Doctors worldwide have used their expertise to speculate about the mental fitness of President Joe Biden following his numerous freezes and gaffes during the first debate of the 2024 general election .
Beginning within the first 15 minutes of Thursday’s debate against former President Donald Trump , Biden, 81, uttered a string of incoherent responses and froze several times. His performance led prominent Democratic strategists to comment at the end of the event that senior players in the party are very concerned with the president’s condition.
Although it is impossible for any physician to give a diagnosis of any patient without a direct examination, doctors are debating whether Biden’s showing is indicative of an abnormal neurological disorder or normal age-related mental changes.
“Being like Biden is not a normal part of aging,” forensic psychologist Carole Lieberman told the Washington Examiner following the president’s showing.
Lieberman, who has worked for over 20 years as a medical expert witness, recalled her experience testifying in contested will cases, having to examine the mental capacity of the testator posthumously.
Biden is the oldest sitting U.S. president. If he were to win reelection, he would leave office at the age of 86.
While she hasn’t examined Biden personally, Lieberman based her opinion upon observing his behavior that dementia is a strong possibility.
“If I had to take a guess, I would say that it is vascular dementia because he has long had cardiovascular problems,” Lieberman said. “He had a brain bleed years ago from an aneurysm. He had atrial fibrillation.”
Vascular dementia results in problems with reasoning, judgment, memory, and thought processes due to brain damage caused by impaired blood flow. Damage to blood vessels in the brain reduces the brain’s vital supply of oxygen and essential nutrients.
Lieberman said she does not believe the president is showing signs of Alzheimer’s disease, a different form of dementia that is thought to be caused by proteins accumulating in the brain.
Other commentators are not convinced that Biden showed symptoms of dementia at all but rather Parkinson’s disease , a neurodegenerative condition that affects both mobility and cognition.
Robert Howard, a geriatric psychology specialist at the University College of London, told the Daily Mail that the symptoms Biden appears to be showing both physically and mentally are more aligned with Parkinson’s because they appear more sporadically.
Parkison’s is second to Alzheimer’s as the leading cause of age-related neurodegenerative decline.
“He’s fine 98 percent of the time, but there are occasions when he appears to have lost his train of thought and others where he can’t stop himself from rambling. These fluctuations and dips in attention are key symptoms of Parkinson’s," Howard said.
A Parkinson’s diagnosis for Biden has also been suggested because of changes in his gait and posture, both of which have grown increasingly strained over the past two years.
The president’s annual physical report from this February addressed his stiffened gait and outlined that he had been examined by neurologic, radiologic, and orthopedic specialists. The report explicitly denies that Biden’s mobility changes are due to Parkinson’s or any other neurological condition.
Itai Gal, a physician, also said in a Jerusalem Post article that Biden does not meet the criteria for dementia but instead shows symptoms of “cognitive decline consistent with his age.”
Lieberman says the cause or explicit diagnosis does not necessarily matter.
“The one good thing about this disaster last night was that it's more obvious to more people,” Lieberman said.
Lieberman, who has been saying since 2020 that Biden’s mental faculties have declined since his time as vice president, said that the problem has noticeably progressed regardless of the exact diagnosis.
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“Since then, it has definitely encroached,” Lieberman said, comparing his performance to the 2020 campaign. “Now you don't have to be a psychiatrist to figure this out. Last night should have made it really obvious for everybody.”
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