A neuropsychologist clarifies science on aging and memory in wake of Biden special counsel report

What is the relationship between aging, memory loss, and overall cognition? That’s a matter of hot debate in the wake of special counsel Robert Hur’s report on President Biden’s alleged mishandling of classified documents.

While the report does not recommend pressing criminal charges against Biden, it has drawn ample attention for its focus on the president’s age, with prosecutors describing him as “a sympathetic, well-meaning, elderly man with a poor memory” and citing instances of the president having trouble remembering dates, names, or details of events. Biden has pushed back against these descriptions: “My memory is fine,” he told a reporter Thursday. And Democrats have also pushed back, citing Donald Trump’s memory lapses.

Medical professionals steer away from armchair diagnoses of public figures. But the current conversation does offer an opportunity to reflect on what we know about memory and the aging brain. To understand more, STAT spoke with Joel Kramer, a professor of neuropsychology at University of California, San Francisco Medical Center, who focuses on the relationship between the central nervous system and behaviors and directs the UCSF Memory and Aging Center. The following interview has been condensed and edited for clarity.

Is aging necessarily linked with memory loss?

There are no hard and fast rules about how our memory changes with age. You have some people whose memories decline rather noticeably, and others who we follow for years whose memory doesn’t change at all. So there’s nothing inevitable about memory decline with age.

So why do we get the impression that memory always declines with age?

It’s because the brain is like any other body part. And as we age, we are more susceptible to all kinds of conditions that are not age themselves, but are associated with being older. I just came from an orthopedist this morning because I have some arthritis in a joint in my hand. Well, it’s certainly common when you get older, but my problem with my wrist is not age, it’s arthritis. The same is true with memory. So there are 30 things that can go awry in our brains as we age … changes that you see that you’re at greater risk for as you get older, but are not inevitable as part of aging.

On average, an 80-year-old will not remember as well as a 60-year-old who won’t be remembering quite so much as a 40-year-old. But these are just general trends. And, you can’t really assume that this particular 80-year-old is going to remember less well than the average 40-year-old, or any 40-year-old.

Do memory lapses and losses in older age always indicate underlying conditions? Do they suggest other cognitive impairment, too?

When there’s a considerable amount of disease, you might expect a more broad-based decline in memory as well as other [mental] skills. But they are really quite dissociable. And in fact, one of the ways that a lot of older people compensate for their memory problems is by having very good reasoning and planning and judgment. Some people argue that as we get older, you see an increase in wisdom and judgment.

There was a great study of airline pilots several years ago that showed that older pilots have slower reaction times, unquestionably, but they have more experience and better judgment. So this whole notion that because someone is 80 years old, they therefore have problems in memory and other skills, is completely bunk.

So as a doctor, when do you start being concerned that memory lapses may be something more serious?

There are actually several things that would trigger concern: If the family is commenting on changes; if we see problems with our cognitive test; if [in] examining someone we see some biological signs that there might be potential disease, we get alarmed.

Going back to memory loss, is it all the same? Or are some kinds more indicative of bigger problems than others?

There are multiple different kinds of memory, and each of those memory systems relies on a different neuroanatomy or different neural networks. It will depend on the kind of disease you have: the types of memory symptoms can vary quite interestingly. You can have a patient who’s really impaired in one memory system and does okay with another, and another patient who has the exact opposite pattern. We see associations that can oftentimes help us diagnostically.

Do you think in the case of Biden, our prejudice against aging is showing?

In some cultures, when the elderly are more venerated and respected, the problem we’ve had clinically is that the family doesn’t recognize that the person is impaired. But in our country, I don’t know if it’s a cultural bias or rather the lowest level of political nonsense. I think there’s a certain degree of that criticizing Biden’s memory and cognitive function … it’s political in this case.