"Tell me, who is the president?"

"The president?" The patient's eyes grew wide. She was ninety-two years old, and her memory was "not the best, dear."

We had just met. I'd quizzed her gently, and she'd responded with bemused indulgence...until now. She looked directly at me, and scowled. "Here it comes," said her daughter. Here it came, indeed! A stream of bitter disapproval...

It was 1998, and we had all just heard of Monica Lewinsky.

At times, we must try to learn if our patients are aware of a larger world, beyond their own surroundings and circumstances. If a patient is forgetful or disoriented, how severe is the impairment? There is a long tradition of asking, "Who is the president...and the one before him...and the one before him?" Unsurprisingly, the question can bring the larger world thundering into my office. The interview stops, and I learn exactly what the patient thinks of the old so-and-so, even if they can't quite remember his name.

When Clinton was president, people tended to forget the elder Bush. It was "Clinton, Reagan, Carter..." That changed when Bush, Jr. assumed office. It became "Bush, Clinton, Bush's father." Now, people are unsure about Ford and Carter. The younger the patient, the greater the confusion about where to place Nixon and Johnson. But the quality of memory depends on the nature and context of the information. (A man with mild Alzheimer's could not recall Clinton's name, but called him "the sex guy.")

In the last few months, the emotional impact of this question has again intensified. I don't need polls to tell me what our community thinks of its leaders.

I do have to be careful, though. One elderly lady unleashed a torrent of opprobrium about the president. But her son stepped in: "Mom, what president are you talking about?" It was Herbert Hoover. Now, that's an impressive long-term memory...