The cognitive status of federal officials needs to be addressed. Too many of them manifest some degree of impairment and are not fit to serve in government. There is little question that our last president, Joe Biden, was intellectually diminished, and may have been suffering from a neurologic disorder. His speech was hesitant and slow when he wasn’t reading, he had difficulty answering questions, and his gait was abnormal. When he ran for president in 2020, he was more intact and deteriorated over the four-year course of his term. Biden is now 82 years old.

Our current president, Donald Trump, is 78 and will be 82 when he finishes his term. Trump at times misnames people and places when speaking and uses the wrong words occasionally. Some of his actions are impulsive, like his idea to take over Gaza, and some appear contradictory. It is unclear at this point whether he is mildly cognitively impaired, has a personality disorder, or possibly both. As people age, personality quirks, present when younger, tend to become more pronounced, particularly if cognitive difficulties have emerged.

Some journalists have labeled Congress as an "old age home." The recent Republican Senate leader, Mitch McConnell, will be 83 this month. John Thune, the current Senate Majority Leader, is 64 years old. The median age of senators in the 118 Congress was 65.3 years. In 2024, 30 Senators were from 70 to 79 years of age, with five over age 80. Chuck Grassley of Iowa was 93, the longest serving Republican in Congressional history. Diane Feinstein of California, retired from the Senate at age 89 and died the next year at 90. During her last years in the Senate, she was in poor health and her mental acuity was compromised. The House of Representatives on average is younger than the Senate. With 437 members in the 118th Congress, the average age was 58 years old. Twelve members were 80 or older and 62 members were in their 70s.

Age itself should not exclude people from political office. Unfortunately, however, as people age their memories fade and problems arise with cognitive function. Though common, this is not universal and there are people in their 80s and 90s who are cognitively intact. But with age, many people develop mild cognitive impairment (MCI) and many of these progress to frank dementia.

Dementia and Alzheimer’s are not synonymous, though Alzheimer’s is the most common cause of dementia. Other disorders that can result in dementia are cerebro-vascular disease (multiple small strokes or a few big strokes), Lewy Body Disease, Fronto-temporal Dementia, Chronic Traumatic Encephalopathy CTE), Parkinson’s Disease, cerebral anoxia of any etiology, and a number of less frequent disorders. Sometimes, cognitive impairment can result from the adverse effects of medications in older people.

According to the U.S. Census Bureau, one in six people in the United States in the 2020 census were 65 or older. The National Institutes of Health reports that approximately two out of three Americans note some level of cognitive impairment at an average age of about 70. This can mean age related memory loss, mild cognitive impairment (MCI) or dementia itself. The older a person becomes, the greater the chances he or she will develop MCI or dementia. The lifetime risk of exhibiting dementia is 37 percent for women at a mean age of onset of 83. For men, the lifetime risk for dementia is 24 percent with a mean age of onset of 79.

People with MCI can often disguise their disability in social situations and may seem quite normal to most observers. But do we want officials with any degree of cognitive dysfunction in leadership roles in our nation? Our health, social and economic well-being is in their hands as well as the possibility of war and the chances of using nuclear weapons. But how do we sort out impairment in our elected leaders before they attain office. The answer is simple but would undoubtedly be opposed by most elected officials.

Before any person over 65 is allowed to run or be appointed to a federal office, he or she should have to undergo a battery of cognitive tests, administered by a three-person panel of independent neurologists, neuropsychologists, or other trained personnel. These would not be ordinary screening tests, but more detailed testing that would pick up minor abnormalities. If a person were found to be borderline impaired, greater diagnostic evaluation would be ordered. Anyone who was impaired would be prohibited from running for federal office. Since elected officials would never agree to this testing voluntarily, this would have to be passed in individual states through referenda. It is likely that some states would proceed to cognitively test their candidates for federal offices and others would not, given the disdain for science and scientific expertise that is prevalent in some areas of our nation. For presidential candidates to get on the ballot in states that mandate cognitive testing, they would have to be tested once.

If over time, cognitive testing was shown to be effective in removing impaired candidates for federal office, more states might adopt this strategy. It is a commonsense solution for an aging nation with aging officials and advanced technology that many older people do not understand. In fact, if testing were successful, older state and municipal candidates for office might also be subject to cognitive testing in the future.