Mind the gap — an uncomfortable but necessary meditation on the shifting cognitive capabilities of aging leaders

Dalton Delan
4 min readDec 8, 2023

As Moore’s Law kicks in and we race or plunge, depending on perspective, toward artificial general intelligence, we are obsessed with fears of out-of-control HAL in “2001: A Space Odyssey.” Perhaps our nail-biting time would be better spent worrying about the structural integrity of the brains in prominent positions walking among us now.

It is an unfortunate byproduct of our current culture, for good and bad, that in overdue striving to remove stigma from potentially personality-altering events, we push back into the closet brain changes that might need to be taken into account when dealing with an individual who has suffered any such syndrome. Chemotherapy, alcoholism and traumatic brain injury — each carries its own deleterious stigma.

Among these, the hidden cost of chemo is one that is particularly cloaked in silence, and for good reason, as no one who needs it should fail to get treatment. The flip side of the coin is that it is equally wrong not to take possible brain change into account.

A notable example is former Housing and Urban Development Secretary Ben Carson. A friend of Carson’s who knew him before he was diagnosed with prostate cancer and underwent chemotherapy whispered to me that the Ben they knew was not the same as the one post-treatment. In my own experience with two colleagues in positions of power who underwent significant chemotherapy, both came out different people. Issues with so-called “executive function” and decision-making ability are recognized signs of “chemo brain” that oncologists are loathe to talk about. But in both cases in my acquaintance, the bald fact is that these two proceeded to make irrational decisions, and no-one curtailed their ability to do so. As for Carson, that’s your call.

Similarly, we now face three major presidential candidates with real reason to question the cognition of each. This is more than a whisper campaign. The fate of the country and even our place in the world may hang in the balance. In the case of the incumbent, the potential for dementia or, in any event, age-related cognitive decline is all too pressing an issue to dismiss simply because we believe it is politically expedient to sweep it under the rug.

When Reagan left office showing signs of dementia, he was 77, a decade younger than Biden would be after a second term of office. Actuarial tables peg average life expectancy for a white male of Biden’s age at 87. In other words, Kamala Harris has equal odds of inheriting the presidency.

It isn’t an idle question. Putin and Xi want to know. I have written in a previous column that Biden would be wise to bring in a vice president whom voters could feel more comfortable with in this event.

He won’t.

The sad case of Robert F. Kennedy Jr., whose own relatives have had to go public to warn against, is harder to pin down. Given his admitted history of addiction, is he an “acid casualty,” as we called them in the 1960s, with synapses permanently affected by psychedelics and heroin? Heroin alters the physiology of the brain. His spasmodic dysphonia might be related to drug use. What else is? RFK Jr. has vowed to legalize psychedelics, and in clinical settings these have shown benefits to those suffering from PTSD. But are his less explicable railings about vaccines and autism the byproduct of a damaged cortex, or just your garden-variety American paranoia? As a public figure who has not taken a COVID vaccine, he is not immune to questions of his own powers of mentation.

Finally, there is the terra incognita of Donald Trump’s brain. Clinicians tell me that narcissistic personality disorder — defined in the Diagnostic and Statistical Manual of Mental Disorders 4 as “an all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy” — was downgraded in the DSM-5. Do we know more now, or are we simply unsure? If it is not a freestanding and clinically significant diagnosis, in the coin of the realm, what the heck is it? A man who publicly claims, as Trump did, “I am the chosen one” is either off his rocker or the messiah. Or an unscrupulous charlatan drunk with power.

As Trump doesn’t drink, his particular elixir is burgers. What of other presidents? Has alcohol been a player? Having spent some small time with George W. Bush both on the wagon and, allegedly, off, I ask myself if he acted differently. Yes. In a worrisome way? No. Given my jailhouse degree, I would say he suffered from something far more serious: Dick Cheney. For that, there is no cure.

And for Trump, scion of a bigot and an egomaniac of Putinesque proportions, to what degree is there a brain to drain? We may not choose to know. Some secrets are best kept. This is your brain on drugs, drink, chemo, power.



Dalton Delan

Winner of three Emmy Awards, Dalton Delan pens biweekly The Unspin Room, which began August 7, 2016 in The Berkshire Eagle; it has appeared in 50+ newspapers.