Ruth Rosen's post provides the ground zero argument for concern about McCain's fitness for office. In spite of her title she makes a reasoned case that it is not McCain's age but his ability to do the job that we should worry about. It is not about age but about overall problems of mental, emotional and physical vitality. McCain's growing diminishment of capacities is obvious. From what I understand of the new research on frailty, it is a risk factor for cognitive impairment, and he is becoming physically frail looking and does not seem to have any regimen for staying fit or mentally sharp. His repertoire of responses to challenging situations has become much narrower, and his pampered life style puts few hurdles or barriers in his way. His recent contributions to legislation have been paltry at best.

Some behavioral aspects to consider. He repeats phrases and words over and over in an attempt to drive home a point but has considerable difficulty expanding on an idea or of extemporizing when needed. I watched him closely at Saddleback and whether he had the questions in advance or not, he had obviously been drilled (!) to a fare-thee-well and could hardly wait to spit out his stump speech bullets lest he forget them.

One of the trickiest things about cognitive decline is that sociability and long standing jokey tics become more predominant, and the person is heavily reliant on these to hide the impairment. This can be seductive to those who aren't around the person all the time and it tends to evoke sympathy. I see this happening with McCain--he has shtick but no longer a sharp wit. I'd be on the lookout for more signs, including increased lack of inhibition--perhaps making inappropriate sexual advances or jokes. I don't think his present level of crudity can be explained away by his POW and Navy background.