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UCI Health neurologist addresses cognitive health among aging candidates

November 15, 2019
UCI Health neurologist Mark Fisher, MD

UCI Health neurologist Mark Fisher, MD

IN THE NEWS: A looming presidential election year has increased interest in assessing cognitive health in aging politicians. UCI Health neurologist Mark Fisher, MD, commented for an article in The Atlantic about a presidential race in which the incumbent and some opposing candidates more than 70 years old:  

…the idea of fitness for office has manifested itself in the customary presidential disclosure of medical records and an annual physical exam. That process, though, is perfunctory at best. After Trump was elected, his physician during the time he ran for office, Harold Bornstein, claimed that the president had dictated his own glowing health assessment. 

“It was very obvious from the start that that examination had no credibility,” says Fisher. “It was unprofessional and unacceptable as an assessment of his health.”

Vice asks “Is It Time to Start Testing Presidential Candidates for Cognitive Decline?” This and other recent articles refer to the 2014 paper, “Executive dysfunction, brain aging, and political leadership,” in which Fisher was the lead author. 

"Based on the known neuroanatomical and neuropathological changes that occur with aging," Fisher and his co-authors write, "we should probably assume that a significant proportion of political leaders over the age of 65 have impairment of executive function."

Asked if people should be concerned about the advanced age of the top tier of the political class, Fisher, who has long-studied the effects of microbleeds and other changes in the aging brain, said, "This is a very legitimate question, and should not be dismissed as 'ageism.'"

The Vice article notes that this issue a particular problem for the U.S., where many of the leading contenders for the White House are over 65, and many congressional leaders from both parties are over 75. 

The 2014 paper goes on to say that “executive function shows a significant decline beginning at age 60, and this is associated with age-related atrophy of prefrontal cortex, cerebral white matter disease, and cerebral microbleeds. … While an individual may appear to be functioning normally with regard to relatively obvious cognitive functions such as language and memory, that same individual may lack the capacity to integrate these cognitive functions to achieve normal decision-making.”

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