Of all the symptoms that accompany Alzheimer’s dementia, loss of executive function is the most disabling and also most characteristic. Executive function is the brain activity that makes it possible for us to plan and execute purposeful multi-step actions like putting on our clothes, cooking a meal, driving to work, and so on. Without it, we are always reacting to immediate stimuli rather than acting towards a goal.
A normal person decides to put on socks and goes to the sock drawer, picks out a suitable pair of socks, and dons them on his/her feet. Task accomplished.
A person with impaired executive function, sees a drawer pull, and opens the drawer because he/she has done that thousands of times before. If it happens to be a sock drawer that was opened, the person may pick out one of more pairs of socks, and depending on the situation, he/she may don them regardless of whether the feet are already wearing socks. For the person with impaired executive function, each act is a separate event rather than part of a goal-directed plan,
There are other symptoms of dementia. These may include memory loss, confusion, agitation, aimless activity such as pacing, and loss of higher-level skills such as shopping, paying bills, telling or comprehending a complex yet coherent story. Very young children display all of these behaviors but are more fortunate than cognitively impaired adults who have no parent(s) to help them navigate a complex world.
Those of us who have dealt with cognitively impaired adults in the clinical setting see these things outside of the clinical setting and often recognize them as signs of illness. Untrained people see the same things and may not recognize the underlying problem. The same untrained folks may see dementia where it does not exist – misinterpreting word-finding difficulties or inability to remember names as signs of dementia when they can and do occur at any age.
I am dwelling on this issue this evening because of Nikki Haley’s readiness to dismiss both Trump and Biden as old guys in cognitive decline. With respect to Trump, I think that she is right. The examples of his impairment include: repeated misattribution of events to individuals who were not participants in the event (ex: running against Obama when he actually ran again Hillary Clinton, claiming that Haley was at the Capitol on Jan 6, 2021 refusing additional protection, and claiming that Biden will precipitate WW II); confabulation (making shit up) – including that the 2020 election was rigged, that American troops took over airports during the American Revolution, and suggesting that injecting bleach might be a cure for COVID. There are many other such examples. His rambling word salad rally rants is another clue that suggests significant cognitive impairment. His inability to control his social media posting and in-court outbursts/behaviors (symptoms of behavioral disinhibition) give another hint.
Biden, on the other hand is a stable gaff machine. That is, Biden has been making gaffs for at least the last thirty years. His most recent gaffs are no different in frequency or significance than they were thirty years ago.
As to Haley’s suggestion that cognitive decline is an inevitable part of aging, I can only say, “Shut up and sit down because you don’t know crap!” The lifetime prevalence of Alzheimer’s disease in women is 20% and 10% in men. In other words, the vast majority of older adults will never develop clinically significant cognitive decline. My own mother died a few weeks short of her 98th birthday and was as sharp as a tack to the very end – interested in astronomy, NASA missions, new medications and treatments (she was a pharmacist), and current events including the doings of his Most Vile and Putrid Orangeness.
The prevalence of Alzheimer’s is 10% in folks 65+. Among folks aged 65-74, the prevalence is 5%. Among people 75-84, the prevalence is 37.2%. I’ll grant you that 37%+ is worrisome, but it doesn’t come close to being the majority of older adults.
So, until there is diagnostic evidence that Biden has cognitive impairment, I’m going to say that Nikki Haley is guilty of three sins:
- She doesn’t know what the fock she’s talking about.
- She is guilty of using false equivalency arguments to equate Biden’s gaffs with Trump’s dementia.
- She is guilty of Ageism.
But the Universe tends to be evenhanded about these things. Nikki, two thirds of all Alzheimer’s disease cases in the USA occur in women. Ponder that.