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Should the nation be concerned about Biden’s cognitive abilities?

When President Woodrow Wilson contracted the Spanish flu after arriving in Paris in April 1919 for peace talks at the end of World War I, he was devastated both physically and mentally, suffering from profound fatigue, coughing, paranoia and disorientation. The White House doctor at the time, Cary Grayson, wrote in a letter to a friend that “the president was suddenly taken violently sick with influenza at a time when the whole of civilization seemed to be in the balance.”

Indeed, as John M. Barry, author of “The Great Influenza,” recently pointed out to me on the “Doctor Radio Reports” program on SiriusXM, Wilson’s illness gave British Prime Minister David Lloyd George and French Prime Minister Georges Clemenceau the upper hand in the ensuing peace talks, which led to severe sanctions against Germany and, ultimately, to the rise of Hitler and the Nazis less than a generation later.

Now, once again, we face a world in crisis, not just with the COVID-19 pandemic but also with the current battle of wits between President Biden and Russia’s Vladimir Putin over Ukraine. Is Biden up to the pressure, his critics and some independent analysts are asking? Is he mentally fit?

It would be pure speculation to assert that he is not capable, given the absence of specific information, to directly call into question the president’s health or competence. And the same kinds of questions have been raised throughout our history regarding more than a few U.S. presidents, especially by foes of their policies or at times of political weakness.

Republicans wondered if Franklin Roosevelt was too sick to negotiate effectively with the Soviets at the wartime “Big Three” conferences in Tehran in 1943 and especially in Yalta in 1945; Democrats questioned Richard Nixon’s mental state as the Watergate scandal closed around him in 1974, and they later speculated about Ronald Reagan being too old to be reelected as president — he was 73 at the time, six years younger than Biden is today — or about Reagan suffering from Alzheimer’s at the very end of his second term. Evidence in retrospect showed these concerns to be well-founded.

Meanwhile, enough issues are being raised today for some professional eyebrows to be raised, too. NBC’s Chuck Todd said on “Meet the Press” last week that, according to the network’s latest poll, the American public is questioning the president’s competence. Todd is correct that there are such public concerns, and Biden’s recent memory lapses, losses of temper and outbursts (such as calling one Fox News reporter’s question “stupid,” or referring to another reporter as a “stupid son of a bitch” while talking into a microphone) could be considered clues to possible cognitive problems.

I have not examined President Biden, of course, and I agree completely with the so-called Goldwater rule, a pronouncement by the American Psychiatric Association in response to spurious attempts by thousands of psychiatrists who speculated that then-senator and presidential candidate Barry Goldwater (R-Ariz.) was crazy during the 1964 election. There also was far too much speculation by multiple psychiatrists about former President Trump’s supposed psychiatric illness during his term.

At the same time, I agree with what President Trump told me during an interview at the White House in July 2020 — that those elderly individuals who would be president should take a cognitive test (as he said he had) as part of a routine physical.

If President Biden has taken such a test recently, it wasn’t included in his last publicly reported physical in November.

What was reported after that physical was a significant worsening in the president’s gait, which in some cases can be related to degenerative disease in the brain or the spinal cord. The exam, conducted by White House physician Kevin O’Connor, also reports calling in neurologists and orthopedists to evaluate this issue, but there were no reported MRI scans or electromyography to assess nerve function. The doctor’s report ascribed the president’s gait as largely a matter of general “wear and tear” — and, more pointedly, he diagnosed Biden as being “healthy, vigorous” and “fit to successfully execute the duties of the Presidency.”

The American Academy of Neurology has estimated that at least 15 percent of those over the age of 75 have some cognitive impairment, a significant number. And several studies reveal that many of those who underwent an open surgical brain aneurysm repair or had a subarachnoid hemorrhage can develop cognitive difficulties as a result. (Biden had two such repairs and a brain bleed in 1988, years before modern endovascular techniques that cause minimal damage were introduced.) Not only that, but a study published in the journal Nature Cardiology in 2018 showed a significant increase in cognitive problems in patients with prolonged atrial fibrillation, from which the president also suffers.

Certainly, many Americans in their 80s and older are in exceptional health — and many who are far younger and seemingly fit suffer debilitating disabilities or death from undiagnosed or untreated conditions. Still, beyond question, the older each of us becomes, the more likely we are to develop a range of serious health issues that can impact our functioning.

Of course, raising legitimate questions is not the same thing as providing honest, complete answers. There is so much at stake in any administration, and it is so important for any president of the United States to be at the top of his or her game in order to guide us through crises, that it certainly makes sense for a simple cognitive or neuro-psychiatric assessment to be part of a routine presidential physical — regardless of age, but especially for those over the age of 75.

Any president who is not fully disclosing his health is following a long-unfortunate tradition.

The great unraveling of President Wilson stands as a lesson for us all.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.” 

Tags American Psychiatric Association Biden Chuck Todd cognitive decline Donald Trump Ethics in psychiatry Goldwater rule Joe Biden Joe Biden Vladimir Putin Woodrow Wilson

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