A neuroscientist explains why Joe Biden’s cognitive health could hand Donald Trump the White House

With age comes wisdom, experience, and unfortunately, cognitive decline. That’s a fact that no American can ignore as we move closer to the next presidential election.

The two main contenders, a sitting president and an ex-president, will be 82 and 78 next year, respectively. When Biden won the election in 2020, he became the oldest sitting president ever, and if Donald Trump wins again — a terrifying but very real possibility — he will be the same age as Biden was when he was sworn in. So, no matter who wins, we are going to have a commander-in-chief who is so old that age-related cognitive decline will be a real concern. This is not an opinion, but a scientific fact of life, and one that will affect all of us who are lucky enough to make it to that age.

While it is clear that age does not necessarily equate to cognitive impairment, science tells us that cognitive decline is an inevitable part of aging. Studies show a slow but steady decrease in cognitive abilities, including memory and processing speed, typically starting around the age of 60, though it may occur earlier in life for some (unless you are lucky enough to be a “super-ager”).

Biden, despite his general physical health, is not immune to these biological realities. Over the past few years, we have seen instances that have raised eyebrows, even among his staunchest supporters. Biden's frequent stumbling over words, forgetting names, or losing his train of thought mid-sentence – they may seem innocuous, chalked up to the stress and exhaustion of the job. But they do raise questions about his cognitive health, especially since Biden isn’t getting any younger.

For example, in a recent speech, Biden made some perplexing statements that were quickly exploited by his critics and ideological enemies, such as, “We have plans to build a railroad from the Pacific all the way across the Indian ocean … I could go on but I’m not; I’m going off script, I’m going to get in trouble.”

This example may seem not worth mentioning, but it is just one of many gaffes that collectively indicate that there may be a reason for concern. Even if there’s no reason to believe the confusion or difficulty articulating policy or current events is affecting his ability to lead, it could certainly affect his ability to debate the eventual Republican presidential nominee., If Biden displays the kind of word salad that has become routine for him over the last couple of years, it could very well hand the presidency to Trump. (Or, say, Florida Gov. Ron DeSantis.)

I know those words are painful to hear right now, but they are a lot less painful than watching Trump get re-elected because no one wanted to say the obvious out of fear of upsetting the tribe.

Whether Biden really suffers from cognitive impairment, it is clear that Americans are paying attention and are concerned. A new poll conducted by ABC and The Washington Post reveals that people’s opinions have been influenced by the media coverage of Biden’s behavior. It showed that 54 percent of respondents believe Trump possesses the mental acuity necessary to perform efficiently as president, while only 32 percent felt Biden displayed the same trait.

Of course, it is completely impossible to know the extent of Biden’s cognitive problems without a detailed clinical assessment — the president has released a summary, but not full details from his 2023 medical check-up — and for that reason you will read opinion pieces with wildly different perspectives on the topic.

An article titled “Let’s Fact Check Biden’s So-Called Mental Decline” was published at The Independent this week arguing that the accusations of mental decline are politically motivated and unjustified. While there is no doubt that the attacks on Biden coming from the right are politically motivated, it is not true that all of the criticisms are unwarranted. If we pretend that nothing is out of the ordinary with Biden simply because he is on our political team, then we are no better than the conservatives who ignore Trump’s pathological lying and narcissism.

Despite the potential problems with Biden’s cognition, I can say with reasonable certainty that he would still make a significantly more competent president than Trump.

In January 2016, almost a year before Trump won the election, I wrote an article for Raw Story called "Trump has a mental disorder that makes him a dangerous world leader,” which was followed by many similar articles over the course of his presidency. From my research and analysis, it is clear to me that Biden’s predictable and tempered leadership style is a far safer bet than Trump's divisive rhetoric, malignant narcissism and erratic unpredictability. A Business Insider article titled “350 health professionals sign letter to Congress claiming Trump’s mental health is deteriorating dangerously amid impeachment proceedings” shows that many medical practitioners agree.

However, the question is not whether Biden is better than Trump, but whether Biden is the best presidential candidate the Democrats have to offer. We must think long and hard about a difficult dilemma, because a failure to do so could lead to a catastrophic mistake.

At this moment, there is simply not enough information about Biden’s cognitive health to be able to accurately assess his vulnerability in the upcoming election. But I can tell you this — if Biden fumbles his way through the 2024 campaign, gets destroyed in the presidential debates and loses as a result, everyone is going to ask, “How did this happen? Who thought it was wise to place the burden of warding off autocracy on an octogenarian grappling with cognitive decline? ? Who is to blame for handing the presidency to Donald Trump?”

Perhaps there’s still time to consider another Democratic candidate. It won’t be the first time a sitting president didn’t run for a second term. There are six presidents who chose not to seek re-election, including Lyndon B. Johnson, who publicly cited health issues as the main reason for the choice. Although Biden says he’s in the race to win, there is absolutely no shame in reversing such a decision, and depending on how the next few months go for Biden, it may be the only responsible thing to do.

To be clear, I am not saying stepping aside is the right thing for Biden to do, because I know I lack the information needed to determine that with any confidence.

But I am saying that it could be, and if we simply ignore the issue, we could be risking everything.

Bobby Azarian is a cognitive neuroscientist and the author of the book The Romance of Reality: How the Universe Organizes Itself to Create Life, Consciousness, and Cosmic Complexity. He is also a blogger for Psychology Today and the creator of the Substack Road to Omega. Follow him on Twitter and Instagram @BobbyAzarian.