Dementia, butterfly ballots, and voter competence

See also page 1100 In democracies, the idealized will of the people is realized through the alchemy of voting. After the 2000 US presidential election in which 537 voters in Florida—the state with the highest proportion of elderly—determined the outcome, the question was raised as to whether cognitively challenged voters may unwittingly have decided the course of history. In Palm Beach County, an awkwardly configured butterfly ballot disenfranchised confused voters who inadvertently designated a third-party candidate. Dimpled ballots and hanging chads were the undoubted bane of other elderly participants in democracy. A total of 2.8 million Floridians, 18% of the population, are 65 years of age or older. Because dementia increases exponentially with advancing age and affects about 10% of the older population, it is reasonable to inquire whether people with dementia actually vote. In this issue of Neurology , Karlawish et al.1 help answer this question, reporting that a substantial number of community-dwelling persons with dementia attending the Alzheimer’s Disease Center at the University of Pennsylvania Medical School cast ballots in the recent presidential election. In their small, nonrepresentative sample of research clinic patients, the proportion of voters with …