speech deficiency meaning

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Overcoming Speech Impediment: Symptoms to Treatment

There are many causes and solutions for impaired speech

• Types and Symptoms
• Speech Therapy
• Building Confidence

Speech impediments are conditions that can cause a variety of symptoms, such as an inability to understand language or speak with a stable sense of tone, speed, or fluidity. There are many different types of speech impediments, and they can begin during childhood or develop during adulthood.

Common causes include physical trauma, neurological disorders, or anxiety. If you or your child is experiencing signs of a speech impediment, you need to know that these conditions can be diagnosed and treated with professional speech therapy.

This article will discuss what you can do if you are concerned about a speech impediment and what you can expect during your diagnostic process and therapy.

FG Trade / Getty Images

Types and Symptoms of Speech Impediment

People can have speech problems due to developmental conditions that begin to show symptoms during early childhood or as a result of conditions that may occur during adulthood. 

The main classifications of speech impairment are aphasia (difficulty understanding or producing the correct words or phrases) or dysarthria (difficulty enunciating words).

Often, speech problems can be part of neurological or neurodevelopmental disorders that also cause other symptoms, such as multiple sclerosis (MS) or autism spectrum disorder .

There are several different symptoms of speech impediments, and you may experience one or more.

Can Symptoms Worsen?

Most speech disorders cause persistent symptoms and can temporarily get worse when you are tired, anxious, or sick.

Symptoms of dysarthria can include:

• Slurred speech
• Slow speech
• Choppy speech
• Hesitant speech
• Inability to control the volume of your speech
• Shaking or tremulous speech pattern
• Inability to pronounce certain sounds

Symptoms of aphasia may involve:

• Speech apraxia (difficulty coordinating speech)
• Difficulty understanding the meaning of what other people are saying
• Inability to use the correct words
• Inability to repeat words or phases
• Speech that has an irregular rhythm

You can have one or more of these speech patterns as part of your speech impediment, and their combination and frequency will help determine the type and cause of your speech problem.

Causes of Speech Impediment

The conditions that cause speech impediments can include developmental problems that are present from birth, neurological diseases such as Parkinson’s disease , or sudden neurological events, such as a stroke .

Some people can also experience temporary speech impairment due to anxiety, intoxication, medication side effects, postictal state (the time immediately after a seizure), or a change of consciousness.

Speech Impairment in Children

Children can have speech disorders associated with neurodevelopmental problems, which can interfere with speech development. Some childhood neurological or neurodevelopmental disorders may cause a regression (backsliding) of speech skills.

Common causes of childhood speech impediments include:

• Autism spectrum disorder : A neurodevelopmental disorder that affects social and interactive development
• Cerebral palsy :  A congenital (from birth) disorder that affects learning and control of physical movement
• Hearing loss : Can affect the way children hear and imitate speech
• Rett syndrome : A genetic neurodevelopmental condition that causes regression of physical and social skills beginning during the early school-age years.
• Adrenoleukodystrophy : A genetic disorder that causes a decline in motor and cognitive skills beginning during early childhood
• Childhood metabolic disorders : A group of conditions that affects the way children break down nutrients, often resulting in toxic damage to organs
• Brain tumor : A growth that may damage areas of the brain, including those that control speech or language
• Encephalitis : Brain inflammation or infection that may affect the way regions in the brain function
• Hydrocephalus : Excess fluid within the skull, which may develop after brain surgery and can cause brain damage

Do Childhood Speech Disorders Persist?

Speech disorders during childhood can have persistent effects throughout life. Therapy can often help improve speech skills.

Speech Impairment in Adulthood

Adult speech disorders develop due to conditions that damage the speech areas of the brain.

Common causes of adult speech impairment include:

• Head trauma 
• Nerve injury
• Throat tumor
• Stroke 
• Parkinson’s disease 
• Essential tremor
• Brain tumor
• Brain infection

Additionally, people may develop changes in speech with advancing age, even without a specific neurological cause. This can happen due to presbyphonia , which is a change in the volume and control of speech due to declining hormone levels and reduced elasticity and movement of the vocal cords.

Do Speech Disorders Resolve on Their Own?

Children and adults who have persistent speech disorders are unlikely to experience spontaneous improvement without therapy and should seek professional attention.

Steps to Treating Speech Impediment 

If you or your child has a speech impediment, your healthcare providers will work to diagnose the type of speech impediment as well as the underlying condition that caused it. Defining the cause and type of speech impediment will help determine your prognosis and treatment plan.

Sometimes the cause is known before symptoms begin, as is the case with trauma or MS. Impaired speech may first be a symptom of a condition, such as a stroke that causes aphasia as the primary symptom.

The diagnosis will include a comprehensive medical history, physical examination, and a thorough evaluation of speech and language. Diagnostic testing is directed by the medical history and clinical evaluation.

Diagnostic testing may include:

• Brain imaging , such as brain computerized tomography (CT) or magnetic residence imaging (MRI), if there’s concern about a disease process in the brain
• Swallowing evaluation if there’s concern about dysfunction of the muscles in the throat
• Electromyography (EMG) and nerve conduction studies (aka nerve conduction velocity, or NCV) if there’s concern about nerve and muscle damage
• Blood tests, which can help in diagnosing inflammatory disorders or infections

Your diagnostic tests will help pinpoint the cause of your speech problem. Your treatment will include specific therapy to help improve your speech, as well as medication or other interventions to treat the underlying disorder.

For example, if you are diagnosed with MS, you would likely receive disease-modifying therapy to help prevent MS progression. And if you are diagnosed with a brain tumor, you may need surgery, chemotherapy, or radiation to treat the tumor.

Therapy to Address Speech Impediment

Therapy for speech impairment is interactive and directed by a specialist who is experienced in treating speech problems . Sometimes, children receive speech therapy as part of a specialized learning program at school.

The duration and frequency of your speech therapy program depend on the underlying cause of your impediment, your improvement, and approval from your health insurance.

If you or your child has a serious speech problem, you may qualify for speech therapy. Working with your therapist can help you build confidence, particularly as you begin to see improvement.

Exercises during speech therapy may include:

• Pronouncing individual sounds, such as la la la or da da da
• Practicing pronunciation of words that you have trouble pronouncing
• Adjusting the rate or volume of your speech
• Mouth exercises
• Practicing language skills by naming objects or repeating what the therapist is saying

These therapies are meant to help achieve more fluent and understandable speech as well as an increased comfort level with speech and language.

Building Confidence With Speech Problems 

Some types of speech impairment might not qualify for therapy. If you have speech difficulties due to anxiety or a social phobia or if you don’t have access to therapy, you might benefit from activities that can help you practice your speech. 

You might consider one or more of the following for you or your child:

• Joining a local theater group
• Volunteering in a school or community activity that involves interaction with the public
• Signing up for a class that requires a significant amount of class participation
• Joining a support group for people who have problems with speech

Activities that you do on your own to improve your confidence with speaking can be most beneficial when you are in a non-judgmental and safe space.

Many different types of speech problems can affect children and adults. Some of these are congenital (present from birth), while others are acquired due to health conditions, medication side effects, substances, or mood and anxiety disorders. Because there are so many different types of speech problems, seeking a medical diagnosis so you can get the right therapy for your specific disorder is crucial.

Centers for Disease Control and Prevention. Language and speech disorders in children .

Han C, Tang J, Tang B, et al. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: a systematic review and meta-analysis . Medicine (Baltimore). 2024;103(2):e36880. doi:10.1097/MD.0000000000036880

National Institute on Deafness and Other Communication Disorders. Quick statistics about voice, speech, language .

Mackey J, McCulloch H, Scheiner G, et al. Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience . Brain Impair. 2023;24(2):168-184. doi:10.1017/BrImp.2023.9

Allison KM, Doherty KM. Relation of speech-language profile and communication modality to participation of children with cerebral palsy . Am J Speech Lang Pathol . 2024:1-11. doi:10.1044/2023_AJSLP-23-00267

Saccente-Kennedy B, Gillies F, Desjardins M, et al. A systematic review of speech-language pathology interventions for presbyphonia using the rehabilitation treatment specification system . J Voice. 2024:S0892-1997(23)00396-X. doi:10.1016/j.jvoice.2023.12.010

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

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Speech disorders - children

A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others. This can make the person's speech difficult to understand.

Common speech disorders are:

• Articulation disorders
• Phonological disorders
• Voice disorders or resonance disorders

Speech disorders are different from language disorders in children . Language disorders refer to someone having difficulty with:

• Getting their meaning or message across to others (expressive language)
• Understanding the message coming from others (receptive language)

Speech is one of the main ways in which we communicate with those around us. It develops naturally, along with other signs of normal growth and development . Disorders of speech and language are common in preschool age children.

Disfluencies are disorders in which a person repeats a sound, word, or phrase. Stuttering may be the most serious disfluency. It may be caused by:

• Genetic abnormalities
• Emotional stress
• Any trauma to the brain or infection

Articulation and phonological disorders may occur in other family members. Other causes include:

• Problems or changes in the structure or shape of the muscles and bones used to make speech sounds. These changes may include cleft palate and tooth problems.
• Damage to parts of the brain or the nerves (such as from cerebral palsy ) that control how the muscles work together to create speech.
• Hearing loss.

Voice disorders are caused by problems when air passes from the lungs, through the vocal cords, and then through the throat, nose, mouth, and lips. A voice disorder may be due to:

• Acid from the stomach moving upward ( GERD )
• Cancer of the throat
• Cleft palate or other problems with the palate
• Conditions that damage the nerves that supply the muscles of the vocal cords
• Laryngeal webs or clefts (a birth defect in which a thin layer of tissue is between the vocal cords)
• Noncancerous growths (polyps, nodules, cysts, granulomas, papillomas, or ulcers) on the vocal cords
• Overuse of the vocal cords from screaming, constantly clearing the throat, or singing
• Hearing loss

Stuttering is the most common type of disfluency.

Symptoms of disfluency can include:

• Repetition of sounds, words, or parts of words or phrases after age 4 (I want...I want my doll. I...I see you.)
• Putting in (interjecting) extra sounds or words (We went to the...uh...store.)
• Making words longer (I am Boooobbby Jones.)
• Pausing during a sentence or words, often with the lips together
• Tension in the voice or sounds
• Frustration with attempts to communicate
• Head jerking while talking
• Eye blinking while talking
• Embarrassment with speech

ARTICULATION DISORDER

The child is not able to produce speech sounds clearly, such as saying "coo" instead of "school."

• Certain sounds (like "r", "l", or "s") may be consistently distorted or changed (such as making the 's' sound with a whistle).
• Errors may make it hard for people to understand the person (only family members may be able to understand a child).

PHONOLOGICAL DISORDER

The child does not use some or all of the speech sounds to form words as expected for their age.

• The last or first sound of words (most often consonants) may be left out or changed.
• The child may have no problem pronouncing the same sound in other words (a child may say "boo" for "book" and "pi" for "pig", but may have no problem saying "key" or "go").

VOICE DISORDERS

Other speech problems include:

• Hoarseness or raspiness to the voice
• Voice may break in or out
• Pitch of the voice may change suddenly
• Voice may be too loud or too soft
• Person may run out of air during a sentence
• Speech may sound odd because too much air is escaping through the nose (hypernasality) or too little air is coming out through the nose (hyponasality)

Exams and Tests

Your health care provider will ask about your child's developmental and family history. The provider will do some neurological screening and check for:

• Fluency of speech
• Any emotional stress
• Any underlying condition
• Effect of speech disorder on daily life

Some other evaluation tools used to identify and diagnose speech disorders are:

• Denver Articulation Screening Examination.
• Leiter International Performance scale-3.
• Goldman-Fristoe Test of Articulation 3 (GFTA-3).
• Arizona Articulation and Phonology Scale 4th Revision (Arizona-4).
• Prosody-voice screening profile.

A hearing test may also be done to check for hearing loss as a cause of the speech disorder.

Children may outgrow milder forms of speech disorders. The type of treatment will depend on the severity of the speech disorder and its cause.

Speech therapy may help with more severe symptoms or any speech problems that do not improve.

In therapy, the therapist may teach your child how to use their tongue to create certain sounds.

If a child has a speech disorder, parents are encouraged to:

• Avoid expressing too much concern about the problem, which can make matters worse by making the child more self-conscious.
• Avoid stressful social situations whenever possible.
• Listen patiently to the child, make eye contact, don't interrupt, and show love and acceptance. Avoid finishing sentences for them.
• Set aside time for talking.

Support Groups

More information and support for people with stuttering and their families can be found at:

• American Institute for Stuttering -- stutteringtreatment.org
• American Speech-Language-Hearing Association (ASHA) -- www.asha.org/
• The Stuttering Foundation -- www.stutteringhelp.org
• National Stuttering Association (NSA) -- westutter.org

Outlook (Prognosis)

The outlook depends on the cause of the disorder. Speech can often be improved with speech therapy. Early treatment is likely to have better results.

Possible Complications

Speech disorders may lead to challenges with social interactions due to difficulty communicating.

When to Contact a Medical Professional

Contact your provider if:

• Your child's speech is not developing according to normal milestones.
• You think your child is in a high-risk group.
• Your child is showing signs of a speech disorder.

Hearing loss is a risk factor for speech disorders. At-risk infants should be referred to an audiologist for a hearing test. Hearing and speech therapy can then be started, if necessary.

As young children begin to speak, some disfluency is common, and most of the time, it goes away without treatment. If you place too much attention on the disfluency, a stuttering pattern may develop.

Alternative Names

Articulation deficiency; Articulation disorder; Phonological disorder; Voice disorders; Vocal disorders; Disfluency; Communication disorder - speech disorder; Speech disorder - stuttering; Cluttering; Stammering; Childhood onset fluency disorder

American Speech-Language-Hearing Association website. Voice disorders. www.asha.org/Practice-Portal/Clinical-Topics/Voice-Disorders/ . Accessed February 22, 2024.

Driver LE, Nelson ME. Pediatric speech disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery . 7th ed. Philadelphia, PA: Elsevier; 2021:chap 183.

Simms MD. Language development and communication disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics . 21st ed. Philadelphia, PA: Elsevier; 2020:chap 52.

Trauner DA, Nass RD. Developmental language disorders. In: Swaiman KF, Ashwal S, Ferriero DM, et al, eds. Swaiman's Pediatric Neurology: Principles and Practice . 6th ed. Philadelphia, PA: Elsevier; 2017:chap 53.

Zajac DJ. Evaluation and management of speech disorders for the patient with cleft palate. In: Fonseca RJ, ed. Oral and Maxillofacial Surgery . 3rd ed. St Louis, MO: Elsevier; 2018:chap 32.

Review Date 2/17/2024

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Related MedlinePlus Health Topics

• Speech and Language Problems in Children

What is a speech impairment?

A speech impairment refers to an impaired ability to produce speech sounds and may range from mild to severe. It may include an articulation disorder, characterized by omissions or distortions of speech sounds; a fluency disorder, characterized by atypical flow, rhythm, and/or repetitions of sounds; or a voice disorder, characterized by abnormal pitch, volume, resonance, vocal quality, or duration.

The American Speech-Language Hearing Association (ASHA) has published its official definitions in Definitions of Communication Disorders and Variations .

Additional information is available from Speech and Language Impairments  hosted by the Center for Parent Information and Resources.

• Patient Care & Health Information
• Diseases & Conditions

Dysarthria occurs when the muscles you use for speech are weak or you have difficulty controlling them. Dysarthria often causes slurred or slow speech that can be difficult to understand.

Common causes of dysarthria include nervous system disorders and conditions that cause facial paralysis or tongue or throat muscle weakness. Certain medications also can cause dysarthria.

Treating the underlying cause of your dysarthria may improve your speech. You may also need speech therapy. For dysarthria caused by prescription medications, changing or discontinuing the medications may help.

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Signs and symptoms of dysarthria vary, depending on the underlying cause and the type of dysarthria. They may include:

• Slurred speech
• Slow speech
• Inability to speak louder than a whisper or speaking too loudly
• Rapid speech that is difficult to understand
• Nasal, raspy or strained voice
• Uneven or abnormal speech rhythm
• Uneven speech volume
• Monotone speech
• Difficulty moving your tongue or facial muscles

When to see a doctor

Dysarthria can be a sign of a serious condition. See your doctor if you have sudden or unexplained changes in your ability to speak.

In dysarthria, you may have difficulty moving the muscles in your mouth, face or upper respiratory system that control speech. Conditions that may lead to dysarthria include:

• Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease)
• Brain injury
• Brain tumor
• Cerebral palsy
• Guillain-Barre syndrome
• Head injury
• Huntington's disease
• Lyme disease
• Multiple sclerosis
• Muscular dystrophy
• Myasthenia gravis
• Parkinson's disease
• Wilson's disease

Some medications, such as certain sedatives and seizure drugs, also can cause dysarthria.

Complications

Because of the communication problems dysarthria causes, complications can include:

• Social difficulty. Communication problems may affect your relationships with family and friends and make social situations challenging.
• Depression. In some people, dysarthria may lead to social isolation and depression.
• Daroff RB, et al., eds. Bradley's Neurology in Clinical Practice. 7th ed. Elsevier; 2016. https://www.clinicalkey.com. Accessed April 10, 2020.
• Dysarthria. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/dysarthria/. Accessed April 6, 2020.
• Maitin IB, et al., eds. Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. Accessed April 10, 2020.
• Dysarthria in adults. American Speech-Language-Hearing Association. https://www.asha.org/PRPPrintTemplate.aspx?folderid=8589943481. Accessed April 6, 2020.
• Drugs that cause dysarthria. IBM Micromedex. https://www.micromedexsolutions.com. Accessed April 10, 2020.
• Lirani-Silva C, et al. Dysarthria and quality of life in neurologically healthy elderly and patients with Parkinson's disease. CoDAS. 2015; doi:10.1590/2317-1782/20152014083.
• Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/signs_symptoms/index.html. Accessed April 6, 2020.
• Neurological diagnostic tests and procedures fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact. Accessed April 6, 2020.

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Speech Disorder

Speech Disorder: any defect or abnormality that prevents an individual from communicating by means of spoken words. Speech disorders may develop from nerve injury to the brain, muscular paralysis, structural defects, hysteria, or mental retardation.

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Definition of deficiency

• drouth
• inadequateness
• insufficiency
• undersupply

Examples of deficiency in a Sentence

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'deficiency.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

defici(ent) entry 1 + -ency

1603, in the meaning defined at sense 1

Phrases Containing deficiency

• acquired immune deficiency syndrome
• deficiency disease
• mental deficiency

Dictionary Entries Near deficiency

deficiency account

Cite this Entry

“Deficiency.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/deficiency. Accessed 18 May. 2024.

Kids Definition

Kids definition of deficiency, medical definition, medical definition of deficiency, legal definition, legal definition of deficiency, more from merriam-webster on deficiency.

Nglish: Translation of deficiency for Spanish Speakers

Britannica English: Translation of deficiency for Arabic Speakers

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The Oxford-Harrington Rare Disease Centre Announces Newly Funded Grant Award Programs to Develop New Therapies for Friedreich’s Ataxia

May 17, 2024

By Ansley Kelm

OXFORD, UK and CLEVELAND, Ohio, US – The Oxford-Harrington Rare Disease Centre (‘OHC’), a partnership (between the University of Oxford , UK and Harrington Discovery Institute at University Hospitals , Cleveland, Ohio) aimed at driving cutting-edge rare disease breakthroughs, is pleased to announce that it has received a philanthropic donation of up to £650,000 to enable the launch of two new grant award programmes to support the research and development of greatly needed therapeutics for Friedreich’s Ataxia (FA): The FA Alliance Catalyst Fund and The FA Alliance Innovation Fund.

In 2021, the OHC established a dedicated programme for recruiting leading disease area experts and coordinating substantial research efforts towards developing new treatments for FA. So far, 18 leading researchers have been recruited and a pipeline of FA projects has been created. This programme is supported by the non-profit organisations EndFA, The Friedreich’s Ataxia Research Alliance (FARA), and Ataxia UK, and is collectively known as the Friedreich’s Ataxia Alliance at Oxford (FA Alliance).

The FA Alliance Catalyst Fund and The FA Alliance Innovation Fund will both initiate and accelerate cutting-edge research currently underway within the OHC for the development of a treatment for FA. The FA Alliance Catalyst Fund will leverage co-funding and support from the University of Oxford’s Translational Research Office to fund research scientists already tackling FA. The FA Alliance Innovation Fund will specifically advance earlier-stage ideas with little or no preliminary data that aim to explore highly innovative, potentially ground-breaking concepts in FA research.

FA is a debilitating, life-shortening, degenerative multisystem rare disease that affects roughly 1 in 50,000 people in the US / UK [1] , with onset typically between 10-15 years of age. Individuals with FA have genetic mutations that result in a deficiency in the production of a protein called frataxin, causing progressive damage and cell death. This leads to the initial symptoms of FA, such as tiredness, vision and hearing loss, chest pain, slow or slurred speech, difficulty walking and a loss of sensation and reflexes. Despite extensive research there is no cure for FA, meaning that significant progress is still required to advance new therapeutics for patients in need.

Matthew Wood, Director and Chief Scientific Officer of the OHC, and Professor of Neuroscience in Oxford’s Department of Paediatrics, said: “Today’s announcement validates and underscores OHC’s commitment to driving innovation and collaboration in research towards new therapeutics to meet the major unmet need of Friedreich’s Ataxia. We are extremely grateful for the support received, which is enabling the launch of these two new award programmes. Through OHC and the FA Alliance, we are bringing a multidisciplinary team of leading researchers and clinicians together to tackle this challenging rare disease as one of our priority areas. Strengthened by the complementary expertise of the Harrington Discovery Institute, this new funding will both accelerate existing projects and advance new projects with the aim of developing a therapeutic to cure or treat FA.”

For more information, visit: Friedreich’s Ataxia Research at OHC

[1] The Friedreich’s Ataxia Research Alliance (FARA) - https://www.curefa.org/what-is-friedreichs-ataxia

Tags: Gifts , Grant funding , Rare diseases , Research

What science tells us about Biden, Trump and evaluating an aging brain

The 2024 presidential race has been dominated by allegations of mental decline. Scientists and doctors offer cautionary notes.

The 2024 presidential election has turned into a crash course in gerontology.

On Election Day, former president Donald Trump will be 78 years old, and President Biden will be a couple weeks shy of 82. Never have two people of such advanced age been the nominees of the major political parties, nor has there been a campaign so rife with suspicions and allegations that candidates are showing signs of age-related cognitive decline.

The situation has worried the electorate. In a Marquette Law School poll conducted in March, 77 percent of registered voters said they consider Biden “too old to be president,” while 52 percent said that of Trump. And in a Pew Research survey in April, 62 percent said Biden did not have the “mental fitness needed to do the job,” while 48 percent reached that conclusion about Trump.

But this public discussion of the aging brain — a scientific topic if ever there was one — has been conducted largely without reference to any scientific facts.

Research on aging, cognition and dementia has become more robust in a time when about 56 million Americans are over age 65, according to the 2020 Census. But medical and scientific experts warn that media reports and punditry about the candidates’ mental fitness have been marred by misinformation about the aging process.

The experts interviewed for this story were reluctant to speculate on the record about the cognitive health of Biden and Trump, noting that a robust assessment requires an in-depth examination potentially lasting days. They were more eager to speak about the aging process generally and what science can reveal about the aging brain — what’s normal, what’s pathological and how to discern the difference.

They also rejected any suggestion that there should be an upper age limit for the presidency.

Aging is not an unmitigated process of cognitive decline and deterioration, they said. Judgment and emotional stability can improve with age — and may be more essential to effective leadership than, say, the ability to remember names or deliver a speech without a flub.

“The really important thing to keep in mind is that the older brain’s a wiser brain,” said Earl Miller, a professor of neuroscience at MIT. “Knowledge and experience count for a lot, and that can more than make up for slight losses of memory as a result of aging.”

Gaffes, fumbles and ‘word salad’

The president is the head of state, the commander in chief, the sole person with the power to order a nuclear strike. It is a demanding job that requires multiple skills, both in public and behind the scenes, and it requires stamina and clear communication. No job in America is so closely scrutinized.

Inevitably, verbal stumbles or any other whiff of mental decline are magnified by an often unmerciful news media.

When President Ronald Reagan ran for reelection in 1984 at the age of 73, his poor performance in a debate against Democratic challenger Walter Mondale, including halting speech in an obvious struggle to find the right words, incited allegations that he was showing signs of dementia.

Reagan rebounded in the next debate with a killer joke: “I am not going to exploit, for political purposes, my opponent’s youth and inexperience.” That brought down the house, and Reagan went on to win in a landslide.

In November 1994, nearly six years after leaving office, Reagan revealed in a letter to the American people that he had been diagnosed with Alzheimer’s disease. That incited a new round of speculation that Reagan had been cognitively impaired while still in the White House, but his defenders have argued the contrary.

In this election cycle, verbal fumbles have been a recurring storyline, with Biden and Trump often mangling names, places, dates and historical events, or routinely uttering “word salad,” challenging the listener to decipher what they are trying to say.

Biden, who has a lifelong stutter, has struggled with articulation at times, and Trump has mocked him for it . Many left-leaning pundits have pointed to Trump’s rambling, disorderly speeches as cognitive warning signs.

The most highly publicized stumbles by the candidates involve mixing up proper nouns. Biden said “Mitterrand” when he meant “Macron,” and Trump said “Haley” when he meant “Pelosi,” for example. Many older people struggle with proper nouns, in part because names are arbitrary labels .

Medical experts say these are just the workings of a normally aging brain, what are sometimes called “senior moments,” and not (absent further clinical investigation) signs of dementia or predictive of cognitive decline.

“They’re articulation problems, mainly, and this just happens as you get older,” said Charan Ranganath, a professor of psychology and neuroscience at the University of California at Davis.

Moreover, trouble retrieving words does not signal a deeper problem with memory.

“In my clinical work, you could see people who seemed young, vital, totally with it who had memory problems that wouldn’t allow them to function,” Ranganath said. “And I’ve seen people who are old, frail, they talk slowly, they move slowly and their memory is fine, and they’re perfectly capable of living on their own and working on their own.”

Experts note that, in contrast to children and young adults, there is tremendous variability in the mental and physical health of older people. There are 90-year-olds who are “superagers” and have the vitality and mental acuity of someone decades younger.

One way in which many older people have an edge on younger people is in emotional stability. As people age, they typically experience a decline in negative emotions, said Laura Carstensen, a professor of psychology and director of the Stanford Center on Longevity.

“Emotional regulation, emotional caring, appreciation, motivation to be social with others — all of those go up with age,” she said, adding her dismay at the tenor of the national discussion about aging political leaders. “The ageism that underlies these discussions is remarkable,” she said.

Trouble with distant diagnoses

Normal aging in the brain involves changes in the smallest components, as well as the broader systems. The machinery our cells use to convert glucose into energy and get rid of waste begins to break down. Cell debris builds up ― imagine a city during a garbage strike. As a result, neurons don’t function as they should. And a feature of aging called “stem cell exhaustion” results in the formation of fewer new neurons.

On average, the weight and volume of a human brain decrease by roughly 2 percent per decade due to a wide range of factors, including loss of cells as well as loss and shrinkage of connecting fibers called dendrites.

At the macro level, the gray matter that processes information and the white matter that helps different areas of the brain communicate with one another both decline in key areas called the hippocampus and frontal cortex. These declines weaken our working memory, attention and mental flexibility, leading to problems with word retrieval, among other things.

But these are gradual processes. Absent an injury or disease, cognition does not tend to decline precipitously, although the process does accelerate when people are close to death, said Allison Sekuler, a professor of psychology at the University of Toronto and at Baycrest Centre, a research and teaching hospital for older patients.

“If you map cognitive function and physical function onto chronological age, nothing lines up,” Sekuler said. “But if you plot it relative to time of death, then it lines up much better.”

What’s most important, Sekuler said, is looking at how a patient changes over time.

“Anyone who’s seeing changes in their emotion, in their speech, in their behavior, in their memory, in their sleep patterns, any of those things, if it’s concerning to you, definitely you should get it looked at,” Sekuler said, speaking of the population generally. “Whether it means that there’s cognitive decline, there’s so many other things that it could mean.”

Factors contributing to a memory or verbal slip could include depression, temporary dehydration or deficiency of vitamin B12, she said.

“It’s very dangerous for us to be diagnosing people based on behavior, what we see in the media, what we see on the news,” she said.

A thorough neuropsychological evaluation is typically a holistic one, “which means it’s an inexact science,” said Ranganath, of UC Davis. It includes an interview and a set of memory tests. The patient might be asked to remember a list of words immediately after the examiner has said them, and then asked again 20 minutes later to recall as many as possible. A series of images, such as faces, can be used to test visual memory.

Memory deficits can be partial, he said: A person could have a deficit in visual memory, for example, but be fine with verbal memory. A doctor will find the results concerning only if the patient performs at an extremely low level, he said. Complicating the evaluation is the fact that cognitive functioning can vary over the course of a day, with many dementia patients becoming more agitated, anxious or confused in the late afternoon to evening.

A call for cognitive transparency

Voters may be tempted to make their own nonmedical assessments, since there is no requirement that candidates undergo a cognitive or psychological evaluation that can be shared with the general public.

The Biden administration in February released a six-page memorandum from his physician, Kevin C. O’Connor, summarizing a few medication-controlled physical ailments. The doctor concluded that Biden is a “healthy, active, robust 81-year-old male, who remains fit to successfully execute the duties of the Presidency,” the report said.

Biden did not, however, take a cognitive test. His doctor and a neurologist did not think Biden needed one, White House press secretary Karine Jean-Pierre told reporters. Just by doing his “very rigorous” job, she said, “he passes a cognitive test every day.”

Trump has claimed repeatedly that he has passed cognitive tests but has released minimal information about his health. In November, Trump released a three-paragraph note from his personal physician describing Trump’s health as excellent and saying “cognitive exams were exceptional,” but providing no details.

The medical journal the Lancet published an editorial in March saying the United States, if “truly invested in the health of its leaders, and not just grasping for fresh mud to sling,” should create a standardized system for sharing information about the health of presidents and candidates.

Biden and Trump, however, have been prominent public figures for decades and have both served as chief executive. Voters may feel they know them well enough to make a decision in November — and additional details about their health probably won’t sway supporters of either one.

Scott Clement contributed to this report.

Judge vacates trespassing cases against ASU pro-Palestinian protesters, but charges could still come

Dozens of pro-Palestinian protesters who were arrested last month on Arizona State University’s campus in Tempe had their cases vacated on Tuesday after ASU police did not refer them to Maricopa County prosecutors.

A judge ruled to dismiss the cases without prejudice, meaning the Maricopa County Attorney’s Office has up to a year to pursue the trespassing charges.

It's unclear why the ASU Police Department has not yet referred the cases. An ASU spokesperson said the campus Police Department "is in the process of submitting complete information regarding the arrests to the Maricopa County Attorney’s Office for its review and charging decisions."

A spokesperson for the County Attorney's Office told The Arizona Republic charges may vary per each case. The office has not received any of the cases from ASU, despite officials sharing different information previously.

"We’ll evaluate these cases as we do every case that comes into the office, including assessing whether there is a reasonable likelihood of conviction," spokesperson Jeanine L'Ecuyer said in an email.

The people arrested in April were still expected to appear for their originally scheduled arraignment on Tuesday in spite of the lack of charges. Attorney Zayed Al’Sayyed called the process a “grave deficiency” in the state’s criminal procedure process.  

“Nobody should have had to have come here,” said Al’Sayyed, one of the attorneys representing the protesters. He is calling on county prosecutors to not pursue the charges later on. 

Mike Colon, 41, a protester from April's encampment, left Tuesday's arraignment with a notice saying his case had been vacated. It advises that he could be summoned to return to court later if county prosecutors pursue charges.

Colon said he has advocated for Palestinian rights for more than two decades and attended the protests to call for divestment from Israel from both ASU and the American government. He criticized the court system and use of police force at April's protest.

"That whole show of force for what?" he said. "It's a waste of taxpayer money."

Late last month, 72 people were arrested after campus police officers said they gave multiple orders to pro-Palestinian protesters to vacate Alumni Lawn on ASU's Tempe campus. The protesters erected tents to form an encampment in support of Gaza, which was later forcibly removed late into the night.

At least 20 students were among those who were arrested. They are now facing an interim suspension as school officials investigate whether they violated the student code of conduct. Those suspensions are now the subject of a lawsuit , alleging students have been unfairly punished for expressing free speech.

One student who appeared on Tuesday, Breanna Brocker, said she hasn't been able to complete her exams this semester and as a result couldn't graduate with her peers last week. Brocker has appealed the decision from the university but has not yet heard back, she said.

"I was standing up for what I believe in," Brocker said. "I truly thought ASU would stand with me."

Al’Sayyed said the arrested protesters will still have Tuesday's cases appear in any background check done since they were dismissed without prejudice.

"That is a grave, irreparable harm that was caused by the state," he said.

Placed on leave: ASU police chief under investigation for handling of pro-Palestinian protest

Helen Rummel covers higher education for The Arizona Republic. Reach her at [email protected] . Follow her on X, formerly Twitter: @helenrummel .

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