When former President Ronald Reagan disclosed in November 1994 that he had Alzheimer's disease, many people could not help suspecting that the illness had begun to rob him of memory while he was in the White House.
Throughout his years in Washington, Reagan had been portrayed by many pundits and political opponents as absent-minded, inattentive, incurious, even lazy. His presidency was marked by a succession of very public mental stumbles _ most notably his dismal performance in the first debate of the 1984 campaign, and his confused and forgetful accounting of his role in the Iran-Contra affair.
But even with the hindsight of Reagan's diagnosis, his four main White House doctors say they never detected any evidence that his forgetfulness was more than just that.
His mental competence in office, they said in a series of recent interviews, was never in doubt. Indeed, they pointed out, tests of his mental status did not begin to show evidence of the disease until the summer of 1993, more than four years after he left the White House.
"There was never anything that would raise a question about his ability to function as president," said Dr. Lawrence Mohr, one of Reagan's physicians in his second term. "Ronald Reagan's cognitive function, belief structure, judgment, ability to choose between options, behavior and ability to communicate were totally and completely intact."
Reagan's diagnosis raised questions not only about his mental competence in office but about how well his White House doctors had monitored it.
Dr. John Hutton, the chief White House physician during Reagan's last two years in office and a family friend, said he was speaking out with the permission of the former president's wife, Nancy, chiefly to rebut published statements questioning Reagan's mental status in office.
The doctors said they had taken the unusual step of discussing their former patient's medical history publicly because neither they nor Reagan had covered up any illness, and because they did not want history to see them as having done so.
While the doctors said they were familiar with Alzheimer's, none is an expert on it. But an Alzheimer's specialist _ after reviewing videotapes of news conferences and major events late in Reagan's presidency, as well as the doctors' descriptions _ said he, too, saw no evidence that Reagan had the disease as president.
One day during his last two years as president, Reagan walked into the White House medical office, greeted Mohr and said: "I have three things that I want to tell you today. The first is that I seem to be having a little problem with my memory. I cannot remember the other two."
As Mohr saw it, Reagan's quip was his characteristically joking way of expressing his anxieties about the mild forgetfulness of aging. "No question, there were occasional short-term memory lapses," Mohr said. "Were they frequent? No. Were they every day? No."
His occasional lapses notwithstanding, the doctors said they had seen no significant changes in Reagan's mental competence in the White House. From his election in 1980 until he retired in January 1989, they said, the president was always well clear of that fuzzy line where forgetting becomes Alzheimer's.
He "never forgot appointments, misplaced or lost things, where he put his glasses, never forgot to put his hearing aids in, never forgot to put his contact lenses in, and these are things he did for himself," Mohr said. "I saw him saddle and bridle horses at the ranch and later put things back exactly where they belonged."
And Reagan, the doctors stressed, was punctual, never depressed and had no difficulty with language or understanding what was going on around him.
Although White House doctors seldom join working sessions, they stay nearby from the time the president goes to work until he retires for the night. That intimate relationship, Mohr said, "allowed us to interact with our patient, Reagan, in a way that most physicians do not interact with their patients."
Hutton and Mohr, along with Dr. Daniel Ruge, a neurosurgeon who was Reagan's physician in his first term, said they had also evaluated his mental status by asking him to subtract 7 continually, starting with 100, and by asking other standard questions in annual check-ups.
But the fourth doctor, T. Burton Smith, a urologist who was the chief White House physician from January 1985 to January 1987, said he had been less thorough at times in examining neurological function.
Mohr said he and Hutton "certainly wanted to watch for any increase" in forgetfulness. At the same time, they acknowledged that, beyond their observations and conversations, they had not taken any special medical measures to assess Reagan's mental competence while in office.
Any mental lapses, they maintained, were not frequent enough to document in a medical chart and were never significant enough to consult experts, take CAT-scan X-rays of the brain or order a formal battery of mental status tests beyond the standard ones used in annual check-ups.
Asked why they had not done such tests earlier, Mohr, an internist who now teaches at the Medical University of South Carolina at Charleston, said the doctors believed that they "should not indiscriminately order medical tests just because someone happens to be president, and we should not indiscriminately order medical tests just to see what they might show."
It was not until the summer of 1990, the year after he left office, that Reagan underwent his first battery of formal mental and psychological tests. The tests gave no hint of what was to come, Hutton said, because "all parameters for his age absolutely were within the normal range."
Indeed, Hutton said, the 1990 tests were done not because of a suspicion of Alzheimer's but to assess Reagan's mental state in the wake of surgery the previous summer to remove a blood clot in his brain, suffered in a riding accident.
The tests, at the Mayo Clinic, lasted about four hours and included those that could indicate Alzheimer's; such tests usually evaluate things like memory of recent and past events, comprehension, attention and spatial relations.
(Questions about Reagan's mental state had been raised again that spring, when he testified in the Iran-Contra trial of his former national security adviser, Vice Admiral John Poindexter. Reagan, for example, did not know that Poindexter's predecessor, Robert McFarlane, had pleaded guilty when Reagan was president; nor could he identify the chairman of his Joint Chiefs of Staff. Videotapes of the testimony were viewed by the Alzheimer's expert consulted by the New York Times. While he saw hints that might have led him to probe further, he said, he found no definitive evidence of the disease. Many people, he added, might not have been able to answer the questions without staff support.)
From a layman's perspective, all of the friends and close White House aides who were interviewed generally seconded the doctors' perceptions. The image of an absent-minded chief executive, they said, was an unsophisticated picture of a sharp and decisive man who was sometimes forgetful and inconsistently attentive.
Howard Baker had been hearing rumors about Reagan's mental competence when he became his chief of staff in March 1987, with a mandate to arrest the disarray in the White House that had come to light in the Iran-Contra affair.
When he arrived at the White House, Baker's top priority was to determine how well the president functioned. "It did not take me a day," said Baker, "to figure out that this man was sharp, well organized, fully capable, and the same person that I knew from previous years."
And when he was engaged, his aides said, his memory was keen.
"You gave him a very complex briefing on some subject, and he absorbed it like a sponge," Baker said. "Yet a few days later, you could ask him about it, and it had been dumped out of his memory."
If interrupted in a conversation, several people said, Reagan could pick it up at the same point days, even weeks, later. Yet, while Reagan had a "phenomenal" memory, you had to be sure that what he was remembering was accurate in the first place, said Donald Regan, one of his chiefs of staff.
"One of the first things that Mike Deaver, Jim Baker, and Ed Meese warned me about, when I was taking over as chief of staff in 1985 and they were departing for other jobs, was not to let him get set on some fact that you don't know for sure is real," Regan said. "Because he had a great habit of reading something, remembering it, and then it would come out at the damnedest time."