Map of life expectancy at birth from Global Education Project.

Tuesday, July 22, 2008


That stands for the Fristian practice of long distance video diagnosis. The observation that John McCain has said some odd things lately is no longer confined to underemployed bloggers. Here CBS notes some (not all) of the recent "gaffes" such as substituting Iraq for Afghanistan, Somalia for Sudan, Russia for Germany, Czechoslovakia for the Czech Republic, Al Qaeda for Shiite "terrorists," and the Pittsburgh Steelers for the Green Bay Packers. I will also note that he recently was unable to remember Mitt Romney's name.

Now, it is obvious that these so-called "gaffes" all have something in common -- he's having trouble with proper names. I'm quite sure that Sen. McCain knows the difference between Russia and Germany, and Iraq and Afghanistan, but his brain is slipping a cog when it goes to access the label. I can't swear that he knows Sunni from Shiite but I'm sure he'd been briefed on it shortly before the news conference with Joe Lieberman in which he committed the error. (The Packers/Steelers thing could be a case of dishonest pandering, of course, but it's sort of hard to believe he thought he could get away with it. A cognitive slip could at least have contributed to the initial error, although a more honest man would have corrected it.)

This is not, as I have said before, a symptom of early stage Alzheimer's disease, which is characterized by failures of short-term memory integration, and looks very different. We all make such errors occasionally. Proper names are actually the most difficult kind of word for the brain to file and retrieve. Who hasn't had the horrible experience of not being able to remember the name of someone you have known fairly well? Still, it does seem to be happening to McCain a lot, and mostly in a fairly specific semantic category, which is actually a bit more suggestive of a real problem than would be a general occasional error in word choice. That he has to labor to read aloud is also suggestive of a problem in generating spoken language.

If this is more than just a few senior moments, the most likely diagnosis would be called primary progressive aphasia, which is a form of frontotemporal dementia. This poorly understood process is usually characterized only by language difficulties in the first two years or so, and often for longer, without other kinds of impairment, although the language difficulties tend to grow more profound and start to extend to comprehension as well as language production. Eventually, the disability spreads to other cognitive functions, affecting memory, and personality. It may seem inappropriate to mention this, and perhaps it is. The evidence is certainly weak, as I say people can make such mistakes without it being a sign of anything seriously wrong. But this man is running for president of the United States.

Finally, full disclosure: I'm a social scientist with a subspecialty in sociolinguistics, not a neurologist. But I have studied the sociology of brain injury, and my father has this precise disease -- now in a very advanced stage. So I have some idea what I'm talking about. McCain's age is not a big issue for me, so long as he's healthy. (Obviously, I don't think he is qualified to be president on other grounds, and I intend to vote for Obama.) But he does have a responsibility to make sure that he is fit for the job. I certainly hope that he has had his physicians perform an in-depth neurological assessment, and recently.

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