Dementia and the baby boomers

In the last few months I’ve encountered three very distinguished academics who experienced significant cognitive decline very close to their 80th birthdays. One involved a formal diagnosis of dementia, another what probably would be diagnosed as some form of dementia if a formal diagnosis were undertaken, and a third is probably either preclinical/subclinical dementia, or just “normal” age-related cognitive decline, to the extent that those are different things.

This got me wondering how many baby boomers are going to end up with dementia before they die, given that the entire 19-year-cohort is now in their (our) 60s and 70s. Fun fact: Donald Trump and Kamala Harris are both baby boomers, born respectively a few months after the start and a few months before the end of the cohort, which runs from 1946 through 1964. BTW the baby boom’s definition is just a product of the demographic observation that the total fertility rate for American women was above 3.0 for this 19-year-period. It wasn’t originally intended as some sort of coherent sociological generation or anything.

Anyway . . . the latest research on this particular question is very sobering indeed, as it estimates a lifetime risk of developing dementia (technically the risk of developing it from ages 55 through 95) of 42%: 48% for American women and 35% for men. The risk for women is so much higher because their odds of living into their 80s and 90s are so much greater, and dementia risk increases exponentially with age. It’s also statistically significantly higher for Black Americans (46%) versus whites (41%).

Those numbers are scary enough, but then consider that an enormous amount of dementia is never diagnosed, because the preclinical stages of the disease can last, at least in the case of Alzheimer’s, up to 15 or more years before symptoms become frank enough for a diagnosis to be made. Furthermore it’s not that unusual, as in the case I reference above, for a diagnosis not to be made even in the presence of frank symptoms, for all sorts of reasons that have nothing to do with medical science per se.

This leads me to a harsh observation, which is that anybody who thinks that any 80-year-old is as cognitively healthy as they were when they were 50 is engaged in sentimental denial. Of course the rate of cognitive deterioration among individuals varies enormously, so that the symptoms of that decline in any particular 80-year-old may be subtle, but the decline is still there.

From this follow all sorts of general observations about among other things the extreme recklessness of having 80-year-olds in the presidency, the absurdity of life tenure for federal judges, the extreme dubiosity of no upper age limit on academic tenure, and the enormous problems that we face because of what could be called the twilight of the gerontocracy.

I don’t like Mondays.