Medical Mystery: Did Reagan have Alzheimer's while president?

During this presidential election season, Allan B. Schwartz, a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine, is writing about medical mysteries in the Oval Office. Today, his subject is the 40th president.

At age 70, Ronald Reagan was the oldest person ever to be inaugurated U.S. president.

Known as the Great Communicator, he had a sense of humor that was legendary, and sometimes targeted on his own age.

He is quoted to have said: "I have left orders to be awakened at any time in case of national emergency, even if I am in a Cabinet meeting."

Another time, he said, "To show you how youthful I am, I intend to campaign in all 13 states."

But some incidents weren't so funny. At a 1984 photo session at the president's Santa Barbara ranch, a reporter called out a question about arms control. Reagan answered: "Well, we uh, well . . . I guess, uh, well, we uh . . ." His wife, Nancy, came to rescue, prompting him with a quiet, "We're doing the best we can."

Smiling, Reagan called out loudly, "We're doing the best we can!"

In 1985, news broke that the administration had supplied weapons to Iran for a hostage exchange, and millions of dollars plus guns were routed to right-wing "Contra" guerrillas in Nicaragua.

On Nov. 13, 1986, Reagan testified before Congress, via video link from the Oval Office. Asked what he knew about Iran-Contra, he said, "I don't recall; I don't remember that; I had so many meetings every day that I can't recall all of them."

Many wondered whether this was a cover-up, or whether Reagan really did forget.

Reagan's memory was a political issue even before he became president. His adversaries often claimed his tendency to forget names and make contradictory statements was a sign of dementia. Reagan tended to substitute terms such as "thing" for specific nouns, and favored using the same words repetitively. He used significantly fewer unique words in the years toward the end of his presidency, noted a study published in the Journal of Alzheimer's Disease.

Did Reagan have Alzheimer's disease while he was in office?

President Ronald Reagan died of pneumonia, a complication of Alzheimer's disease, on June 5, 2004, at his California home. A short time after his death, Nancy Reagan released a statement: "My family and I would like the world to know that President Ronald Reagan has died after 10 years of Alzheimer's disease, at 93 years of age."

The president himself announced in 1994, after he had left office, that he had the condition.

"I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer's Disease. . . . At the moment, I feel just fine. I intend to live the remainder of the years God gives me on this earth doing the things I have always done."

But others say his dementia was apparent long before.

"My father . . . floundered his way through his responses, fumbling with notes, uncharacteristically lost for words," the president's son Ron Reagan Jr., said of a 1984 debate with Walter Mondale. "He looked tired, bewildered."

Lesley Stahl, former CBS White House correspondent, described meeting with the president in 1986: "Reagan didn't seem to know who I was. He gave me a distant look with those milky eyes and shook my hand weakly. . . . Oh, my, he's gonzo, I thought." Then, Reagan regained his alertness and Stahl thought, "I had come that close to reporting that Reagan was senile."

According to a bio on the Alzheimer's Disease Foundation website, Lawrence K. Altman, a physician and reporter for the New York Times, noted that "the line between mere forgetfulness and the beginning of Alzheimer's can be fuzzy" and that all four of Reagan's White House doctors said they saw no evidence of Alzheimer's while he was president.

Though Alzheimer's remains incurable, more now is known about the brain, especially the long-term impact of repeated concussions and lesser slights known as "sub-concussive blows."

As a youngster, Reagan had such poor eyesight that he was seated in the front row of class to see the board. When playing sports, he was often hit in the head by the ball he could not see. Once given eyeglasses, he said he was surprised to discover that "trees had leaves and butterflies existed."

But he didn't wear the glasses while playing college football. His vision was limited to the square yard of turf occupied by the opposing team's guard and he was often hit by unseen opposing players.

In 1989, Reagan was thrown from a horse. A blood clot between the skull and brain was found, and neurosurgeons inserted a drain for a day to relieve pressure on the brain. An earlier blood clot on a different part of the brain that had healed on its own was disclosed by Reagan's neurosurgeon.

Did President Reagan actually have post-concussive syndrome, as has been recognized in professional athletes and military veterans? Did he have lingering Chronic Traumatic Encephalopathy (CTE) and perhaps a genetic risk factor known as APOE4, worsening with age and seen in some cognitive disorders and Alzheimers? It's impossible to know for certain.

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