The country keeps watching short clips and drawing big conclusions about the oldest contenders ever to seek the White House. A geriatric physician with almost five decades caring for thousands of older adults says we’re asking the wrong questions. From his seat in the clinic, the campaign conversation is a mess—heavy on spectacle, light on what actually signals mental fitness for the presidency.
This doctor has been here before. Decades ago, he opposed publishing the full details of President Gerald Ford’s physical, including intimate exams that had nothing to do with job performance. His point was simple: don’t scare good candidates away with irrelevant disclosures. But he backed releasing information that truly affects a leader’s ability to serve or survive. That same line holds today.
He looks at the 2024 field and sees three very different medical narratives. Kamala Harris, he says, released enough information and shows no behavior that raises specific health alarms. Joe Biden and Donald Trump, meanwhile, are trapped in a storm—though for different reasons. Biden is judged through the lens of age. Trump, through the noise around his selective disclosures and public bravado about his own sharpness. Different paths, same chaos.
What normal aging looks like—and what doesn’t
Here’s the part the geriatrician finds maddening: people often confuse everyday aging with cognitive disease. Normal aging can slow recall, especially for names and recent events. It can make multitasking harder and speeches a little choppier. None of that equals dementia. Doctors look for patterns that persist across settings and time, not one-off gaffes or a stiff walk on a cold day.
So what are doctors actually watching for? Two big buckets: cognition and function. Cognition covers memory, attention, language, and executive function (planning, problem-solving, judgment). Function covers the real-world stuff: can a person manage complex tasks, track details, adapt under stress, and keep a long schedule without getting lost or overwhelmed?
- Common in normal aging: slower recall that improves with cues, word-finding pauses that don’t derail complex thought, more time needed to switch tasks, and a preference for written notes.
- Concerning signs: rapid forgetting even with cues, losing the thread of conversations repeatedly, getting confused across familiar settings, personality or behavior changes, poor judgment with safety or money, and consistent difficulty managing multi-step tasks.
Doctors also check the basics that can masquerade as cognitive decline: sleep problems, hearing loss, depression, anxiety, thyroid issues, low B12, infections, and medication side effects. Fixing those can restore attention and memory. That’s why a single “cognitive test” taken once isn’t the whole story.
Speaking of tests, brief screens like the MoCA or MMSE are useful snapshots, not IQ tests. A solid score can be reassuring, but it doesn’t capture everything a presidency demands. Executive function—especially under pressure—matters more than reciting word lists. In real life, that shows up as keeping a heavy schedule, absorbing briefings, weighing tradeoffs, and making decisions without getting boxed in by stress or fatigue.
Gait, hearing, and vision get less attention in politics but matter in geriatric medicine. A slower gait or hearing loss doesn’t equal cognitive failure, but both can drag down performance if unmanaged. Hearing loss, in particular, makes it harder to follow fast talk and can look like poor memory. Good hearing aids and clean audio can fix that.
Judging candidates without a clinic—Biden, Trump, and Harris
How should voters think about Biden and Trump with all of that in mind? Start with the record you can see: long-run behavior, not edited clips. Watch for sustained patterns. Listen for how they process questions, manage details, and correct themselves when they misspeak. Presidents have speechwriters and teleprompters, sure—but they also face unscripted moments. Consistency across those moments tells you more than a viral stumble.
Biden’s age is the center of his narrative. His stiff gait and verbal stumbles get outsized attention. The geriatric view: those signs can be part of normal aging, especially with orthopedic issues or neuropathy, and they don’t prove cognitive disease. What matters is whether he shows ongoing problems with judgment, orientation, and managing complex decisions over time. That requires looking beyond clips to his day-to-day functioning in office: briefings, meetings, negotiations, crisis responses. If those hold steady, the case for impairment is weak. If they wobble across settings and months, that’s different.
Trump sits in a different swirl. He has leaned on a short cognitive screen he once took and has resisted releasing granular medical details. His public style—rapid, tangential, and combative—forces people to make health guesses off rhetoric. That’s risky. Doctors don’t diagnose from rally footage. They look for consistent mental slips across contexts, not a speaking style. Again, the useful questions are the same: Can he track complex briefings? Correct factual errors when presented with new information? Maintain judgment under stress? Handle multi-day work without apparent cognitive fatigue? If yes, that weighs against claims of decline; if not, that’s relevant.
Harris is the quiet outlier here. Her disclosures have been straightforward, and there hasn’t been a stream of health-related alarms around her public behavior. In medicine, no news—when paired with adequate transparency—often means nothing concerning has popped up.
So what should medical transparency look like for a president? The geriatrician’s Ford-era stance still fits: release what matters for job performance, not what’s private and irrelevant. Voters don’t need to know the details of a rectal exam. They do need to know about conditions that can impair attention, memory, judgment, or stamina—and how those are being managed.
A useful presidential health summary would cover:
- Major diagnoses that could affect cognition or stamina (e.g., stroke history, sleep apnea, significant head injury, uncontrolled diabetes, major psychiatric conditions), plus how they’re treated.
- Medications that can cloud thinking or cause daytime sleepiness—and whether safer alternatives exist.
- Hearing and vision status and whether they’re corrected during work.
- Sleep quality, including any treatment for apnea, because poor sleep undermines attention and decision-making.
- Any recent, validated cognitive screening and how to interpret the score in context, not as a pass/fail.
- Functional capacity: the ability to handle long schedules, briefings, travel, and crisis management without signs of confusion or sustained error.
What shouldn’t be in a report? The same as in Ford’s day: intimate, unrelated findings that have no bearing on the job. Publishing those doesn’t protect democracy; it just invades privacy and may scare capable people from running if they have harmless, embarrassing, or unrelated conditions.
One more thing the doctor stresses: timing and trend matter more than a headline. A single clean physical tells you less than a stable pattern across years. Likewise, a single viral misstep tells you almost nothing. In geriatrics, the rule is to watch the arc. Does someone recover from mistakes quickly? Do they adapt when a plan changes? Do they ask clarifying questions and incorporate new facts? That’s executive function in action.
For voters, the checklist is straightforward. Focus on decision quality, not delivery style. Look for sustained attention, not perfect memory. Give more weight to consistent performance across months than to any one debate or gaffe. Ask campaigns for disclosures that address actual risks to leadership. And remember the doctor’s warning: public talk about aging often misses the mark. The goal isn’t a perfect brain scan. It’s a reliable leader.
Strip away the noise and the standard is the same for Biden, Trump, and Harris: show that the brain systems behind planning, judgment, and adaptability are intact and well supported. That’s what geriatric medicine tries to measure. And it’s what the public deserves to see—less theatre, more proof.
Underneath the headlines, the lesson is simple. Elevate the signals that truly track cognitive health. Stop treating normal aging like a diagnosis. And demand the kind of medical transparency that reveals whether the next president can do the job, not whether they have a private finding that belongs in a clinic, not a campaign ad.
