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What went wrong for Joe Biden? A neuropsychologist’s verdict

Biden’s performance seemed good for most of his debate with Trump. No one with dementia or mild cognitive impairment could have sustained that. There is a ‘but’, however

President Joe Biden speaking during the first 2024 US presidential election debate with former president Donald Trump at CNN's headquarters in Atlanta, Georgia, on Thursday. Photograph: Kenny Holston/New York Times

Ian Robertson
Mon Jul 1 2024 - 06:00

One mystery about Thursday evening’s US presidential debate is why President Joe Biden’s team agreed to it. An incumbent president, burdened with more responsibilities than even the fittest 40-year-old person could cope with could – should – simply have said no.

Speculation arose that this was a ploy by some to engineer a pre-convention failure so bad that it would force Biden to step down and be replaced by a younger and more image-friendly candidate. Even Machiavelli would be impressed with this.

Biden’s team knows that he has been a pretty competent president in most domains. But if you make a hundred decisions in complex global or domestic situations, 10 of them are going to be wrong by chance.

They let him enter this disastrous debate because they could see the real competence behind the superficialities of television appearances. They were, however, blind to what the rest of us could see with dismay and which made Biden fare so badly.

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But what do these superficialities reveal – or not reveal – about his underlying cognitive competence?

1: Physical appearance

Biden may have lost the debate in the first 10 seconds, before a word was spoken. His stiff gait and largely expressionless face contrasted painfully with the loose-limbed stride of Trump who breezed in looking confident, combative and in charge. If a visitor from Mars had been asked to guess which man was boss, it would have picked Trump.

But arthritic-like gait is unrelated to brain function. Biden has always been a low-key speaker with poor articulation and a penchant for pithy one-liners cutting to the heart of an issue. He also listens carefully when asked a question – but looks down, stops blinking and lets his mouth open a little as he does so – not a sharp look.

Trump, on the other hand, doesn’t listen and largely responded to questions with largely irrelevant – and mostly false – tropes that he has repeated thousands of times before. Hence the cognitive demands made on him were low, compared with Biden, who seemed to care about truth. This freed up Trump’s brain to concentrate on manipulating superficial appearances and fact-free slogans of the type that win television debates.

2: Confidence and competence

Before the 2004 US congressional elections, a Princeton University study rated the relative “competence” of two unfamiliar politicians’ faces flashed up for a mere second on a computer screen. With this sliver of information, the participants presaged the actual election results for these politicians at a 70 per cent accuracy. Swiss primary schoolchildren predicted election success with similar accuracy, even of unknown political faces.

The researchers subsequently unravelled how precisely “competence” was being judged – it was based on how masculine the faces looked.

Compare Biden’s face, tightened with age, with Trump’s fleshy, stronger looks, and you will understand which the Swiss schoolchildren would choose as more competent-looking. Unfortunately, many voters in most democracies have their decisions swayed by such superficial and largely unconscious judgments.

And then there was the voice – Biden’s husky, low-energy, sometimes indistinct voice, compared with Trump’s boom. Likely the Swiss children would have rated confidence in Trump’s favour based on hearing these sounds alone. Apparent competence can also easily be faked. The more confidently people look and act, the more persuasive they become and the more status others accord them.

That is why it does not matter one bit to many that Trump’s assertions were largely false – his swagger means that they are persuaded and vote for him.

3: Memory

Stiff joints, downward gaze and drooping lower lip may not signify any cognitive loss, but consider one of Biden’s apparent “senior moments” where he lost the thread of his – presumably much-rehearsed – script with a confused sentence “Everything we had to with ... we finally beat Medicare”. Trump pounced – “He did beat Medicare!”

In another question, Biden tailed off at the end, letting Trump in with the brutal “I don’t know what he said at the end of that sentence – I don’t think he knows either.”

These and a few other apparent senior moments are what can happen to even the most professional of actors when they lose track of their lines. Biden’s performance seemed actually pretty good for most of this gruelling debate. No one with dementia or mild cognitive impairment could have sustained a fraction of this.

However, the man was anxious in a world screaming “dementia” and “old man” at him – and so he had repeatedly learned his lines, in between trying to steer his country between wars, social unrest and economic threats. And he did pretty well for 95 per cent of his lines but of course, the few seconds of actor-line-block are magnified and replayed over and over until it seems to those who didn’t watch the debate that he was incoherent throughout.

He was not. He was anxious about screwing up, he was trying too hard, he was embarrassed when he misspoke trillions instead of billions and other slips. He had a sore throat and was tired trying to stand there for an hour and a half quelling his outrage at the cavalier lies of his opponent – “The problem they have is they’re radical because they will take the life of a child in the eighth month, the ninth month and even after birth, after birth,” Trump claimed.

Should Biden step down?

Biden is old but he needs time to express himself and, like any old actor, forgets his lines sometimes. His performance as president has been well-rated by objective observers. He cares about truth and this places a cognitive burden which can slow him and cause missteps. His opponent has no such burden and there is no reason to believe that his age-related cognitive performance is any different from Biden’s.

But Biden has to step down because the superficialities of his age-related appearance will lose him the election. The world needs someone the Swiss schoolchildren would select as the most competent.

Prof Ian Robertson is founding director of the Global Brain Health Institute at Trinity College Dublin and author of How Confidence Works: The new science of self-belief (Penguin, 2022)

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