WIs there a relationship between aging, memory loss and general cognition? This is a matter of heated debate following special counsel Robert Hur’s report on President Biden’s alleged misuse of classified documents.
While the report does not recommend criminal charges against Biden, it has drawn considerable attention for its focus on the president’s age, with prosecutors describing him as “a benevolent, well-intentioned, elderly man with a memory of weak” and citing instances of the president having trouble remembering dates, names or details of events. Biden has pushed back against those descriptions: “My memory is good,” he told a reporter Thursday. And Democrats have pushed back, too, citing Donald Trump’s memory lapses.
Medical professionals shy away from armchair diagnoses of public figures. But the current conversation provides an opportunity to reflect on what we know about memory and the aging brain. To learn more, STAT spoke with Joel Kramer, a professor of neuropsychology at the University of California, San Francisco Medical Center, who focuses on the relationship between the central nervous system and behaviors and directs the UCSF Memory and Aging Center. The following interview has been condensed and edited for clarity.
Is aging necessarily associated with memory loss?
There are no hard and fast rules for how our memory changes with age. You have some people whose memories are clearly fading, and others we follow for years whose memory doesn’t change at all. So there is nothing inevitable about memory decline with age.
So why do we get the impression that memory always declines with age?
This is because the brain is like any other part of the body. And as we age, we are more susceptible to all kinds of conditions that are not age itself but are associated with being older. I just came from an orthopedist this morning because I have arthritis in a joint in my hand. Well, of course it’s common as you get older, but my wrist problem isn’t age, it’s arthritis. The same is true with memory. So there are 30 things that can go wrong in our brains as we age … changes that you see you’re at greater risk for as you get older, but aren’t inevitable as part of aging.
On average, an 80-year-old will not remember as well as a 60-year-old who will not remember as much as a 40-year-old. But these are only general trends. And, you can’t really assume that this particular 80-year-old will remember less than the average 40-year-old, or any 40-year-old.
Do memory errors and lapses in older age always indicate underlying conditions? Do they also suggest other cognitive impairments?
When there is a significant amount of disease, you can expect more widespread memory decline as well [mental] skills. But they are really quite separable. And in fact, one of the ways many seniors compensate for their memory problems is by having very good reasoning, planning, and judgment. Some people argue that as we get older, you see an increase in wisdom and judgment.
There was a large study of airline pilots a few years ago that showed that older pilots have slower reaction times, no doubt, but they have more experience and better judgment. So this whole notion that because someone is 80 years old that they have problems with memory and other abilities is completely nonsense.
So as a doctor, when do you start to worry about that Could memory errors be something more serious?
In fact there are several things that would cause concern: If the family comments on the changes; if we see problems with our cognitive test; whether [in] Examining someone, we see some biological signs that there may be possible diseases, we are alarmed.
Going back to memory loss, is it the same thing? Or are some types more indicative of bigger problems than others?
There are many different types of memory, and each of these memory systems relies on a different neuroanatomy or different neural networks. This will depend on the type of disease you have: the types of memory symptoms can vary quite interestingly. You may have a patient who is really impaired in one memory system and is fine in another, and another patient who has the exact opposite pattern. We see associations that can often help us diagnose.
Do you think that in the case of Biden, our bias against aging is showing?
In some cultures, when the elderly are more honored and respected, the problem we have had clinically is that the family does not recognize that the person is impaired. But in our country I don’t know if it is a cultural prejudice or rather the lowest level of political nonsense. I think there’s a certain degree that criticizing Biden’s memory and cognitive function… it’s political in this case.