Let’s be real: watching your grandpa get flustered trying to log into his email is one thing. Watching the President of the United States trail off mid-sentence during a live interview? That hits a little different. But instead of jumping to “he’s just old” or “he’s totally fine,” let’s take a beat. Executive function—the brain’s CEO—is about more than just remembering names or looking sharp at press conferences. It’s the system that helps us focus, plan, adapt, and hold it all together under pressure (sound familiar?).
So what does it look like when executive function starts to slip? And more importantly, how can we tell the difference between normal aging and something more concerning in a public figure like President Biden? We asked a geriatric specialist (with decades of experience in aging brains) to decode 11 subtle but telling signs. Here’s what they flagged—and why each one matters more than a viral clip or hot take.
1. Micro-Stumbles and Gait Shifts: Watch the Walk, Not Just the Talk
Okay, here’s a weird but real one: the way someone walks can tell you a lot about what’s happening upstairs. According to a study shared by PubMed, changes in gait speed and balance often correlate with early cognitive changes—particularly executive dysfunction. It’s like the brain’s motor planning department starts missing memos.
For Biden, we’ve seen multiple slow, deliberate steps, and occasional stumbles that get written off as “just age.” But to a geriatric physician, these subtle shifts might suggest issues with coordination, proprioception, and divided attention. When someone needs to consciously think about walking, their brain is reallocating resources that used to work automatically. And that’s not just clumsiness—it’s a neurological workload issue.
2. Verbal Drift: When Sentences Wander Off a Cliff
You know that moment when someone starts a sentence, takes a detour, then never quite circles back to the point? That’s verbal drift, and it’s not just a quirk—it’s often tied to changes in executive function. According to The New York Times, geriatricians pay close attention to these patterns because they can signal declining cognitive agility, especially when paired with word-finding issues or slowed speech.
With Biden, some public appearances have shown that kind of meandering delivery—where the sentence structure collapses under the weight of mid-thought pivots. While occasional slips are human (and let’s be honest, relatable), consistent verbal drift can mean the brain’s working memory and self-monitoring systems aren’t firing on all cylinders. In day-to-day life, this might mean forgetting the question halfway through an answer—or jumping from Point A to Point Q with no stops in between.
3. Emotional Blunting: That “Flat” Affect Isn’t Just Fatigue
Let’s talk about emotional energy—or lack thereof. When someone’s responses start to seem overly neutral, disconnected, or flat, it could be more than just “resting president face.” Per a deep dive by ScienceDirect, blunted affect is often a red flag for executive dysfunction, especially in older adults navigating high-stress environments.
This isn’t about needing a Red Bull or missing a nap. It’s about the brain’s frontal lobes struggling to regulate emotional nuance—those little expressions, tonal shifts, and spontaneous reactions that usually come so naturally. In high-stakes conversations or unscripted moments, this can make someone appear less engaged or even robotic. Geriatricians see this in early-stage neurodegenerative conditions, where the person is still “there” but the spark gets dimmer. Sound familiar?
4. Trouble Shifting Gears: When Rigid Thinking Sets In
Flexibility isn’t just for yoga—your brain needs it too. Cognitive flexibility is what lets us pivot mid-conversation, change our minds, or rethink strategies when plans go sideways. According to WebMD, older adults with executive dysfunction often struggle to “shift mental sets,” leading to repetitive phrasing or getting stuck on a talking point like it’s a record scratch.
You’ve probably seen it: the same phrase repeated verbatim, even when the question’s changed. Or circling back to a previous thought minutes after the topic has moved on. This kind of rigidity can make someone seem scripted—or worse, confused. For a president, that’s especially noticeable when fielding rapid-fire questions or handling unexpected changes on the world stage. It’s less about memory, more about agility.
5. Masking with Memorization: When the Script Is the Lifeline
You know how some actors can hit every line perfectly, even if they have no idea what the movie’s about? That’s kind of what it looks like when someone relies heavily on rehearsed scripts due to weakening executive function. The Guardian notes that tightly scripted appearances—and the avoidance of open-ended interviews—can sometimes be a subtle workaround for declining cognitive spontaneity.
In geriatric practice, we call this “compensatory behavior.” It’s when someone leans hard on routine, rehearsal, or visual cues to mask processing difficulties. It’s not deceit—it’s survival. For high-functioning individuals (like, say, a president), this can make cognitive decline harder to spot, because they still look sharp during prepared remarks. But throw in a follow-up question? The system glitches.
6. Overreliance on Cue Cards and Prompters
Look, we all love a good cheat sheet. But when someone always needs one—even for basic intros or familiar topics—it might mean the brain’s “initiation engine” is sputtering. In the clinical world, this can point to something called initiation deficit, where the person struggles not with knowing information, but with launching it unprompted. It’s like knowing all the lyrics but waiting for karaoke mode to light them up.
You might’ve noticed Biden frequently checking cue cards or closely following a teleprompter even during small or informal events. That doesn’t automatically scream “decline,” but if it’s paired with hesitations, long pauses, or getting derailed when the tech fails? That’s when a geriatrician’s eyebrow quietly raises. It’s not about memory loss—it’s about the system that cues memory into action getting rusty.
7. That Tell-Tale Delay Between Question and Response
In a fast-paced conversation, a second can feel like forever. When responses start taking just a little too long—like someone buffering mid-Zoom call—it can suggest slowed processing speed, a common marker of executive decline. Geriatricians call this “latency,” and while it might be subtle, it’s one of the earliest signs that the brain is taking longer to retrieve, evaluate, and verbalize thoughts.
With Biden, there’s often a noticeable delay between a journalist’s question and his answer—especially in unscripted moments. Sometimes he lands the plane, sometimes it circles the runway a few times first. That pause isn’t always bad (hey, thinking before you speak is underrated), but when it becomes chronic, it’s often the brain’s version of a spinning pinwheel. And in the White House, that lag can have real implications for decision-making under pressure.
8. Confabulation—Mixing Up Details That Sound Close Enough
Confabulation isn’t lying. It’s what happens when the brain tries to fill in gaps with something plausible, even if it’s not quite right. Think of it as your mind running a best-guess autocomplete. This happens more often in folks with mild cognitive impairment, and it’s often unintentional—but still noticeable to those paying close attention.
When President Biden mixes up dates, places, or names (like confusing war locations or timelines), it’s not always malicious or even forgetfulness. It could be a subtle form of confabulation. To a geriatric doc, this suggests that the internal fact-checker isn’t keeping up. The details feel true to the person saying them—which makes it even trickier to catch. But repeated misstatements over time? That’s a clue.
9. Flattened Spontaneity: The Spark Just Isn’t Sparking
There’s something magnetic about a person with executive sharpness—they’re quick, witty, and unpredictable in the best way. But when spontaneity fades, conversations get flatter, more predictable, even a bit… beige. This doesn’t mean someone can’t still function well or lead, but it hints that the brain’s creative and adaptive circuits aren’t firing quite like they used to.
Many public appearances from Biden in recent years have been marked by cautious, rehearsed speech and very few improvisational moments. When off-the-cuff questions or jokes arise, he often pivots back to the script—or freezes. That lack of verbal playfulness, that spark we expect from someone seasoned and savvy, can quietly slip away with executive function. And it often does so without anyone realizing when the change started.
10. Perseveration: Saying the Same Thing on Loop
If you’ve ever had a relative keep circling back to the same story about the time they met Elvis in the grocery store (three times in one dinner), you’ve witnessed perseveration. It’s the neurological version of getting stuck in a loop. This can show up as repeating the same phrase, anecdote, or point in a short span of time—often because the brain can’t quite regulate what’s been said versus what still needs to be said.
Biden’s repeated use of certain catchphrases or fallback phrases (“I’m not joking, folks”; “No joke”) could be chalked up to personal style. But when those loops dominate a conversation—especially when the context doesn’t call for it—it’s worth a second look. A geriatrician wouldn’t diagnose off one rally or press clip, but a pattern of perseveration? That’s a hint the internal filter is glitching.
11. Poor Risk Assessment in High-Stakes Moments
Executive function isn’t just about memory or multitasking—it’s what helps us weigh outcomes, judge timing, and think five steps ahead. When that system falters, a person might make odd timing decisions, miss social cues, or take unnecessary risks in conversation or behavior. Think: saying something controversial without realizing it, or doubling down on something tone-deaf in a sensitive moment.
Critics have noted that Biden occasionally makes awkward jokes or off-script comments that fall flat—or seem oddly timed. While public figures are always under the microscope, consistent misjudgments in tone or timing can suggest weakened executive control. It’s not that the person doesn’t care—it’s that the internal GPS that usually reroutes us before hitting a conversational pothole isn’t recalibrating like it used to.