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The Justice Department’s lengthy report on President Biden’s handling of classified documents included an alarming assessment of the president’s health and mental health.
Special Counsel Robert K. Hur said the 81-year-old Biden was an elderly man with “poor memory,” “deteriorating capacity,” and “no recollection of his time as vice president.”
In conversations recorded in 2017, Biden was “often painfully slow” and “struggled to remember events, sometimes straining to read and communicate his notes.” Biden is so mentally impaired that it is unlikely a jury will convict him, Ho said.
Republicans were quick to jump on board, with some calling the president unfit for office And they are demanding his dismissal.
But while the report downplayed Biden’s mental health, medical experts on Friday said the decision was not based on science and that the method doctors use to assess possible cognitive impairment. He pointed out that it was not similar to the method used for this purpose.
In its simplest form, this is an issue that doctors and families have been grappling with for decades. How do we know that an episode of confusion or memory loss is part of a serious functional decline?
The answer is “no,” says David Loewenstein, director of the Center for Cognitive Neuroscience and Aging at the University of Miami’s Miller School of Medicine.
Diagnosis requires a series of sophisticated objective tests that look at several areas, including different types of memory, language, executive function, problem solving, spatial skills and attention.
He said the tests will determine whether a person has a medical condition and, if so, its nature and extent. Dr. Loewenstein and other experts said stumbling over words is not evidence.
“Forgetting an event doesn’t necessarily mean there’s a problem,” says Dr. John Morris, a professor of neurology at Washington University in St. Louis.
Special Counsel Hoare based his conclusions on a review of five hours of interviews conducted in the two days after Hamas’s surprise attack on Israel and an interview with a ghostwriter recorded in 2017.
However, to scientifically identify memory problems, doctors assess changes in a person’s cognitive function over time to see if the magnitude is sufficient to reduce the patient’s ability to perform normal activities. Dr. Morris said.
The best way to determine whether such changes have occurred is to compare the results of today’s memory tests with those of tests taken five or 10 years ago, he added. If this is not possible, doctors may interview someone who knows the person well (usually a close relative) to find out whether there has been a decrease in symptoms.
Dr. Mary Ganguly, a professor of psychiatry, neurology, and epidemiology at the University of Pittsburgh, pointed out that recall is just one aspect of cognition.
To make an accurate diagnosis, a geriatric psychiatrist may ask how long the patient has had problems with the ability to plan, organize, and express themselves. If you are forgetful, what do you forget and when?
“We want to know not just ‘memory,’ but specifically what kind of loss was observed,” Dr. Ganguly said. “Did it just happen once when the person was tired or sick, or did it happen consistently and with increasing frequency?”
Dr. Ganguly added that it is important to rule out other causes that may affect cognitive function, such as stroke or head injury, or even the use of certain common drugs.
For example, diphenhydramine (sold under brand names such as Benadryl) often causes memory loss. People who chronically use sleep to fall asleep end up being more forgetful. (Patients often tell her they take Tylenol at night, but she said Tylenol PM actually contains diphenhydramine.)
Dr. Ganguly added that dementia has a unique pattern of memory loss and should not be confused with everyday forgetfulness. People with dementia usually forget recent events, such as what they had for breakfast, but remember things from the distant past, such as their wedding day.
Dr Ganguly said a detailed examination could take an hour and may also include interviews with family members. Your family doctor may perform a more simplified assessment, including a brief memory test such as the Mini-Mental Status Examination or the Montreal Cognitive Assessment, known as the MoCA.
For these tests, patients are asked for the date, time, and clinic location. You may also be asked to draw a clock showing a specific time. They are told a few words and asked to repeat them after a moment.
To assess cognitive status, Dr. Lowenstein often uses a much longer and more empirical series of objective tests. A basic principle in the field is never to diagnose a patient you haven’t seen in a medical setting, he said.
“‘Oh, this person went to the refrigerator and forgot why,’ or ‘Oh, they have another name, and they replaced someone’s name with another name,'” Dr. Loewenstein said. I was furious at the experts who had the audacity to make a diagnosis.” what’s in their head. ”
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