "What are you doing to grow your good mental health, including your cognitive abilities?"
You and I both know that when Trump says he succeeded in the two cognitive tests he was given, that the test was measuring Mental Status, not cognition. It's also apparent from all of Trump's behaviors, words, threats and ramblings that he is NOT MENTALLY HEALTHY. President Biden is, although his mental acuity may not be as sharp as it was four years ago.
Thanks for your thought-provoking articles.