President Joe Biden, already the oldest sitting president in U.S. history, will turn 79 in just a few weeks. In Congress, much of the senior leadership is, well, quite senior: House Speaker Nancy Pelosi is 81, and Mitch McConnell, the Senate’s top Republican, is 79. Meanwhile, there have been calls on the left for 83-year-old Supreme Court Justice Stephen Breyer to step down (while there’s a Democrat in the White House to appoint his replacement). Should a Republican win the 2024 presidential election, it’s likely Clarence Thomas, currently 73 years old, will hear similar grumblings from conservatives. 

Indeed, many of the country’s top decision makers are septuagenarians and octogenarians—and according to Sen. Bill Cassidy (R-La.), that’s a real problem. “At some point, and statistically it’s in the eighties, you begin a more rapid decline,” the 64-year-old, who is also a gastroenterologist, told Axios last month. “It’s usually noticeable. So anybody in a position of responsibility who may potentially be on that slope, that is of concern. And I’m saying this as a doctor.”

The solution, according to Cassidy, lies in cognition tests for those of all three branches of government. “Would it be reasonable to have…an annual sort of evaluation in which they would have to establish, ‘Yes, I’m doing okay’?” Cassidy asked. “I think that’s actually a reasonable plan.”

Though Cassidy was careful not to name-check anyone in particular, it’s easy to find anecdotes to substantiate his concerns. Sen. Dianne Feinstein (D-Calif.), 88, faced allegations of cognitive decline. Sen. Patrick Leahy (D-Vt.), 81, was hospitalized earlier this year, sending Democrats into a panic given their razor-thin Senate majority. Republicans have also been quick to point to any video of Biden stumbling over his words or appearing to doze off during events as evidence of the president’s senility. Democrats employed a similar tactic when Trump was in the White House. (Should Trump run again in 2024—at which point he would be 77—that line of attack is likely to return.) 

The age issue exists in the court system too: According to a 2010 ProPublica survey, 12% of the roughly 1,200 sitting federal district and circuit judges are 80 or older. “Federal judges make life or death decisions,” said Gabe Roth, executive director of Fix the Court, a nonprofit group that seeks reform in the federal court system. “They can impact civil rights, financial markets, health care, voting. I think every citizen has the right to expect that a judge has the mental acuity to adjudicate the case fairly and is up to the task.” 

The age question isn’t just an issue of senility, but also representation. The national median age in the U.S. is about 38, per the latest Census data; the average age in Congress, on the other hand, is roughly 61. Such a disparity can cause the government to ignore the issues that younger constituents really care about, like climate change legislation or free community college—which have been respectively scaled back and cut from the reconciliation bill.

“At every level of government, older folks are running the show,” said Amanda Litman, the cofounder of Run for Something, which helps young progressives to run for state and local office. “That’s not to say that they don’t have wisdom and experience and knowledge that benefits us, but it is to the detriment of young people whose voices are left out of the space.”

A proposal like Cassidy’s to require cognitive tests has some precedent. As Time’s Charlotte Alter pointed out, many states require anyone over 70 to take additional tests in order to meet driver’s license renewal requirements. But when it comes to government, no such exam exists. The Founders set minimum ages for serving in Congress and the White House, not maximum. (While there’s been no movement on legislation to implement cognition tests for members of Congress or the White House, a 2018 bill to require such tests for federal judges did pass the House Judiciary Committee, though it never made it to the House floor.)

So what might a cognition test for the U.S.’s political and judicial leaders actually look like? For starters, policymakers could check out the Mini-Mental State Exam (MMSE), which quickly assesses a person’s ability to follow instructions, maintain attention, and learn and retain new details. The MMSE isn’t meant to be administered just one time; rather, it’s intended to be taken repeatedly, as a means of showing longer-term changes in reasoning and retention.

“It’s not a diagnostic exam, where it’s positive or negative. It’s more like, here’s your trajectory over time,” said Jeremy Samuel Faust, a doctor at Brigham and Women’s Hospital emergency-medicine department. “It’s really about a pattern and less about one instance or one outcome.”

In the case of a Trump vs. Biden rematch, regular MMSE testing could give constituents some peace of mind and settle, for both men, rumors of any mental decline. 

“The more public our public figures become—because there’s cameras always on—the more likely we are to be exposed to these situations,” he said. “We have to make sense of them.”

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