Alzheimer's Dementia and the Presidency: New Challenges in an Aging Society

• In Event: Politics of Aging: A Global Perspective

Abstract

The U.S. political system puts almost unlimited power in the hands of one single person, the President, and thus must reckon with the problems this creates. The Founders envisioned a powerful President who is a robustly healthy and imminently wise man capable of good judgment. But what happens when this is not the case and the President has Alzheimer’s dementia leaving him with cognitive impairment, diminished critical thinking and decision-making dysfunction? The reality of a President with Alzheimer’s dementia and the complexities of the disease create new challenges under the 25th Amendment, the Constitutional safeguard to remove a president “unable to discharge the powers and duties of his office.” While families every day have to decide whether to take away the keys to the car from Grandpa, what if instead it is the country facing the dilemma of taking away the keys to the Oval Office from the president?

This paper overlays the prism of Alzheimer’s dementia onto the institution of the presidency. Using the perspective of political gerontology, a unique set of questions emerge at the intersection of politics and aging relative the disease's political and policy consequences and relative the procedures of the 25th Amendment and a president with Alzheimer’s dementia.

One in seven people or 14% over the age of 70 has Alzheimer’s. Putting that figure into the context of the current political leaders’ ages, a foreshadowing is cast onto the future of the nation having to deal with a president with Alzheimer’s. For example, the 2016 election was between two senior citizens, Trump now 72 and Clinton now 71. Many of the potential 2020 candidates are senior citizens: Sanders-77, Biden-76, Warren-69, Romney-71, Kasich-66, Corker-66, Sherrod Brown-66. This is not meant to raise alarm about electing a president over age 65 since Alzheimer’s dementia is a disease, not normal aging.

The focus of this paper’s first set of questions is: How do the symptoms of Alzheimer’s dementia have risks and consequences for domestic and foreign policy and for political institutions? The symptoms of confusion, forgetfulness, mood swings, frequent anger, lashing out, blaming others, talking in “word salad,” executive dysfunction, increased television watching, and minimal reading comprehension can have significant political consequences. These manifest in confusing and poorly developed policies, low staff morale, resignations, allies questioning the country’s dependability, Congress refusing to pass any bill without an unequivocal guarantee of being signed, unprovoked military action—all culminating in total chaos for the administration and the country.

The paper’s second set of questions addresses the political problems inherent in the procedures of the 25th Amendment wherein the Vice President and the majority of the Cabinet transfer power if a president has Alzheimer’s dementia. What political incentives exist for these officials, who owe their job to the president, to invoke the 25th Amendment? They can merely carry on behind the scenes in running the government and keep the president’s condition under wraps. How would a medical diagnosis of Alzheimer’s dementia become a partisan diagnosis? There is no definitive diagnostic test outside of the plaques and tangles in the brain found on autopsy, so an Alzheimer’s diagnosis is made through the elimination of other possible causes and by psychological tests. These subjective measures will surely raise partisan doubts. Also, there is no mechanism to force a president to submit to any testing. When and how is it determined that the president is no longer competent to make national decisions? The usual markers to remove responsibilities from a person with Alzheimer’s are difficulties with one’s routine tasks, but those are absent from a president who has a cook, driver, steward and assistants to attend to his every need. The triggers for concern would likely be advanced stage behaviors such as pouring coffee on his morning eggs or wearing his underwear outside his clothes. Without question, these behaviors would be hidden by family and staff. At what stage of Alzheimer’s dementia should the president be removed from office? Unlike a coma or a stroke that has a specific incident precipitating a president’s incapacity, Alzheimer’s dementia has gradual onset over months and years as the symptoms become progressively worse. Adding to this complexity is the fluctuation of the person’s cognitive impairment from one day to the next or even at different times of the day.

We would like to think that a president unable to carry out his duties because of Alzheimer’s dementia would without question set into motion the removal from office under the 25th Amendment. The reality is the political forces inherent in the removal process and the complexities of Alzheimer’s dementia are likely to impede any steps in that direction. This paper concludes with consideration of other potential mechanisms as safeguards for a president with Alzheimer’s dementia.

Author

• Janie S. Steckenrider, Loyola Marymount University