The 25th Amendment provides a process to remove a president who is “unable to discharge the powers and duties of his office.” But there is no process for assessing the capabilities of candidates for president.

The Federal Aviation Agency requires commercial airline pilots to undergo regular cognitive assessments and lists more than 200 neuropsychologists across the country certified to conduct these assessments. Air traffic controllers must also undergo cognitive testing. For years, the Air Force, Navy, Marine Corps and Coast Guard have required officers to pass a series of cognitive and personality tests for qualification and assignment. The military now requires all personnel, including generals, to take cognitive tests at least once every three years. A bipartisan bill introduced in 2024 would expand this to all military branches.

People entrusted with crucial responsibilities in their professions are increasingly screened and monitored for their cognitive health. Shouldn’t this apply to the person with the most crucial responsibilities: the commander in chief? A cognitive fitness assessment is a necessary first step for people in positions of power responsible for the safety and well-being of others, but not sufficient on its own. A comprehensive assessment tailored to the unique requirements of the position is essential.

The voters think so too. A remarkable 75 percent of likely voters surveyed in 2023 said presidential candidates should take a cognitive test. This demand was voiced by Republicans, Democrats and independents alike. Such a large portion of the electorate rarely agrees on anything, but this is seen as common sense regardless of party affiliation.

Brain disorders that lead to cognitive decline can occur at any age and become increasingly common as people age. A 2020 analysis of 29,304 participants in the Health and Retirement Study concluded that “about two in three Americans experience some degree of cognitive impairment at an average age of about 70.”

Although changes in thinking ability usually occur as we age, some older people maintain high cognitive function and some younger people do not. Therefore, as with the professions mentioned, we recommend that all presidential candidates undergo a cognitive assessment, with subsequent monitoring once elected. This should also apply to other government leaders, including federal judges.

Historically, simple cognitive screening tests such as the Montreal Cognitive Assessment or the Mini Mental State Exam have been discussed in this context. We believe that this is insufficient. None of the career assessments of military leaders and the FAA are based on such simple screening tests. Instead, they use assessments that are tailored to the requirements of the profession. Some of these assessments are automated, while others are administered by a trained professional. At a minimum, an assessment of presidential candidates and other senior government officials should include an evaluation of complex attention, reasoning and problem solving, learning and memory, language, and social cognition. It is critical that a qualified professional oversee this assessment.

With each presidential candidate questioning the mental capabilities of the other, there has never been a time when cognitive fitness assessments for government leaders have been more important and urgent. The American public deserves leaders who are cognitively capable of meeting the demands of office. Neither Republicans nor Democrats want cognitive impairment on the ballot.

Dr. Anahita Dua is an associate professor of surgery at Massachusetts General Hospital and Harvard Medical School. Dr. Brad Dickerson is a practicing behavioral neurologist and professor of neurology at Massachusetts General Hospital and Harvard Medical School.