Campaign trail gaffes by Trump and Biden put a spotlight on their ages. Should voters worry?

Standing under bright lights, delivering yet another key speech to a standing-room-only crowd with viewers watching live around the world ‒ it's a recipe for anyone of any age to stumble and make verbal missteps.

That's why several neurologists and experts on language and the aging brain weren't particularly concerned when Republican candidate and former President Donald Trump, 77, recently confused his opponent Nikki Haley with former House Speaker Nancy Pelosi. Travel, long days, the stress of campaigning, his criminal and civil trials might be adding to Trump's mental burdens right now, they said.

Similarly, President Joe Biden, 81, once called out to a congresswoman during a news conference, a few weeks after she'd died in a car accident.

"Whenever a person is under a lot of pressure, errors can happen," said Catherine Price, who studies brain function and changes in older adults at the University of Florida.

Price and other experts who spoke with USA TODAY emphasized they had no specific insights on the brain health of either Trump or Biden but spoke in general terms about aging and cognition.

Although Haley has made much of Trump's misstatement, the glee that partisans on both sides take in the missteps of the other leading candidate is not based on science, the experts said. The jabs only serve to reinforce anti-age bias and discourage older people who may need medical help from actually getting it.

"Attacks on dementia, disability, and mental competence may be useful in the short term for gaining a political advantage. However, this rhetoric may also have a chilling side effect in preventing older adults with legitimate concerns about their memory and language from seeking help," said Jamie Reilly, a professor of speech-language pathology and neuroscience in the College of Public Health at Temple University in Philadelphia.

"It is fair to judge people on the content of their language output and the consequences of their actions over months and years, but not on the form of their speech,” he said.

Biden had a stutter as a child and has referred to himself as a "gaffe machine."

Older people's brains perform differently than younger ones ‒ not necessarily better or worse, said Dr. Alvaro Pascual-Leone, a professor of neurology at Harvard Medical School and Medical Director, Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife.

The risk of brain diseases increases with age, but there is no reason an 85-year-old should consider their brain any less able than a 25-year-old's, Pascual-Leone said. "It is simply ‘differently able.'"

While young people can learn new facts more quickly, senior citizens can better integrate those facts into a bigger picture ‒ what might be called "wisdom" – and precisely what the public might value in a president, he said.

"Do we really want world leaders to be assessed and judged by how easily they can find their glasses? I think there are bigger fish to fry," he said.

To learn more: How old is Donald Trump? Here's how old the former president will be when we vote in 2024.

How should a candidate's mental fitness be judged?

There's no perfect way to assess a candidate's mental fitness for office, said Reilly, also an expert on dementia and the aging brain.

People can take cognitive tests to assess their mental awareness, reasoning and memory. Trump has bragged several times, including in New Hampshire, about acing such memorization tests.

The answers to many are readily available online, Reilly said, so anyone who knew they were going to be given a particular test could study ahead of time and do well.

Also, some of the tests are subjective, so a doctor biased in favor or against a particular candidate might be able to skew their findings to show a glowing result or a downward spiral.

That's why brain health should be routinely assessed by clinicians with measures not in the public domain and by board certified professionals, Price said.

Pascual-Leone added such brain health screening exams should be given routinely starting in middle age, to capture changes over time, rather than a snapshot that might miss an individual's decline.

In surveys, the vast majority of people say they want to be tested, so they'll know if a brain disease is setting in, Pascual-Leone said. Most primary care doctors agree they should offer their patients such testing, but less than 20% do in part because they lack the tools that fit in their time-pressured schedules.

Even the president's annual physical, which is summarized for the public, doesn't routinely include cognitive testing.

"There is a huge gap between the expressed desire and need, the awareness by clinicians and the reality of what is being done," Pascual-Leone said.

What normal aging looks like

Everyone's brain ages at a different pace, because of factors like education, nutrition, exercise and the setting under which they are operating, said Price, of the University of Florida.

Typically, as people age, they tend to take longer to retrieve words, names and thoughts.

To read more: How old is Joe Biden? The oldest US president just blew out another candle.

Sometimes older people mispronounce a word or start it with the wrong letter.

There are also "semantic" errors, where people will mix two things from the same category. If Trump categorized both Nikki Haley and Nancy Pelosi as "female competitors" in his mind, experts said, that might explain why he mistakenly said Haley was at the Capitol building on Jan. 6 when it was actually Pelosi.

"There are many different error types that can happen," Price said.

She also considers whether the person recognizes when they've made an error. If they quickly correct themselves, it generally means they know they've made a mistake and still have insight into their own behavior.

Trump typically doesn't correct his misstatements, while Biden often does, but that could be part of Trump's persona, rather than a sign of any brain aging, experts said.

How to maintain a healthy brain with advancing age

Fitness and general health affect brain health, Price said. What's good for the heart is good for the brain, keeping blood flowing throughout this vital organ.

Regular exercise is important, Price and the others noted, along with avoiding tobacco and excessive drinking, maintaining a healthy weight and eating a diet with lots of fruits and vegetables.

Controlling other health issues is also key, Pascual-Leone said: Preventing diabetes and effectively treating any high blood pressure, high cholesterol, sleep apnea, thyroid problems or vitamin deficiencies.

Biden and Trump presumably get the best possible medical care. Biden takes a statin and a drug that prevents blood clots, along with medication to treat seasonal allergies, sinus problems and acid reflux, his 2023 physical reported. Trump also takes a statin to lower his cholesterol, according to his 2020 physical, the last one made public. No other regular medications were disclosed.

Biden wins more points on lifestyle.

Although more than three years older, the president maintains a regular exercise routine, working out at least five days a week, according to his physical, while Trump avoids exercise other than golf.

Biden is trimmer. In 2020, Trump tipped into the obese category, with a body mass index, a ratio of weight to height, above 30.

Apparently, first lady Jill Biden has pressured her husband to eat more fish and vegetables, though he prefers peanut butter and jelly sandwiches, BLTs and ice cream. Trump famously enjoys a lot of fast food, including fried chicken and hamburgers.

Neither man smokes nor is known to drink.

Changing habits isn't easy, but having information is empowering and a healthy lifestyle is hugely important for the aging brain, Pascual-Leone said, reducing the risk of brain illness progression by 40% to as much as 80%.

"It's a crime" that most people aren't aware of the role of lifestyle in maintaining brain health, he said.

Worried well versus reasons for concern

Price said she often sees the "worried well" who walk into a room, forget why they are there and are concerned it is a sign that they are "losing it." Typically it's not. But getting an evaluation is appropriate.

When thinking about whether a politician's behavior raises red flags, Price said it's a good idea to consider how you'd react if a family member or someone you know well made the same mistake.

If they made it once or twice, you'd probably laugh it off or think nothing of it, she said.

If the number and types of errors increase over time and particularly if the person isn't recognizing or acknowledging their mistakes, you might get increasingly concerned.

Waiting to address memory issues after they're already a problem is a terrible idea for anyone, Pascual-Leone said.

By then, it's probably too late for medications or lifestyle changes to reverse damage to the brain. And when a patient raises memory concerns, they are typically referred to a specialist.

Even in Boston, where there are more brain specialists than in all of the United Kingdom, the typical wait for a cognitive neurologist or neuropsychologist runs 9 to 12 months, Pascual-Leone said.

"Do you know how many neurons you lose in 12 months if you have progressive disease? It's crazy," he said.

A much more effective approach would include having primary care providers do regular testing from middle age onward that can flag the earliest signs of decline, providing further tests, lifestyle recommendations and effective medications, if needed, he said.

"And I think that should be true for all of us ‒ including for our presidents."

This article originally appeared on USA TODAY: Both Trump and Biden's ages worry voters. Verbal gaffes make it worse.