Originally published in 2024. Substantially updated September 2026.
During the 2024 presidential election, Americans spent a tremendous amount of time talking about age, memory, cognitive functioning, and whether someone’s behavior on television could tell us something about the health of his brain.
The discussion surrounding then President Joe Biden created a much larger conversation about an issue that affects millions of families: How do we distinguish normal aging from cognitive impairment or dementia?
As a psychologist, there is another important question I think deserves attention: How much can we really determine about someone’s cognitive functioning by watching television clips?
The answer is: not nearly as much as people often think.
A Necessary Clarification About President Biden
I did not evaluate President Biden, and I cannot diagnose him based on speeches, interviews, debates, video clips, or media reports.
That is an important distinction, particularly for psychologists who provide media commentary.
Psychologists can explain what dementia is, what cognitive decline looks like clinically, how normal aging differs from neurocognitive disease, and how cognitive functioning is actually evaluated. We should not convert those general observations into a diagnosis of a person we have never assessed.
This article therefore uses the public discussion surrounding President Biden as a starting point for explaining aging, dementia, cognitive screening, and neuropsychological assessment. It should not be interpreted as a diagnosis or psychological opinion about President Biden.
Normal Aging Is Not the Same as Dementia
One of the biggest misconceptions about aging is that becoming older inevitably means developing dementia.
It does not.
Some cognitive changes occur normally with age. A person may take a little longer to retrieve a name, occasionally misplace an object, or need more time to learn something new.
That is very different from a progressive cognitive disorder that significantly interferes with someone’s ability to function independently.
The National Institute on Aging distinguishes common age related forgetfulness from more serious cognitive problems. Mild changes can occur with normal aging, while dementia involves cognitive difficulties significant enough to interfere with everyday functioning.
Read More From the National Institute on Aging About Memory and Aging
Examples of Normal Age Related Cognitive Changes
Normal aging may involve things such as:
- Occasionally forgetting a name but remembering it later
- Taking longer to retrieve information
- Misplacing something from time to time
- Occasionally forgetting an appointment
- Needing more time to learn something unfamiliar
- Slower processing speed
- Finding multitasking somewhat more difficult
The important issue is whether the person continues to function independently.
Signs That Cognitive Changes May Need Further Evaluation
Cognitive problems become more concerning when they are persistent, progressive, and begin interfering with everyday functioning.
Examples can include:
- Repeatedly forgetting important recent information
- Frequently asking the same questions
- Difficulty managing finances that were previously manageable
- Problems managing medications
- Getting lost in familiar places
- Marked changes in judgment or problem solving
- Increasing difficulty following conversations
- Significant changes in language or communication
- Difficulty completing familiar tasks
- Loss of independence because of cognitive problems
A single mistake, forgotten word, verbal stumble, or bad decision does not establish dementia.
What Is Major Neurocognitive Disorder?
The DSM-5-TR uses the term Major Neurocognitive Disorder for conditions commonly referred to as dementia.
In broad terms, diagnosis involves evidence of significant decline in one or more areas of cognitive functioning, such as:
- Attention
- Executive functioning
- Learning and memory
- Language
- Perceptual and motor abilities
- Social cognition
The cognitive impairment must be significant enough to interfere with independent functioning and cannot be better explained solely by another condition.
That last point is important because memory and concentration can also be affected by depression, anxiety, sleep disorders, medications, substance use, medical conditions, neurological disorders, and many other factors.
You Cannot Diagnose Dementia From a Television Clip
This is probably the most important point I would make as a psychologist discussing a political figure, celebrity, executive, athlete, or anyone else in the news.
Behavior observed on television is information, but it is not a neuropsychological evaluation.
A person may stumble over a word because of fatigue. Someone may lose a train of thought because of distraction. Another person may perform poorly during one interview and perform very differently the following day.
None of those observations, individually, establishes a neurocognitive disorder.
A responsible clinical opinion requires substantially more information.
What Does a Cognitive Evaluation Actually Include?
Evaluation for suspected cognitive impairment can involve several components depending on the individual and referral question.
These may include:
- Detailed medical and psychological history
- Information from family members or other knowledgeable people
- Review of medications
- Assessment of everyday functioning
- Standardized cognitive testing
- Memory testing
- Attention and processing-speed testing
- Executive-function testing
- Language assessment
- Visuospatial testing
- Mood and personality assessment when relevant
- Neurological examination
- Laboratory testing
- Brain imaging when clinically indicated
The National Institute on Aging notes that cognitive screening is often used to determine whether more extensive evaluation is warranted.
Learn More About Cognitive Assessment From the National Institute on Aging
What About the Montreal Cognitive Assessment?
The Montreal Cognitive Assessment, or MoCA, became part of the political conversation surrounding presidential cognition.
The MoCA is a widely used cognitive screening instrument that examines several areas of functioning, including memory, attention, executive functioning, language, visuospatial ability, and orientation.
But this point is important:
A cognitive screening test is not the same thing as a comprehensive diagnostic evaluation.
A screening result can indicate that additional evaluation may be appropriate. It does not, by itself, establish the cause of someone’s cognitive strengths or weaknesses.
Learn More About the Montreal Cognitive Assessment
The Role of Neuropsychological Testing
Neuropsychological assessment goes substantially beyond a brief cognitive screen.
Neuropsychologists and other appropriately trained psychologists can use standardized tests to examine patterns of functioning across memory, attention, language, processing speed, executive functioning, visuospatial abilities, and other cognitive domains.
The pattern of performance can help clinicians determine whether reported problems are consistent with normal aging, mild cognitive impairment, a neurocognitive disorder, another neurological condition, a psychiatric condition, or another potential explanation.
Testing is generally interpreted alongside medical history, behavioral observations, functional information, and other relevant clinical data.
Mild Cognitive Impairment Is Different From Dementia
Another term people frequently misunderstand is Mild Cognitive Impairment, or MCI.
Someone with MCI has greater cognitive difficulty than would typically be expected for age, but generally remains capable of carrying out everyday activities independently.
MCI does not automatically mean someone will develop Alzheimer’s disease or another dementia.
Some individuals remain relatively stable, while others progress and some improve depending on the cause of their difficulties.
What Is Anosognosia?
The original discussion surrounding dementia also raised the concept of anosognosia, or impaired awareness of one’s own neurological or cognitive deficits.
Anosognosia can occur in some neurological and neurocognitive conditions. A person may genuinely have difficulty recognizing the extent of his or her impairment.
That can create challenges involving treatment, driving, finances, medications, independent living, and family relationships.
But anosognosia should not be casually inferred simply because someone disagrees with criticism about his or her abilities.
Determining whether poor insight is actually a neurological symptom requires clinical assessment and context.
Why Family Members Often Notice Cognitive Changes First
When a genuine neurocognitive problem develops, family members sometimes notice changes before the individual does.
They may observe repeated questions, forgotten conversations, unusual financial decisions, getting lost, missed appointments, or changes in judgment.
That information can be very useful during a cognitive evaluation because cognitive disorders are evaluated not only by test scores but also by whether changes are affecting everyday functioning.
Dementia Has Many Possible Causes
Dementia is not one disease.
Neurocognitive disorders can be associated with conditions such as:
- Alzheimer’s disease
- Vascular disease
- Lewy body disease
- Frontotemporal degeneration
- Parkinson’s disease
- Traumatic brain injury
- Substance or medication effects
- Other neurological or medical conditions
That is another reason why watching behavior from a distance cannot establish a diagnosis.
Psychologists and Public Figures
As a psychologist who regularly speaks with journalists and provides media commentary, I think there is an important line between explaining psychology and diagnosing someone from afar.
If a journalist asks me about a politician, celebrity, criminal defendant, athlete, or other public figure whom I have not evaluated, I can explain the psychological principles involved.
I can discuss what dementia typically looks like, how cognitive testing works, what warning signs may warrant evaluation, and why certain behaviors might raise questions.
What I cannot responsibly say is, “That individual has dementia,” based simply on television appearances or news reports.
That distinction actually makes psychological commentary more useful because the discussion remains grounded in science rather than speculation.
Read the American Psychological Association’s Guidance on Psychologists Working With the Media
Cognitive Testing Is Used Outside Dementia Evaluations Too
Cognitive assessment is not limited to older adults or dementia.
Psychologists may assess cognitive functioning for many different reasons, including neurological conditions, traumatic brain injury, ADHD, learning problems, occupational questions, disability evaluations, fitness-for-duty concerns, and other clinical or forensic referral questions.
In high-responsibility occupations, cognitive abilities such as attention, judgment, processing speed, executive functioning, and decision-making may be especially important depending on the role.
Learn More About Psychological Testing and Assessment at D’Arienzo Psychology
When Should Someone Seek an Evaluation?
A cognitive evaluation may be worth discussing with a qualified healthcare professional when changes in memory or thinking are persistent, worsening, or beginning to interfere with everyday functioning.
Examples include difficulty managing finances or medications, repeatedly forgetting important conversations, getting lost, significant changes in judgment, or increasing difficulty completing previously familiar tasks.
The earlier significant cognitive changes are evaluated, the sooner potentially reversible causes can be considered and appropriate planning can begin.
Frequently Asked Questions About Aging and Dementia
Does forgetting names mean someone has dementia?
No. Occasional word-finding difficulty and slower recall can occur with normal aging. The larger concern is persistent cognitive decline that begins interfering with everyday functioning.
Can you diagnose dementia by watching someone speak?
No. Speech and behavior can raise questions, but diagnosis requires substantially more information and appropriate clinical assessment.
Does a low MoCA score prove dementia?
No. The MoCA is a cognitive screening instrument. Screening results need to be interpreted within the larger clinical picture and may indicate the need for additional evaluation.
Is dementia a normal part of aging?
No. Some mild changes in memory and processing speed may occur with normal aging, but dementia is not considered a normal consequence of getting older.
What is the biggest difference between normal aging and dementia?
One of the most important distinctions is functional impairment. Normal age-related changes generally do not substantially interfere with independent daily life. Dementia does.
About Dr. Justin D’Arienzo
I am Dr. Justin D’Arienzo, Psy.D., MSCP, ABPP, a board-certified clinical psychologist, forensic psychologist, former active-duty U.S. Navy psychologist, author, speaker, and media commentator.
My professional work includes clinical and forensic psychology, psychological assessment, occupational and public-safety psychology, relationships, clinical psychopharmacology, and helping the public understand complicated psychological issues.
I regularly provide psychological commentary for television, print, podcasts, digital media, and social media on issues involving mental health, human behavior, forensic psychology, relationships, trauma, workplace psychology, public safety, and major news events.
View My Media Appearances and Psychology Commentary
This article is educational and is not intended to diagnose President Biden or any other public figure. Clinical and diagnostic opinions require adequate information and an appropriate professional evaluation.
