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Should Biden take a cognitive test? Here's what it would — and wouldn't — tell us

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Should Biden take a cognitive test? Here's what it would — and wouldn't — tell us

It seemed like a sensible suggestion for assessing the capabilities of an 81-year-old man seeking voters’ approval to remain in the White House until January 2029.

To reassure the American people, ABC’s George Stephanopoulos asked President Biden, would he be willing to take a cognitive test and share the results with the American people?

Biden demurred. In carrying out his duties as leader of the free world, he said, “I have a cognitive test every single day.”

Though the president dismissed the suggestion, medical experts said the idea of having Biden — along with his 78-year-old challenger, former President Trump — take some kind of cognitive exam had merit.

“Let’s give it to both of them,” said Dr. Louise Aronson, a geriatrician at UC San Francisco.

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Kevin Duff, a neuropsychologist at the Oregon Health & Science University’s Alzheimer’s Disease Research Center, likened the proposal to the long-standing practice of asking presidential contenders to release their tax returns.

There would be several types of tests to choose from. A simple screening exam could involve just a handful of questions and be completed in minutes. An in-depth evaluation could take a full day.

When former White House physician Dr. Ronny Jackson evaluated Trump in 2018, he opted for the popular Montreal Cognitive Assessment, or MoCA Test. Over the course of about 15 minutes, patients are asked to recall a list of five words, draw a clock with its hands set to a particular time, do subtraction with double-digit numbers, and come up with the names of animals in a drawing, among other tasks. At the time, Trump scored a perfect 30 out of 30.

Whether long or short, a good test measures multiple “domains of cognition,” Aronson said. There’s short-term memory and long-term memory. There’s the ability to communicate through both spoken and written language. There’s attention, comprehension, judgment, reasoning, problem-solving, decision-making and more.

“If a person completely aces a test, that tells you something,” said Dr. Laura Mosqueda, a professor of family medicine and geriatrics at USC’s Keck School of Medicine. “And if they bomb a test, it tells you something.”

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A score that’s somewhere in between can be trickier, experts say.

An abnormal result on a cognitive test doesn’t necessarily mean that a patient has a true cognitive problem. In about 10% of cases, it can be chalked up to a side effect of medications, an infection, a thyroid problem, a vitamin deficiency, a mood disorder such as anxiety or depression, or something else that’s reversible.

“The thing we see constantly as geriatricians are medication reactions,” Aronson said. “I can’t tell you how often we withdraw medications and then the person goes back to normal.”

Sometimes it’s even simpler than that.

“I’ve seen people diagnosed with dementia who’ve actually had a hearing problem but didn’t want to admit it,” Mosqueda said. “They couldn’t hear the questions and so they were giving weird answers.”

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Some cognitive changes are a normal part of the aging process. Thinking speed is a prime example.

“As we age, we will do things more slowly,” Aronson said. That isn’t necessarily a sign of cognitive impairment, she said, recalling a 101-year-old patient who missed only one point on a test but needed extra time to complete it.

If a patient’s cognitive problems persist, or if caregivers want to get a better handle on the subtleties of their condition, a more in-depth assessment may be in order.

The tasks are more challenging, Duff said. For instance, instead of seeing whether a patient can remember five words after five minutes, a neuropsychologist might give a patient 15 words and see how many they recall half an hour later.

On the MoCA Test, a score of 25 or lower is considered abnormal regardless of any other factors. With a more sensitive test, the results are compared with the performance of other people of the same age, educational background, career history and other characteristics, Duff said.

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A person with Biden’s background would probably perform well on a MoCA test even if his cognition has declined, experts agreed.

“In certain patients who are particularly verbal, they won’t remember the word they want but they can work their way around it,” Aronson said. In such cases, a normal score on the test “would not necessarily rule out cognitive impairment.”

Duff said it would be like having an IndyCar driver who wants to compete in the Indianapolis 500 take the same behind-the-wheel test that the DMV uses for 16-year-olds.

“My concern is that a relatively easy test still doesn’t mean you’re up to the challenge of leading one of the most powerful countries in the world,” he said.

This isn’t an issue limited to presidential candidates. It may be appropriate to ask airline pilots, bus drivers, surgeons and other people with jobs that entail a high degree of responsibility to take cognitive tests as they get older, experts said.

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“I think you can argue this is a job where your brain should be working pretty well,” Aronson said.

There is no expert consensus on whether to screen all older adults for cognitive impairment. The U.S. Preventive Services Task Force weighed the issue in 2020 and determined there wasn’t enough evidence to make a broad recommendation one way or the other.

One of the reasons for the hesitation is that screening tests aren’t good enough, said Dr. Colleen Christmas, a geriatrician at the Johns Hopkins School of Medicine.

“You’re going to catch a lot of people who don’t have issues, and you’re going to miss a lot of people who do,” she said.

There’s also the fact that the aging process varies greatly from person to person.

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“It’s incredibly heterogeneous,” Christmas said. “There’s no way to say 80 equals old whereas 75 equals young.”

Besides, no test, no matter how sensitive, can provide a full picture of a patient’s cognitive function. Doctors also need the results of blood tests, brain scans, and information from family members, among other things. If an MRI revealed evidence of several small strokes in parts of the brain that align with the patient’s cognitive deficits, for example, it would suggest a diagnosis of vascular dementia.

“It’s like putting a puzzle together,” Mosqueda said.

Biden may be in a unique position, but his bristling reaction to the idea of taking a cognitive test was pretty typical, Christmas said.

“I think people are so afraid of the diagnosis of dementia that it’s upsetting to have your doctor or a family member suggest that you need cognitive testing,” she said. “It’s a really scary prospect.”

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Very little plastic being recycled in California as state efforts falter

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Very little plastic being recycled in California as state efforts falter

California touts itself as a leader on the problem of plastic garbage, but recent developments suggest otherwise.

A new report issued by the state’s waste agency shows plastic yogurt containers, shampoo bottles and restaurant takeout trays are being recycled at rates only in the single digits.

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Polypropylene, labeled as #5 on packaging, is used for yogurt containers, margarine tubs and microwavable trays. Only 2% of it is getting recycled. Colored shampoo and detergent bottles, made from polyethylene, or #1 plastic, are getting recycled at a rate of just 5%.

Other plastics, including ones promoted as highly recyclable, such as clear polyethylene bottles, which hold some medications, or hard water bottles, are being recycled at just 16%.

No plastic in the report exceeds a recycling rate of 23%, with the majority reported in just the single digits.

Adding to this disquieting assessment, CalRecycle also just pulled back regulations that were supposed to finalize a landmark single-use plastic law known as Senate Bill 54 — a law designed to make the majority of packaging waste in the state recyclable or compostable by working with the plastic and packaging industries.

The report and delay have sparked a wide variety of reactions by those who have closely watched the law as it was written and implemented.

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The proposed regulations were regarded as friendly to industry. As a result, some are hopeful that CalRecycle’s decision to pull them back for tweaking means the agency will make the law stronger. Others say the two developments just show the state has never really been serious about plastic recycling.

“California’s SB 54 … will NEVER increase the recycling rates of these items … because cartons and plastic packaging are fundamentally not technically or economically recyclable,” said Jan Dell, the founder of Orange County-based Last Beach Cleanup, an anti-plastic organization.

Industry representatives are also expressing disappointment, saying the more delays and changes the state makes, the harder it is “for California businesses to comply with the law and implement the resulting changes,” said John Myers, a spokesman for the California Chamber of Commerce, which represents companies that will be affected.

Reports on abysmally low rates of recycling for milk cartons and polystyrene have been widely shared and known. But the newest numbers were still a grim confirmation that there are few options for dealing with these materials.

According to one state analysis, 2.9 million tons of single-use plastic and 171.4 billion single-use plastic components were sold, offered for sale or distributed in California in 2023.

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Single-use plastics and plastic waste more broadly are considered a growing environmental and health problem. In recent decades, plastic waste has overwhelmed waterways and oceans, sickening marine life and threatening human health.

Last spring, the Newsom administration was accused of neutering the regulations that CalRecycle had initially proposed to implement the law. The changes excluded all packaging material related to produce, meat, dairy products, dog food, toothpaste, condoms, shampoo and cereal boxes, among other products. These are all products that might fall under the purview of the U.S. Food and Drug Administration and the U.S. Department of Agriculture.

It also opened the door to “alternative” recycling, such as chemical recycling, which environmentalists say is polluting, and was banned in the language of the law.

The waste agency then submitted those draft regulations to the Office of Administrative Law, whose lawyers and staff review proposed regulations to ensure they are “clear, necessary, legally valid, and available to the public” before finalizing them. They were set to release their determination on Friday; CalRecycle pulled the regulations back before the office issued its determination.

Neither the law office nor governor’s office responded to requests for comment.

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Melanie Turner, CalRecycle’s spokeswoman, said the agency withdrew its proposed regulations “to make changes … to improve clarity and support successful implementation of the law,” and its revisions were focused on areas that dealt with “food and agricultural commodities.”

California State Sen. Ben Allen (D-Santa Monica), author of the original legislation, called the delay “entirely avoidable” in a statement, but said it would allow CalRecycle an “opportunity to ensure the regulations truly follow the law as it was signed.”

He urged the waste agency and Newsom’s administration not to “allow broad, sweeping exemptions that would undermine the program and increase costs for ratepayers.”

Critics of the watered-down regulations, such as Anja Brandon, the director of plastics policy for the Ocean Conservancy, said she wasn’t surprised by the withdrawal.

The proposed regulations “would have gone beyond CalRecycle’s authority by creating a sweeping categorical exclusion for food and agricultural packaging — effectively a loophole that would have allowed producers to continue putting vast amounts of plastic packaging into the marketplace, completely undermining SB 54’s goals and success,” she said in a text message.

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Turner said CalRecycle will conduct a 15-day comment period — although when that begins has not yet been divulged.

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Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind

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Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind

The American Cancer Society’s 2026 Cancer Statistics report, released Tuesday, marks a major milestone for U.S. cancer survival rates. For the first time, the annual report shows that 70% of Americans diagnosed with cancer can expect to live at least five years, compared with just 49% in the mid-1970s.

The new findings, based on data from national cancer records and death statistics from 2015 to 2021, also show promising progress in survival rates for people with the deadliest, most advanced and hardest-to-treat cancers when compared with rates from the mid-1990s. The five-year survival rate for myeloma, for example, nearly doubled (from 32% to 62%). The survival rate for liver cancer tripled (from 7% to 22%), for late-stage lung cancer nearly doubled (from 20% to 37%), and for both melanoma and rectal cancer more than doubled (from 16% to 35% and from 8% to 18%, respectively).

For all cancers, the five-year survival rate more than doubled since the mid-1990s, rising from 17% to 35%.

This also signals a 34% drop in cancer mortality since 1991, translating to an estimated 4.8 million fewer cancer deaths between 1991 and 2023. These significant public health advances result from years of public investment in research, early detection and prevention, and improved cancer treatment, according to the report.

“This stunning victory is largely the result of decades of cancer research that provided clinicians with the tools to treat the disease more effectively, turning many cancers from a death sentence into a chronic disease,” said Rebecca Siegel, senior scientific director at the American Cancer Society and lead author of the report.

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As more people survive cancer, there is also a growing focus on the quality of life after treatment. Patients, families and caregivers face physical, financial and emotional challenges. Dr. William Dahut, the American Cancer Society’s chief scientific officer, said that ongoing innovation must go hand in hand with better support services and policies, so all survivors — not just the privileged — can have “not only more days, but better days.”

Indeed, the report also shows that not everyone has benefited equally from the advances of the last few decades. American Indian and Alaska Native people now have the highest cancer death rates in the country, with deaths from kidney, liver, stomach and cervical cancers about double that of white Americans.

Additionally, Black women are more likely to die from breast and uterine cancers than non-Black women — and Black men have the highest cancer rates of any American demographic. The report connects these disparities in survival to long-standing issues such as income inequity and the effects of past discrimination, such as redlining, affecting where people live — forcing historically marginalized populations to be disproportionately exposed to environmental carcinogens.

Dr. René Javier Sotelo, a urologic oncologist at Keck Medicine of USC, notes that the fight against cancer in Southern California, amid long-standing disparities facing vulnerable communities, is very much about overcoming educational, cultural and socioeconomic barriers.

While access to care and insurance options in Los Angeles are relatively robust, many disparities persist because community members often lack crucial information about risk factors, screening and early warning signs. “We need to insist on the importance of education and screening,” Sotelo said. He emphasized that making resources, helplines and culturally tailored materials readily available to everyone is crucial.

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He cites penile cancer as a stark example: rates are higher among Latino men in L.A., not necessarily due to lack of access, but because of gaps in awareness and education around HPV vaccination and hygiene.

Despite these persisting inequities, the dramatic nationwide improvement in cancer survival is unquestionably good news, bringing renewed hope to many individuals and families. However, the report also gives a clear warning: Proposed federal cuts to cancer research and health insurance could stop or even undo these important gains.

“We can’t stop now,” warned Shane Jacobson, the American Cancer Society’s chief executive.

“We need to understand that we are not yet there,” Sotelo concurred. ”Cancer is still an issue.”

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Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations

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Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations

As the state continues multiyear marathon discussions on rules for what residents in wildfire hazard zones must do to make the first five feet from their houses — an area dubbed “Zone Zero” — ember-resistant, the Los Angeles City Council voted Tuesday to start creating its own version of the regulations that is more lenient than most proposals currently favored in Sacramento.

Critics of Zone Zero, who are worried about the financial burden and labor required to comply as well as the detrimental impacts to urban ecosystems, have been particularly vocal in Los Angeles. However, wildfire safety advocates worry the measures endorsed by L.A.’s City Council will do little to prevent homes from burning.

“My motion is to get advice from local experts, from the Fire Department, to actually put something in place that makes sense, that’s rooted in science,” said City Councilmember John Lee, who put forth the motion. “Sacramento, unfortunately, doesn’t consult with the largest city in the state — the largest area that deals with wildfires — and so, this is our way of sending a message.”

Tony Andersen — executive officer of the state’s Board of Forestry and Fire Protection, which is in charge of creating the regulations — has repeatedly stressed the board’s commitment to incorporating L.A.’s feedback. Over the last year, the board hosted a contentious public meeting in Pasadena, walking tours with L.A. residents and numerous virtual workshops and hearings.

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Some L.A. residents are championing a proposed fire-safety rule, referred to as “Zone Zero,” requiring the clearance of flammable material within the first five feet of homes. Others are skeptical of its value.

With the state long past its original Jan. 1, 2023, deadline to complete the regulations, several cities around the state have taken the matter into their own hands and adopted regulations ahead of the state, including Berkeley and San Diego.

“With the lack of guidance from the State Board of Forestry and Fire Protection, the City is left in a precarious position as it strives to protect residents, property, and the landscape that creates the City of Los Angeles,” the L.A. City Council motion states.

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However, unlike San Diego and Berkeley, whose regulations more or less match the strictest options the state Board of Forestry is considering, Los Angeles is pushing for a more lenient approach.

The statewide regulations, once adopted, are expected to override any local versions that are significantly more lenient.

The Zone Zero regulations apply only to rural areas where the California Department of Forestry and Fire Protection responds to fires and urban areas that Cal Fire has determined have “very high” fire hazard. In L.A., that includes significant portions of Silver Lake, Echo Park, Brentwood and Pacific Palisades.

Fire experts and L.A. residents are generally fine with many of the measures within the state’s Zone Zero draft regulations, such as the requirement that there be no wooden or combustible fences or outbuildings within the first five feet of a home. Then there are some measures already required under previous wildfire regulations — such as removing dead vegetation like twigs and leaves, from the ground, roof and gutters — that are not under debate.

However, other new measures introduced by the state have generated controversy, especially in Los Angeles. The disputes have mainly centered around what to do about trees and other living vegetation, like shrubs and grass.

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The state is considering two options for trees: One would require residents to trim branches within five feet of a house’s walls and roof; the other does not. Both require keeping trees well-maintained and at least 10 feet from chimneys.

On vegetation, the state is considering options for Zone Zero ranging from banning virtually all vegetation beyond small potted plants to just maintaining the regulations already on the books, which allow nearly all healthy vegetation.

Lee’s motion instructs the Los Angeles Fire Department to create regulations in line with the most lenient options that allow healthy vegetation and do not require the removal of tree limbs within five feet of a house. It is unclear whether LAFD will complete the process before the Board of Forestry considers finalized statewide regulations, which it expects to do midyear.

The motion follows a pointed report from LAFD and the city’s Community Forest Advisory Committee that argued the Board of Forestry’s draft regulations stepped beyond the intentions of the 2020 law creating Zone Zero, would undermine the city’s biodiversity goals and could result in the loss of up to 18% of the urban tree canopy in some neighborhoods.

The board has not decided which approach it will adopt statewide, but fire safety advocates worry that the lenient options championed by L.A. do little to protect vulnerable homes from wildfire.

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Recent studies into fire mechanics have generally found that the intense heat from wildfire can quickly dry out these plants, making them susceptible to ignition from embers, flames and radiant heat. And anything next to a house that can burn risks taking the house with it.

Another recent study that looked at five major wildfires in California from the last decade, not including the 2025 Eaton and Palisades fires, found that 20% of homes with significant vegetation in Zone Zero survived, compared to 37% of homes that had cleared the vegetation.

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