Recently, I’ve asked many patients to name the President of the United States. How patients answer this question provides some information as to their orientation to the world. Some of these patients are delirious; some of them have dementia. Some of them are neither delirious nor demented, though their disorganized thoughts and behaviors suggest to their physicians that they may be cognitively impaired.

Here’s a sample of the answers I have heard. (Keep in mind that Seattle is a liberal city.)

The man with a recent traumatic brain injury.

“Ugh! I hate him.”

“What is his name?”

“I don’t know, but I hate him.”

The man with alcohol-related amnesia (Korsakoff’s amnesia).

“He’s an idiot.”

“What is his name?”

“It doesn’t matter. He’s an idiot.”

“Tell me the name of this idiot.”

“Tricky Dicky.”

The elderly woman with dementia and multiple medical problems.

“Oh, I like him.”

“Who is he?”

“Isn’t it Clinton?”

The older woman who is neither delirious nor demented, but is psychotic.

“George W. Bush! His father was President, too!”

The woman with dementia.

“Carter. He’s a good man.”

Another man with a recent traumatic brain injury.

“Isn’t his wife running for President now? Hillary?”

“Well, that man isn’t currently President….”

“It’s not still Bush, is it?!”

People with dementia vote. One study from 2003 reported that 60 people with dementia (out of 100—researchers asked both patients and caregivers) voted in the November 2000 Presidential election. Another study from 2002 from the same election described that 48 people with dementia (out of 75— researchers asked the caregivers only if the people voted) cast a ballot. A small handful of articles have inquired into the capacity of people with dementia to vote.

(Insert joke about Florida here.)