The Excerpt podcast: Biden's gaffes, Trump's flubs: are they a sign of cognitive decline?

On a special episode (first released on February 1, 2024) of The Excerpt podcast: We’ve all seen the videos of President Joe Biden and former president Donald Trump making verbal gaffes – or just simply displaying confusion. Their opponents love to keep those moments in the discourse, insisting that it means there’s something wrong. But is there? What are signs of cognitive decline and when is it appropriate to raise the alarm, particularly for candidates vying to be leaders of the free world? USA TODAY Health Reporter Karen Weintraub joins to discuss what she's learned from neurologists and others who study the brain.

Hit play on the player below to hear the podcast and follow along with the transcript beneath it.  This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

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Dana Taylor:

Hello, and welcome to the Excerpt. I'm Dana Taylor. Today is Wednesday, February 1st, 2024, and this is a special episode of the Excerpt.

We've all seen the videos of President Joe Biden and former President Donald Trump making verbal gaffes or just simply displaying confusion. Their opponents love to keep those moments in the discourse, insisting that it means there's something wrong. But is there flubs, gaffes, misspeaking? Are these signs of cognitive decline? And when is it appropriate to raise the alarm, particularly for candidates vying to be leaders of the free world? I'm joined now by USA Today health reporter Karen Weintraub, who can help us dig into it. Thanks for being on the excerpt. Karen.

Karen Weintraub:

Thanks for having me.

Dana Taylor:

Both Biden and Trump's ages worry voters. Biden is now 81, and Trump is 77. Questions about their mental fitness are a fair game, and they've both made recent gaffes that have brought the issue to the fore. Let's start with Trump. There's one clip that's circulating of Donald Trump confusing Nikki Haley with Nancy Pelosi when he was speaking to supporters in New Hampshire. Let's take a listen.

Donald Trump:

Nikki Haley is in charge of security. We offered her 10,000 people, soldiers, national guards. Whatever they want. They turned it down.

Dana Taylor:

When Haley got wind of this, she questioned Trump's mental fitness. Karen, can we gauge mental fitness from this kind of gaffe? What did the experts say?

Karen Weintraub:

So the neurologist I spoke with said, "No," that you can't gauge somebody's mental fitness from a gaff like this. The bright lights, the pressure of the campaign trail, the sleepless nights, things like that would make anybody of any age make a mistake like that. So no, it isn't necessarily age that drove Trump to make a mistake like that.

Dana Taylor:

For Biden, there is a recent moment from his speech at a brewery in Wisconsin. It's hard to make out what he's saying. Here's that clip.

Joe Biden:

And by the way, used to make beer brewed here. It is used to make the brewed beer here. Oh, Earth Rider, thanks for the Great Lakes. I wonder why...

Dana Taylor:

Karen, what might be going on here with Biden?

Karen Weintraub:

So Biden notoriously misspeaks and speaks in word salads. He was a stutterer as a child. He has called himself a gaffe machine. He loses his train of thought sometimes, and he just kind of speaks in a language that maybe makes sense to him but not to the rest of us. I don't think, or from what I've heard from people who followed him for years, this is nothing new. This is just Bidenisms. I guess we used to call them Bushisms when George Bush Jr. did them. So I think it's just the man, not his age.

Dana Taylor:

How can people determine the difference between just a normal gaff and when there's actually something wrong?

Karen Weintraub:

Right. It's hard to do with sort of a one-off. Think about a family member or yourself when you have a, quote, unquote, "senior moment." If it happens every once in a while, it's not a big deal. If it happens all the time, if it happens regularly, or if it's really quite a serious thing, if you say you're on the way to work and suddenly don't know where you are or don't know where you're going, that's a more serious event than just kind of losing your train of thought in the middle of a conversation.

Dana Taylor:

So how can voters find out if a candidate is mentally capable of serving as president or cognitive tests trustworthy?

Karen Weintraub:

That's a really tricky thing, and the short answer is not really. The folks I spoke with say that there are tests available. You can easily download a cognitive test on the internet. Trump has bragged before about acing those tests, but you can study for those ahead of time. There are some more sophisticated tests available, but you have to get that through a special cognitive assessment through a specialist. The people I spoke with say everybody should be getting those from middle age on a pretty much annual or every other year basis so that you can see decline over time, that that's what's key. We all have different starting points, and it's really the change over time that matters, not a single moment in time.

Dana Taylor:

Karen, politically speaking, the issue of a candidate's mental fitness is a genie that's hard to put back in the bottle. Is there some magic trick that Biden or Trump can pull out to make these narratives go away? And how might the two campaigns differ in their strategies to do that?

Karen Weintraub:

In a sense, they both have the same problem in that they're pretty similar in age. There's the same generation. I don't think it's going to go away. Haley is trying to use it to her advantage. The experts I spoke with say that it's actually a problem that she's using that. That it's emphasizing age bias and stigma in a way that's inappropriate, that's going to make other older people feel self-conscious inappropriately.

Dana Taylor:

Most of us lose the mental sharpness we had in our 20s and 30s as we get older. But our older brains do some things really well. On a cognitive level, what's the main difference here between, say, how a 25- or 35-year-old's brain works and the brain of someone in their 50s or 60s?

Karen Weintraub:

Yeah, so really, it's speed. A 25- 35-year-old is going to be faster. They're going to learn things much more quickly and maybe have a faster reaction time, where a 70- or 80-year-old is going to take longer to learn that piece of information. But it's going to be able to put that piece into a larger context more easily. As one person described it to me, it might be what we would call wisdom. And so we have this stereotype that older people are wiser, and that's really why we have that image.

Dana Taylor:

What are some signs of normal aging, and what kinds of errors become more likely for folks as they get older?

Karen Weintraub:

Everybody loses their keys or their glasses some of the time walks into a room and wonders, "Why I'm here? Why don't I come here to get..." That's normal. Again, if you losing your way on the way to work, familiar settings that suddenly feel unfamiliar, if that happens a number of times, that's cause for concern, really. I read a story once about a woman who looked at herself in the mirror and didn't recognize herself, and that was a moment that she knew she needed to get a cognitive assessment. So those are the kinds of things that are probably more concerning. If you are worried, it's worth getting an assessment. Again, the people I spoke with said, "People should be getting these routinely. We get our blood pressure checked. Why not get our brains checked? It's certainly an important facet of our lives." And the brain really shouldn't... The healthy brain doesn't deteriorate with age. It's only a brain that is sick that really deteriorates with age. And so if you feel like you're declining mentally, it might be a sign of illness, and so it should be something that's checked out.

Dana Taylor:

And what does medical help for cognitive decline look like?

Karen Weintraub:

So there's just the beginnings of medications available to defer, delay, slow down the progression of things like Alzheimer's. It's still very early days. There are no miracle cures yet. There's nothing that really works wonders, but we're just starting to be there. So I don't think there's going to be anything that's going to help people of Biden and Trump's generation, but maybe of our generation or certainly younger people. There will be some treatments available.

Dana Taylor:

Is cognitive decline reversible?

Karen Weintraub:

So once it's really started, once brain cells are dying, there is no way to bring them back. But there are a lot of things that you can do to defer, decline, except in the presence of really, if you're born with some arable genetic condition, it may not be preventable. But in general, for most of us, yes, we can put off decline with the things you already know, unfortunately, maybe don't want to do. But things like not smoking, not drinking too much, getting exercise, eating a healthy diet, all those things, the things that we know that are good for our hearts are also good for our brains.

Dana Taylor:

And Karen, you've mentioned some of the things that people can do to keep their brains healthy as they advance and age. How do Biden and Trump compare when it comes to following these tips?

Karen Weintraub:

So the two men actually are quite different in a lot of ways in following the tips. Trump notoriously does not eat a very healthy diet. He loves fast food, and he hates exercise. He golfs, but otherwise does not believe in exercise. Biden is very active. He gets some, according to his latest physical, gets activity, five days a week. Jill Biden has encouraged him to eat a healthier diet, although apparently he loves ice cream and peanut butter and jelly sandwiches, and so he has a healthier lifestyle despite his slightly older age. So unclear whether either of those has an implication for either man's mental health or brain health. But over time, generally, those things do have an impact. Neither man smokes or drinks. So that's good for both of them.

Dana Taylor:

Karen, thanks so much for joining me.

Karen Weintraub:

Thanks so much for having me. Appreciate it.

Dana Taylor:

Thanks to our senior producer, Shannon Rae Green, for production assistance. Our executive producer is Laura Beatty. Let us know what you think of this episode by sending a note to podcasts@usatoday.com. Thanks for listening. I'm Dana Taylor. Taylor Wilson will be back tomorrow morning with another episode of The Excerpt.

This article originally appeared on USA TODAY: The Excerpt podcast: Biden's gaffes, Trump's flubs. Cognitive decline?