What is a cognitive test, which many want US President Joe Biden to take?

A cognitive test checks for problems with cognition, which includes brain functions such as thinking, learning, remembering, and using judgment and language. But is it exclusively an age-related condition?

U.S. President Joe Biden gestures as he boards Air Force One at Harrisburg International Airport on July 7, 2024. (REUTERS/Nathan Howard)

Written by: Ankita Upadhyay

3 min readNew DelhiJul 8, 2024 07:01 PM IST First published on: Jul 8, 2024 at 07:01 PM IST

Amid concern over 81-year-old Joe Biden’s fitness to stay in the race for the White House, there have been calls for the President to take a cognitive test to determine the level of his mental acuity.

Biden, who many feel is too old for the physical and mental demands of the world’s toughest job, has remained adamant in the face of an increasingly urgent campaign to have him step aside. The concern increased sharply following Biden’s poor performance in the presidential debate, after which Donald Trump widened his lead over the President in polls.

In that June 27 debate and in recent speeches and interviews, Biden has been faltering and incoherent, spoken haltingly in a raspy voice, and demonstrated an absence of facial animation, resulting at times in a flat, open-mouthed expression.

What is a cognitive test, which many of both Biden’s supporters and critics want him to take?

A cognitive test checks for problems with cognition, which includes brain functions such as thinking, learning, remembering, and using judgment and language. Problems with cognition are described as cognitive impairment.

Cognitive testing is a structured and validated process that seeks to identify deficits, the reasons for their occurrence, and the spheres of the subject’s brain they affect. On the basis of the test results, a diagnosis is reached on whether the subject has cognitive impairment, dementia, or pseudo dementia, and interventions — including behaviour therapies and cognitive therapies — are decided.

For whom is this test recommended?

People who have memory deficits, or who think they are losing memory or becoming forgetful, have difficulty in focusing or in judgment, or whose mind is not working as they think it should be working, should take the test.

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The test is frequently given by doctors in order to differentiate among dementia and pseudo dementia, and to suggest interventions for cognitive rehabilitation. “For us, doing cognitive function tests is a very regular thing,” Dr Praveen Gupta, principal director and unit head of neurology at Fortis Hospital, Gurgaon, said.

Is this a test specifically for older people?

Age is a significant factor in cognitive decline: the risk of dementia increases in every decade after 60, and becomes very significant after age 75. Dr Gupta said President Biden is of an age at which the risk of cognitive impairment is particularly high.

Biden has, however, refused to undergo any kind of neurological examination, including a cognitive test, and releasing the results to the public. Being President and running for re-election are their own cognitive tests, he has said.

Some younger people also show signs because of stress, overwork and multitasking, Dr Gupta said. “Those people also take these tests to differentiate between early onset of dementia and cognitive impairment, and pseudo dementia,” he said.

And how is this test done?

The test is basically like an exam in which a psychologist checks functions such as memory, retention, language functioning, calculating ability, and special organising ability, in order to evaluate the functioning of individual parts of the brain that are responsible for each of these mental functions.