With McCain voters should consider odds of Alzheimer’s as they should with any candidate

The fact of the matter is that as we age, the chances of developing Alzheimer’s disease increase. There are relatively simple, if time consuming, psychological tests to increase the accuracy of predicting one’s odds. I was given a half hour version of the test on the phone before I could get long term health care insurance. Is such a test part of McCain’s public medical record?

Most people have a general idea of signs of Alzheimer’s or dementia, often from having a loved one with the disease. But there are also many misconceptions about what is normal and what should be of concern. There are many web sites which can be helpful. A good one is “Warning Signs of Alzheimer’s” (LINK) from the Alzheimer’s Association.

You can read this web page and click off your own list of indications that an individual, from John McCain to yourself, may need a medical work-up with a specialist.

To get a better idea of what the clinical tests entail, strongly recommended by doctors if you report the indications in the above web site in yourself or a loved one, this is from a 2005 study:

The strongly predictive tests were, in order of their power, a Paired-Associate Learning Test, which cued participants to recall five semantically related and five semantically unrelated pairs of words; and a Perceptual Identification Task, which measured how fast participants read aloud words briefly presented on a computer screen. To test implicit memory, experimenters repeated some words to see whether “priming” took place, which would help participants read those words faster.

On the word-pair memory test, people destined to develop Alzheimer’s disease didn’t do any better when words were related than when they weren’t. The authors think these participants may already have lost key knowledge of word attributes that normally help people to more easily remember words by means of their semantic associations. You can read a short summary of this study here.

While predicting who will develop Alzheimer’s and what its course will be is an inexact science at best, tests such as this one are still all we have at this time. They should be done by a qualified neuro-psychologist (a Ph.D.) or neurologist (an M.D.).

Alzheimer’s can develop well before the age of seventy, with an unfortunate few getting early onset Alzheimer’s in their fifties. Because it is a disease which effects to varying degrees crucial aspects of mental functioning we’d expect a president to have unimpaired, shouldn’t we demand that all candidates for this office have such testing done and the results reported to the public?

Democrats have recently been accused of using code words to refer to John McCain’s age, with commentators adding that ageism is now rearing its ugly head along with sexism and racism in this campaign.

However, there is a real issue when a candidate for president has demonstrated memory problems and misspoken words which could, and I emphasize could, be an early indication of Alzheimer’s.

It matter’s not that McCain is physically vigorous and quick with a retort, which aspects of his behavior used by his supporters to dismiss age as an issue.

What is important is indications in what he says that may indicate he is in the earliest stage of Alzheimer’s.

As many of us become older we become forgetful or we may garble our words or not say precisely what we mean. This is not necessarily a sign of Alzheimer’s. It may be caused by simple inattention or distraction, or even depression.

Perhaps John McCain has had a full neuro-psychological examination. This is not just a simple mental status exam done by his regular doctor. It is a series of tests that often takes a full day. If he has we deserve a report on the results. If he hasn’t, he should.

To be fair, Barak Obama should have the same tests.

Hal Brown is not a physician. If you have any concerns about a medical problem you should consult with your family doctor. Hal has been a clinical social worker and psychotherapist since 1971. He often writes about politics and politicians from a psychological perspective.


  1. Ted Remington

    Not to mention the candidates for vice president?

    The problem you’d have to deal with is this:

    The diagnostic criteria for Alzheimer of the NINCDS-ADRDA (NINCDS and the ADRDA) are among the most used.[80] These criteria require that the presence of cognitive impairment and a suspected dementia syndrome be confirmed by neuropsychological testing for a clinical diagnosis of possible or probable AD while they need histopathologic confirmation (microscopic examination of brain tissue) for the definitive diagnosis. (from the wikipedia article on Alzheimer’s disease.)

    Note that the definitive diagnosis (as opposed to the clinical diagnosis, which is really just a best guess, though usually a good one) requires microscopic examination of brain tissue. How many politicians are going to allow a sample of brain cells to be removed for examination? My doctor told me the other day that the diagnosis requires a postmortem examination to be completely accurate.


  2. Hal Brown

    My understanding (and I could be wrong – among our readers isn’t there a physician could could help out?) is that as the symptoms get worse the differential diagnosis (ruling out strokes, blood clots, brain aneurysms, brain tumors, seizure disorders etc.) becomes more reliable.

    Read about the differential diagnosis of Alzheimer’s here. Note that there are many symptoms you may think indicate Alzheimer’s which are caused by other conditions, so treatable and even reversible.

    It is true that only an autopsy can determine for certain if a person had Alzheimer’s.

  3. pollchecker

    That’s all we need. A President that can’t remember the conversations he has had with other world leaders!

    McCain is an antique. He is already show signs of either dementia or alzheimer’s in the comments he makes.

    He’d make a much better pundit that POTUS. Maybe after Obama beets him in November, he can go to work for FOX News or the Daily Show.

  4. Helen Rainier

    McCain’s ability to speak extemporaneously leaves much to be desired. I still haven’t been able to determine if he is just intellectually lazy and doesn’t bother to learn what the issues are about (witness not knowing the difference between Sunni and Shia) or if he is just shooting off his mouth without knowing what he is talking about.

    Either way though, I believe it is a red flag that there is something seriously deficient in his ability to serve this country. I don’t want someone as the leader of this country who doesn’t care enough to learn the facts or someone who just shoots from the lip. We’ve already had eight years of that with Bush and we sure as hell though don’t need another four years of the same damn thing.

  5. Warren

    The requiring of medical tests bothers me. Were we to require a test for Alzheimer’s for the President, we would be legitimizing pretty much any sort of test for anything from anybody. That’s a slippery slope I’d rather not move further down than we already are.

  6. shade

    I just recently familiarized myself with the Warning signs of Alheimers’ site. Because I thought I was losing my mind, but so far, it is only my keys, or where I wanted to go when I left one room for another.

    There is also such a thing as the Biological versus the Chonological age. The Chinese have been occupied with this a lot longer than the western world.

    With the recent totally unexpected death of Tim Russert, who, as one looks at his Dad, apparently had “good genes”, one can imagine how lifestyle and life’s experiences also play a big part in “aging”.

    Sadly, and without wanting to be “agist”, when one remembers the horrendous situations McCain went through in Vietnam, it is not surprising that at a fairly young age of 71, he presents as someone older than his chronological age. That alone, should give one pause at the voting booth. And, of course, the choice for VP becomes a lot more important.

    Some links:
    Blog: Biological Age vs. Chronological Age



  7. Hal Brown

    Requiring vs. disclosure:

    Response to Warren:

    The requiring of medical tests bothers me. Were we to require a test for Alzheimer’s for the President, we would be legitimizing pretty much any sort of test for anything from anybody. That’s a slippery slope I’d rather not move further down than we already are.

    I agree with this excellent point. But there is a way already in place to keep us informed as to whether our candidates have diseases that increase the odds of them dying in office. We’ve already been provided with information about the likelihood McCain’s melanoma could recur.

    I don’t think it is a requirement as such, but traditionally in modern times candidates have allowed their medical records to be released. It seems to me that a responsible physician who saw indications of early Alzheimer’s would refer their patient for further tests with a specialist.

    Of course the patient wouldn’t be required to follow though, but the observations leading to the recommendation should be part of the medical record.

    Whether a less than entirely ethical doctor would leave this out of the record of a candidate for political reasons remains to be seen.

  8. HB

    You make a valid point, but I disagree with the testing methodology. I couldn’t pass that test, and I don’t have Alzheimer’s. I work with my brain and am a part-time grad student. I’m in my early 50s – for decades I’ve had to write things down so I could recall them, and I have no recollection of family events that my wife remembers clearly. What I do have is ADD. The symptoms appear to dovetail.

    Let’s face it, given our present level of medical knowledge and expertise, McCain is simply too old to become president. The odds that he will develop a debilitating disease are unacceptably high. I’m not a McCain supporter, and I don’t know where this leaves McCain supporters. Perhaps they should pay special attention to their choice of VP.

  9. jgw

    The man is simply too old for the job. Reagan was that old and left office in trouble. If one ages 6 years for every year served it means that he would functionally be 85 years old after the first two years of his presidency.

    I suspect, however, this is the least of his problems. Has anybody noticed that television only seems to show the right side of his face. Sometimes, however, he will reflexively turn his head and then it gets pretty interesting. The left side is where he had the cancer operations. If you get a good shot there is also that purple ‘something’ on his face, just below the ear which is NOT where the operation happened. I used to think it was just shadow. Now I think otherwise. My wife, who understands such things, says that they have this area seriously covered with makeup.

    My thought is that he will probably be replaced when they have their convention. This, of course, will completely throw the Dems off their plan. We live in interesting times….

    Port Angeles, WA