A debate rages on whether President Reagan did or didn't have Alzheimer's disease during his time in office.

With what we have learned in the last decade about the disease, the question is relatively meaningless, except perhaps to score political points.

The simple answer: of course he did.

The newest technology—consisting of imaging and spinal taps—shows  that the disease process begins its relentless course as many as 15 years before a firm diagnosis. By the time the first symptoms appear, the disease is already progressing. While in office, Reagan had moments of incomprehension interspersed with fully lucid thinking. So Reagan was well along the glide path to dementia when he was staring down the Evil Empire.  The beloved conservative acronym WWRD might have been reframed: WSHBDAR: What Should Have Been Done About Reagan.

It doesn't really matter. Reagan will retain his exalted status within conservative hagiography. The more interesting question lurks ahead for future presidential candidates. The most significant advance in the Alzheimer's field in recent years is the advent of these imaging and spinal fluid "biomarkers" that can probe the course of the disease years before the first symptom. The techniques might not be fully ready for prime time, but they're getting there fast. In January, an FDA advisory panel voted to recommend, with just a few conditions, the approval of an imaging test that shows in living patients the buildup of the amyloid protein fragments characteristic of the disease.

Aging remains the biggest risk factor for Alzheimer's and, reminiscent of Reagan, many presidential candidates are well on in years. Once these tests gain acceptance, pressure will justifiably grow for a candidate to undergo testing to prove that the slip-of-the-tongue on the campaign trail was just an innocuous error. A man or woman who holds the public trust to make a decision about when to push The Button to send ICBMs hurtling on their way needs to be playing with the fullest of decks. In Search of the President's Brain—with a nod to Garry Trudeau—may become a refrain of future campaigns. Watch for bioethicists and neurologists to take a place alongside pollsters and other handlers during this new decade.

 SOURCE: Executive Office of the President