Though I have never examined President Joe Biden nor read through his full health records, nevertheless, as a practicing internist who treats many elderly patients, I have reason to be concerned. What exactly is his level of cognitive function?
Most worrying is the area of executive function, which includes the ability to plan, pay careful attention to detail, perform tasks, concentrate on detailed information and most of all make decisions. It goes without saying that the president as this country’s chief executive must have a very high level of executive function.
The best way to approach Biden’s apparent multiple memory lapses and periods of disorientation is not to speculate based on video clips alone but to demand full disclosure and transparency, especially of a president almost 80 years old with a significant medical history. If he decides to run again, I’m on record demanding full health transparency of all candidates for higher office, tracing back to when John McCain was 71 and running for president in 2008. I called it “the McCain Protocol” in 2016 when both Donald Trump and Hillary Clinton were over 70 and running for president.
I would prefer Biden have a cognitive neuropsychiatric test right now, much as Trump underwent the Montreal Cognitive Assessment when he was in office and released the results.
Of course, there’s substantial precedent for ill presidents hiding their ailments from the public, from Woodrow Wilson’s severe case of Spanish flu (which arguably affected the Treaty of Versailles) and subsequent stroke to Franklin Roosevelt’s heart failure to the extent of Dwight Eisenhower’s heart disease to John Kennedy’s Addison’s disease, all while still in office.
There’s reason to pause before demanding full disclosure by a sitting president for fear of sending a message of weakness — more than Biden is already doing with his erratic behavior — to our enemies. Still, annual presidential physicals are now routine, and there comes a point where impairment is substantial enough that the impact of the illness is more dangerous than the need to present a strong face.
Has this president reached that point? We don’t know.
But there are reasons to be concerned based on what we do know. Last fall, the president’s physician, Dr. Kevin O’Connor, released a letter summarizing his latest physical. Most troubling was the report his gait had stiffened significantly over the prior year. This was attributed to degenerative arthritis, but there was no MRI, no cognitive test reported and no evaluation from a neurologist included.
Though the letter was reassuring in that it stated there was no evidence for Parkinson’s disease or stroke, still, detail was sorely lacking — and in fact a stiffening gait can be associated with multiple conditions (including white matter damage or normal pressure hydrocephalus) that cause cognitive decline. With another presidential physical coming up soon, it’s time to include a comprehensive cognitive exam.
Back in 1988, Biden had two brain aneurysms surgically clipped and he sustained a brain bleed, both of which medical literature has shown to lead to long-term risks of cognitive decline. Not only that, but atrial fibrillation, an arrhythmia the president has had for more than a decade, has also been found to be associated with cognitive problems as well as silent damage to the brain, according to the recent Swiss Atrial Fibrillation Cohort study.
Most recently, the president survived COVID, and though he did not appear to suffer from post-COVID complications, there’s still a significant risk it exacerbated pre-existing neurological issues if they exist.
Simply being over the age of 75 carries with it a higher risk of cognitive impairment of at least 20%.
There are 40 million people in America with mild cognitive impairment, much of which is not diagnosed. But when it comes to the president of the United States, piloting the ship over the rough waters of international and domestic crises, dealing with Russian President Vladimir Putin and Chinese President Xi Jinping, not to mention the Mexican drug cartels, the border crisis and a faltering economy, what is mild in someone’s grandfather instantly becomes magnified by the demands of the highest office.
The president should certainly be cognitively tested if he decides to run again and the results released at that point if not sooner. Add an MRI and a formal neurological assessment for good measure.
I know many neurologists who aren’t reassured by general statements from the president’s doctor and would like to see a more comprehensive evaluation administered and reported with the upcoming annual physical.
Dr. O’Connor has an obligation based on medical ethics to determine the functionality of the president. This ongoing assessment should include a full neurological evaluation.
Marc Siegel, M.D., is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a Fox News medical analyst.