Could aging be Donald Trump’s biggest challenge?

Donald Trump has been one of the most frequently used words in the media these days. I won’t repeat all the scandals and controversies that he has been alleged here - too boring.

What I’d like to point out is that, putting aside those that are dramatically shocking our moral system and induced our undisguisable emotions matters, Donal Trump is a very successful man, who has lived three different successful lives: a business man, a reality TV show star and a politician that won the world’s most competitive and elaborated campaign of the world’s most powerful country (for now), the United States. Like what he said, think big, dream bigger.

 Figure 1, Recreated picture. Two source original pictures are from internet.

70 years old and being a president of the United States, there were some concerns over Trump’s physical health during the presidential campaign, but not so much about how aging might shadow his cognitive functions along the road, esp. in a very stressful environment.

I would like to first address the biological reality briefly about how the brain itself aging. I will then address how aging may affect different aspects of cognition processes, for example: memory, information processing speed, emotion regulation, particularly the executive functions and decision making that are highly demanded by the presidency job.

According to WHO, the most recent definition of elderly amongst developed country is 65. Some research further subcategorize into young old, old old and the oldest old (Forman et al, 1991). Taking consideration of the variations of ranges for each subgroup, 70 is in the middle of the young old group.

General cognitive aging basics:

Aging is a continuous and gradual process that starts unkindly early, (Salthouse, 2012; Sowell et al., 2003; Terry & Katzman, 2001), way earlier than 65. Sowell et al. (2003) used magnetic resonance imaging (MRI) to obtain the brain image of 176 normal individuals age from 7 to 87; mapped each individual brain into a standardized space, segregated gey matter, white matter and cerebrospinal fluid; further labelled interested sulci on each individual brain and identified patterns of the grey matter density (GMD) declining across age. Their findings revealed that for most of the brain regions, the loss of GMD was at its greatest age 7 – 60, with different velocity in different stage. But up to age 30, this GMD loss is concurrent with the continued brain growth, which suggested increased myelination into the peripheral neurophil (Sowell et al., 2001). The white matter volume has also been found to have a decrease of 16-20% for participants older than 70 (Meier-Ruge et al., 1992). In addition, diffusion tensor imaging (DTI) has shown decline of white matter integrity with aging (Madden et al., 2009). 

These results of neuroanatomy changes are inline with results from cognitive tests (Salthouse 2009a) and are consistent across many studies (Borella, Carretti, & De Beni, 2008; Clark et al., 2006; Dore et al., 2007; Salthouse, 2009b, 2010a, 2010b, 2012; Van der Elst et al., 2006). In addition, neuroimaging studies have consistently showed that older adults engages more brain regions to complete same tasks than younger adults (Cabeza et al., 2004; Colcombe et al., 2005; Langenecker, Nielson, & Rao, 2004). It has been suggested that the extra regions of the brain served as a compensational purpose (Langenecker et al., 2004; Prakash et al., 2009). Positive correlations of behavioural process and the regions of brain involved in were found that was consistent with this suggestion (Cabeza et al., 2004; Reuter-Lorenz et al., 2000).

Executive function is a set of abilities such as self-monitor, plan, organize, reason, mentally flexible, problem solving (Harada, Love & Triebel, 2013). Research has shown that older adults showed less mental flexibility, especially after 70 (Lezak et al., 2012; Wecker et al., 2005) because they have the tendency of thinking in a more concrete way than younger adults (Oosterman et al., 2010; Wecker et al., 2005).

Decision making is such a complex activity that involves almost all the other cognitive contribution. Therefore, with suboptimal cognitive functions in many aspects in older adults, their decision making is more likely to be compromised. It has been suggested that older adults are more likely to make risk adverse choices in various decision making tests. (Di Rosa et al., 2017; Lejuez et al., 2002). Both studies however have been reported to be adjusted to achieve better performance over repetition.  More recent neuroimaging study has evidenced that the GMD of right posterior parietal cortex play a role in older adults’ risk preference (Grub et al, 2016).  

Despite the declination of the important part of brain regions for emotion regulation and executive function, older adults in many situations showed better emotional resilience than young adults. Evidences suggested that older adults tend to pay more attention to the positive information while ignore the negative ones (Di Rosa et al., 2017; Guerreiro, Murphy, & Van Gerven, 2010; Healey et al., 2008). Ebner and Johnson (2010) asked participants to identify targets with faces as distractors and found that younger adults were most distracted by angry faces while older adults were most distracted by happy faces. Studies also showed that for older adults that showed higher cognitive control than lower cognitive control, it is more likely to yield positive effects (Mather & Knight, 2005; Petrican, Moscovitch, & Schimmack, 2008). However, when their attention is controlled, i.e. to keep attend to the negative stimuli, older adults showed worse cognitive reappraisal than the younger group (Opitz et al., 2012, Winecoff, LaBar, Madden, Cabeza, & Huettel, 2011).

So the argument over inauguration number (Figure 2 and 3). With the best intention of both sides were telling their truth: it is possible the from Trump’s perspective, he did see many crowds (Figure 1) which could have been initially lead to disbelief of the mainstream media (Figure 2). It may reflect some declined mental flexibility, to be able to adapt to the news he see in the media. Or perhaps it also reflected that his unwillingness to shift attention from the positive outcome as he thought. What about his other choices, climate change, abortion, revive coal, travel ban?

  

Figure 2. The view of the crowd from where Trump was standing. 

Picture source, telegraph.co.uk.

Figure 3. The view from the opposite.
Picture source, telegraph.co.uk. 

Of course, there are individual differences and the population that all the studies have based on are general healthy populations. Research showed that involving in high complexity careers, exercises, high educational attainment, exercise, socializing and day to day activities that are involving active thinking are associated with high cognitive function in older adults (Crowe et al., 2003; Scarmeas et al., 2001; Wang et al., 2002; White et al., 1994; Woollett & Maguire, 2011; Wilson et al., 2009). These factors are in Trump’s favour in terms of maintaining his cognitive performance to certain extent. 

Could it have always been his character and has very little to do with aging? Certainly could be, and some psychologists suggesting that Donal trump has narcissist personality disorder, without examine him they also said ( https://howardgardner.com/2016/01/28/is-donald-trump-a-narcissist/ ; https://twitter.com/johndgartner).  These factors all interact with each other and one might magnify the other or lead to another problem. Would In the USA, to avoid age discrimination, being 70 or older cannot be the reason stopping someone being hired, with some professions have certain mandatory retirement (https://en.wikipedia.org/wiki/Mandatory_retirement). What about the President?

Figure 4 

Figure 5 

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https://en.wikipedia.org/wiki/Mandatory_retirement

https://howardgardner.com/2016/01/28/is-donald-trump-a-narcissist/ 

https://twitter.com/johndgartner