Serious neurological conditions in US presidents: Is it the job or unfortunate luck?
Key Takeaways
Presidents Woodrow Wilson and Ronald Reagan both experienced cognitive issues while in office.
Experts remain unsure whether the demands of the Presidency could contribute to cognitive decline, as research on this topic is limited.
Some experts argue a cognitively enriching environment, such as the job of the President of the United States, could help protect against dementia and other neurodegenerative conditions.
Cognitive abilities have taken center stage in the 2024 presidential race, but this isn’t the first time cognitive strength has been a topic of concern in the Oval Office.
Two other past presidents had well-documented cognitive issues while in office: Woodrow Wilson had a major stroke that left him incapacitated, and many Americans argued that Ronald Reagan displayed possible signs of cognitive impairment during his tenure as president.[][]
But could the Presidency itself contribute to cognitive decline? Experts aren’t sure.
A high-stress job
“They're working in a high-stress occupation where there's no break. It's seven days a week, it can be 24 hours a day, so it's clearly a high-stress occupation,” Victor Henderson, MD, MS, a professor of neurology and neurological sciences at Stanford, tells MDLinx. “Whether or not that contributes to cognitive decline, I don't think anyone knows.”
Dr. Henderson does not believe there’s sufficient evidence to confirm that the high stress of the job position has a meaningful impact on cognitive decline. “On the other hand, if there is some cognitive impairment present, then working in that kind of environment clearly will bring out the deficits that are already there,” he says. “It may not cause them, but [it may] cause performance to be more easily noticed. And in that case, it becomes very important.”
Woodrow Wilson suffered a stroke
Woodrow Wilson, the 28th president, experienced a number of strokes before and during his presidency.[] His most significant stroke occurred in October of 1919 during his second term as president. He was rendered incapacitated and bed-bound, and accounts of that time suggest he did not see sufficient recovery to fulfill his duties as president.
Instead, his personal physician and wife managed his presidency on his behalf and kept his condition a secret from the public as he served the remainder of his term. Records suggest he was severely impacted by his neurological condition during this time.[]
Dr. Henderson argues that Wilson’s experience reminds us how a person’s cognitive capacity and health can change significantly, even within the four to eight years of a presidential term.
“Woodrow Wilson is a good example of that. Of course, his problem is attributed to a stroke, [but] I think the stroke was superimposed upon the other preexisting conditions,” Dr. Henderson says. “So yes, there are conditions that can do that. Could a neurodegenerative disorder like Alzheimer's disease go from being non-obvious to something quite obvious and clinically relevant over a four-year period of time? I think, even there, the answer is yes,” he says.
A modern example: Ronald Reagan
The cognitive capacity of Ronald Reagan has been the subject of both academic and public debate for decades. Our 40th president sparked speculation among the public when he showed signs of possible cognitive decline while still in office.[]
An analysis of transcripts of his speeches given while in office demonstrated a notable reduction in the number of unique words he used over time, as well as an increase in conversational fillers and the use of non-specific nouns. These can be indicative of the onset of dementia.[]
An analysis of Reagan’s personal diaries from his second term also found less text, difficulties finding words, spatial confusion, and disinhibition, which are possible signs of early cognitive impairment.[]
Reagan was 69 years and 11 months old at the time he took office. He left office in 1989 at the age of 77 and was diagnosed with Alzheimer’s disease in 1994.[]
The age factor
Dr. Henderson says even without the presence of a condition like Alzheimer’s, age can influence cognitive capacity. “Age itself affects cognition. People at age 70, at age 80, on a number of cognitive tasks don't perform as well as they would have on the same task at age 20 to 30. It's not true for all kinds of cognitive abilities, but it's true for a lot of them,” he says.
“On the other hand, at age 70, age 80, or age 60, people have a lot more experience, and so there is this knowledge pool they can draw on, even though cognitive abilities might not be as good as they were several decades before.”
While being president means you must constantly manage high-stress situations, expert opinions of whether the profession may contribute to cognitive decline is mixed.
Complex interactions
David Merrill, MD, PhD, is a board-certified adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center in Santa Monica. He argues a profession like the presidency may even guard against cognitive decline.
“It’s known that being in a cognitively enriching environment is protective against developing Alzheimer’s with aging. For example, it’s more protective, cognitively, to be a manager of an office team than to work alone as a toll booth operator or night-time security guard,” he tells MDLinx. “Over the years, patients have asked me how cognitively stimulating occupations can be protective against dementia if someone like Ronald Reagan can end up demented. First off, dozens of factors determine whether someone develops dementia.”
“But certainly, the extremely high level of stress that comes with being leader of the free world is likely, if not inevitably, associated with an increased risk of developing age-related disorders like Alzheimer’s disease and perhaps Parkinson’s disease. We know that chronic elevation of cortisol is toxic to the hippocampal memory centers of the brain. And work-life balance may be hard to achieve when the weight of the world is on your shoulders. What’s remarkable is how many former Presidents don’t develop dementia. Jimmy Carter has been a shining example of successful aging–even in the context of being on hospice for over a year now. [It’s] truly remarkable.”
What this means for you
Speculation surrounding President Joe Biden’s cognitive capacity has been a topic of debate among commentators. But he isn’t the first president to spark speculation on the state of the incumbent’s cognitive capacity. Evidence suggests that both Woodrow Wilson and Ronald Reagan experienced cognitive issues while in office. Some experts say being President may not negatively impact neurological outcomes, although research in the area is limited. Other experts argue in favor of the notion that an enriching environment like the presidency may effectively guard against age-related cognitive decline.