Older candidates spark valuable discussion on brain health

When are you too old to work? How do you assess competency?

These questions are now being asked with a sense of urgency to these two men, who will be in their 80s if elected to a second term as president. This is a time when people are nearing retirement, cementing their legacies, imparting wisdom to the next generation, and enjoying the fruits of their labor while spending quality time with their families and communities. The focus is on spending time.

We show in pictures how individuals age through presidential terms. The loss of new strands and gray hair, the wrinkles etched into a shrunken face, and the tired dark circles under the eyes. The ultimate example of this accelerated aging process is best reflected in the death mask of 56-year-old President Abraham Lincoln, who carried the burden of a young nation at war with his own.

The office of president is often said to be the toughest job on earth. However, we have never really established what the physical and psychological requirements are to successfully perform this job. Political commentators debate these issues. The public jokes about them. The doctor will write an article about any underlying medical conditions that are apparent in the candidate. However, no formal efforts have been made to determine which metrics to use.

At the end of his oath of office, the president says, “I will do my best.” But what is that ability? Should there be age-based ranges? American presidents have faced numerous health conditions, including paralysis, endocrine disorders, heart abnormalities, malignancies, gunshot wounds, and even dementia.

President Ronald Reagan is believed to have begun showing signs of Alzheimer’s disease during his second term in office. After leaving his presidency, he informed the nation of his diagnosis in a poignant farewell letter.

Many people were shocked to learn that he had this disease because he had performed well, especially in scripted scenes befitting his previous acting career, and this This was before the onslaught of social media tracking every comment. But did this cognitive decline, even mild, affect understanding of complex situations and decision-making?

The issue has recently come to the forefront with the release of Special Counsel Robert Hur’s report, which comments on President Biden’s age and poor memory of dates, including the death of his son. There is. How many of us can’t remember the day our loved one died, but we remember every detail of our surroundings and the sense of hopelessness that filled our hearts during this tragic time? Inability to remember dates of highly emotional events is a weak indicator of the disorder.

The report raised concerns that age is a medical condition and that people without medical training are armchair doctors diagnosing others, which can have a negative impact on their lives and careers. It was an implication. In this case, statements or questions are often used to discriminate.

It is not unreasonable to question whether a surgeon can operate, whether a pilot can fly, whether a human can drive, and whether a president can make convincing decisions even at an advanced age. Their actions can affect safety. However, we need to ask whether these abilities depend on chronological age or biological age, and whether there is a correlation between the two.

Additionally, we know that hand-eye coordination, muscle strength, and bone mass decline with age, and blood vessels may harden. But knowing what actually affects human performance and how to quantify it is a complex question that requires unbiased, apolitical subject matter experts to answer. there is.

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

Prevention, diagnosis, and treatment of brain-related diseases are often associated with fear, and there is little we can do. We downplay brain and cognitive decline by treating it as an embodiment of aging, a “senior moment” when we forget, but we laugh at it.

However, we now know that environment, genes, behavior, and lifestyle can have a major impact on how the brain changes over time. Ironically, while the general public fears dementia and neurocognitive disorders, one of the most significant risk factors for dementia is freely prevalent throughout society. It is the SARS-CoV-2 virus that causes coronavirus disease (COVID-19).

This is not a horror movie plot. In the infected brain, “zombie” cells, or senescent cells, accumulate, accelerating brain aging. Although these cells are damaged, they refuse to “die” or be removed and accumulate in the brain, causing further inflammation and harm.

Research shows that this coronavirus, like viruses such as HIV, is neurotrophic and can infect and damage the brain and nerve cells. This can lead to early-onset dementia and other neurological symptoms. Even mild infections throughout life, including childhood, can cause cell damage, and the effects of multiple infections are cumulative.

After an acute infection, many patients complain of brain fog, decreased memory and attention, difficulty finding words and multitasking, and even personality changes. Some people recover from these long-term COVID-19 infections over time.However, long-term effects are unknown.

In healthcare, vital signs are monitored as indicators of health status. We undergo laboratory tests to assess conditions that may lead to illness and educate patients on how to modify their behaviors for better outcomes.

One area that needs more attention is brain health. We need more sensitive, cheaper, and easier-to-administer tools to screen and diagnose brain conditions early, as well as treatments to delay or reverse findings. Research from the microgravity of space has shown that the brain can rewire to changes in the environment, a type of neuroplasticity. We need to explore ways to maximize this capacity on Earth.

Most importantly, you need to prevent injuries and protect your brain at every stage of life. We are never too old to start.

Dr. Saralyn Mark is a geriatrician, endocrinologist, and former senior medical advisor to the White House, Department of Health and Human Services, and NASA. She is the COVID-19 response director for the American Women’s Medical Association and the Charles F. Bolden Group’s strategic advisor for human health and performance.