Topline
President Joe Biden has refused calls to take a cognitive exam in the wake of his startling June debate performance that’s heightened concerns about his health, but doctors say an exam alone couldn’t make a definitive determination whether Biden is fit for duty and could be misconstrued by non-medical professionals who don’t have a full picture of the president’s health.
US President Joe Biden walks to the White House in Washington, DC, on July 7, 2024, after attending ... [+]
Key Facts
Biden told ABC’s George Stephanopoulos on Friday that the challenges of his job amount to a daily cognitive test—though multiple top Democrats, including Reps. Adam Schiff, D-Calif. and Nancy Pelosi, D-Calif., have suggested both Biden, 81, and former President Donald Trump, 78, should undergo cognitive testing amid the backlash to Biden’s debate performance.
Such tests aren’t routinely performed and are usually conducted when a patient or their family expresses concern about potential signs of mental decline, such as repeatedly misplacing keys, forgetting appointments, or having trouble concentrating or thinking of word choices, experts said.
When asked whether he would be willing to take such an exam, Biden told Stephanopoulos “no one said I had to,” apparently referring to his doctors.
There are varying degrees of cognitive testing available, ranging from a detailed, hours-long neuropsychological evaluation that includes writing, drawing or answering questions, according to the Cleveland Clinic, to a 10-minute “Mini-Mental State Examination,” which can include a scoring mechanism that assesses the odds of dementia, the severity of cognitive impairment and the patient’s presumptive education level.
Multiple doctors, including former New York Times medical correspondent Dr. Lawrence Altman and CNN chief medical correspondent Dr. Sanjay Gupta, have said publicly the behavior Biden exhibited during his debate performance—halting speech, a blank facial expression and disjointed sentences—warrants a cognitive test.
But other experts warned that a cognitive test alone, even the most rigorous one available, a neuropsychological evaluation, wouldn’t show the full picture of someone’s brain function and must be considered along with a number of factors, including education level and whether they or family members have noticed a decline over time—making the results difficult for the general public to interpret.
“Sometimes someone that seems impaired may be cognitively fine,” Dr. Duke Han, professor of psychology and family medicine at the University of Southern California’s Keck School of Medicine, told Forbes, adding “we’ve seen patients that seem cognitively fine but are actually cognitively impaired,” he said, noting that “releasing just numbers on a particular test won’t give the whole story on how a person is functioning.”
Crucial Quote
“A snapshot in time is not a diagnosis,” Dr. Sharon Sha, clinical professor of neurology and neurological studies at Stanford University, told Forbes, adding that cognitive tests don’t provide a diagnosis either, but can instead suggest whether more detailed testing, such as an MRI or brain scan, is needed. “Just a score on that test is not as helpful as the quality of the information the test tells you and whether it suggests there should be additional testing.”
Tangent
Trump underwent cognitive testing at his own request in 2018 amid concerns about his mental acuity and has repeatedly boasted that he “aced” the exam. Then-White House physician, now Rep. Ronny Jackson, R-Texas, reported Trump scored a 30/30 on the test, the Montreal Cognitive Assessment, which asks participants to answer 30 questions, such as drawing a clock or identifying objects in photos, in 10 minutes.
Key Background
Biden has defiantly rejected suggestions that he should step aside in the race following a debate performance that compounded concerns the 81-year-old president is slipping mentally and is too old to serve as president. Biden has blamed his poor debate performance on exhaustion, his travel schedule and a cold, while insisting it was a “bad night” and expressing confidence he can beat Trump in November. Multiple major media outlets, some Biden megadonors and at least nine House Democrats have called on Biden to step down in the wake of the debate. Biden told MSNBC’s “Morning Joe” on Monday he believes the “average voter” still wants him to run and dismissed his detractors as “elites in the party.” White House physician Dr. Kevin O’Connor wrote in the president’s annual medical report released in February that the president underwent an “extremely detailed neurological exam” which found no evidence of Parkinson’s, stroke or any other “cerebellar or other central neurological disorder,” but the report did not mention cognitive testing, and the White House has said O’Connor did not recommend one.
Big Number
59%. That’s the share of Democrats who view Biden as too old to be president, according to a New York Times/Siena poll taken after the debate, representing an eight-point increase from a survey taken a week before the debate. The survey found 74% of voters overall believe Biden is too old.
Surprising Fact
Biden, for years, has rebuffed calls to take a cognitive exam. He snapped at a reporter in 2020 who asked whether he had taken such a test, telling the CBS correspondent, “that’s like saying to you, before you got on this program, if you had taken a test were you taking cocaine or not. What do you think, huh? Are you a junkie?”
Further Reading
Biden Tells Democrats He’s ‘Firmly Committed’ To Staying In The Race Amid Mounting Calls To Drop Out (Forbes)
4 More House Democrats Say Biden Should Drop Out: Here’s Who Has Called For Biden To End Campaign (Forbes)
Biden Interview: President Refuses Cognitive Test, Blames Poor Debate On Cold, Exhaustion (Forbes)
