Why it's important that President Biden's mental capacity is investigated

President Joe Biden is clearly having some memory slips on camera but this can happen to any of us - especially under pressure, jet-lagged or after a sleepless night. Whether this constitutes early dementia would be up to his doctors to decide. Instead of speculation and innuendo from the media, in view of the magnitude of importance of his presidential duties, it seems unfathomable that formal tests for dementia have not already been conducted.

It seems rather strange that we have to get a doctor's approval to drive a car over 70 but there does not seem to be the same rules to run a country. Any signs of dementia should be publicly declared as even early dementia can be linked to problems with memory recall and the ability to form new memories which can result in poor decision making, personality changes, lack of alertness and demotivation.

For people whose decisions affect the safety and well-being of millions of other people it would seem imperative to establish either whether he should consider stepping down from office or hopefully reassuring people that these TV slips are not caused by physical brain damage but are a part of being human - in which case the President can be left to get on with his job.

What tests are available to detect or exclude dementia?

In the first instance, it's important to rule out other causes of reduced cognitive function including side-effects of medication for raised blood pressure, painkillers or even anti-histamines. Medical conditions such anaemia, iron and B vitamin deficiencies reduce oxygen delivery and energy utilisation. More recently, I am seeing a lot more mineral deficiencies, particularly iodine deficiency leading to an underactive thyroid which commonly affects memory.  

Specialist memory clinics usually measure brain capacity using functional activity and memory questionnaires and perform CT or MRI scans of the brain. These can spot brain atrophy (shrinking), calcification in the vessels or even other unexpected pathology such as a slow growing tumour or previously mini strokes.

What causes dementia?

Often, no cause is found, and not reassuringly if you are caring for a relative with dementia it does tend to run in families. Ironically most studies report it affects educated and uneducated people alike, if you exclude dietary factors. The most common cause of dementia, Alzheimer’s, is caused by an accumulation of abnormal proteins in the brain called amyloid. MRI scans, in patients with Alzheimer’s disease may see changes in the hippocampus, a part of your brain involved in memory and learning. Although there are some rare infective causes via Prion proteins the formation of amyloid plaques are linked with excess chronic inflammation in the body.

Chronic inflammation is the response to an ageing, ailing immune system, accelerated by poor gut health, vitamin D deficiency, a diet high in sugar and meat, chronic lack of sleep and low in phytochemicals (the natural chemicals which give plants their colour, smell and taste). Vascular dementia is caused by hardened arteries in and around the brain which restricts blood flow, depriving brain cells from vital oxygen. Of the factors linked to vascular dementia, I'm sure the president has his blood pressure and cholesterol levels monitored habitually and is an enthusiastic exerciser who does not smoke so it is unlikely that blood vessel disease is a risk for him - although you never know.

Brain cell damage can also be caused by repeated head trauma such as in boxers, rugby and even football players. Joe Biden was a wide receiver on the high school football team, scoring ten touchdowns, so may have had some head knocks but there are no reports these were particularly significant. Other causes of brain damage include heavy metal poisoning as well as heavy alcohol intake. The President is a wealthy teetotaller and is unlikely to have sandpapered the paint off his own window sills, a risk for lead toxicity .

Age is one factor not in president Biden's favour as the chance of dementia does increase to 11% by 81 years old and this goes up to nearly 20% by 86 years old. That said, this does mean that the majority of 81-year-olds are of sound mind, albeit not as sharp as in their twenties.

Why is it medically important to detect or exclude early dementia?

if reduced cognitive function is established, there may be some reversible interventions possible such as changing medication, correct anaemia and thyroid function. Even if early dementia is detected, there are lots of support strategies and treatments available including medications such as donepezil or rivastigmine which helps with memory, concentration and mood. In terms of lifestyle and dietary interventions, once noticeable symptoms have developed, a lot of the brain cells have already been killed but it’s never too late to make changes. Many studies have shown that healthy self-help strategies can slow the rate of damage and ensure the remaining brain cells are running as efficiently as possible. These include exercise, improving gut health, vitamin D and increasing omega fat intake but one of the most important strategies is to increase consumption of phytochemical rich plants.