Joe Biden released his partial medical history on Tuesday, but it conspicuously made no mention of cognitive health — despite the former vice president recently admitting he struggles to formulate words when tired.

The 77-year-old Democrat, who has worried even top allies with his frequent gaffes, made a summary of his medical history available to the press in order to allay concerns about his fitness for office. The three-page document prepared by Biden’s personal physician, falls short of the promise the former vice president made in September to release his extensive medical records. It is, however, the most in-depth glimpse of Biden’s health offered since he was running alongside Barack Obama in 2008.

The summary produced by Dr. Kevin O’Connor showed the former vice president was being treated for an irregular heartbeat, high cholesterol, gastroesophageal reflux, and seasonal allergies. O’Connor noted that Biden had no residual damage from the near-fatal aneurism he suffered in 1988 and had several procedures to remove benign skin lesions and a non-cancerous polyp on his colon.

“Vice President Biden is a healthy, vigorous, 77-year-old male, who is fit to successfully execute the duties of the presidency, to include those as chief executive, head of state, and commander in chief,” wrote O’Connor, who also serves as the director of executive medicine at George Washington University.

Despite the pronouncement of health, O’Connor’s summary made no mention of cognitive or neurological health. Similarly, O’Connor fails to note the former vice president suffered what appeared to be a burst blood vessel in his eye during a televised town hall earlier this year.

The failure to discuss the former vice president’s cognitive health comes as his campaign struggles to explain his frequent “gaffes,” which more often than not take the form of an inability to recollect dates, places, and individuals.

One of the most recent examples of this took place this month when Biden told a group of Iowa voters he was vice president in 1976. Likewise, since launching his campaign, Biden has repeatedly forgotten the name of his former running mate, Barack Obama, claimed to be in Ohio, while actually in Iowa, and even promised his first priority in the White House would be to defeat President Donald Trump.

The most notable of these lapses occurred over the summer when Biden shocked a group of reporters by claiming to have been vice president at the time of the mass shooting at Marjory Stoneman Douglas High School in Parkland, Florida.

“Those kids in Parkland came up to see me when I was vice president,” Biden said, before claiming that when the survivors visited Congress, lawmakers were “basically cowering, not wanting to see them. They did not want to face it on camera.”

The statement was quickly disproved as the shooting, which resulted in 17 fatalities and over a dozen injuries, actually occurred on February 14, 2018 — more than a year after Biden left office. In response, Biden’s team claimed the candidate had simply misspoken and pivoted to attacking the media for pushing its own “narrative” around the gaffes.

Over time, though, Biden’s verbal lapses have shown no indication of dissipating even as his campaign has hired a speech coach and curtailed public appearances so the former vice president “pace himself” on the stump. In fact, Biden has continued making gaffes in spite of such efforts.

In August, more than two months after the speech coach was hired, Biden confounded many by fabricating an emotional story about the Afghanistan War. The fabrication, resulting from Biden conflating details from three different stories, was followed by the former vice president struggling to remember the word “escalator” while speaking to a Florida audience in September. During October’s Democrat presidential primary debate, Biden claimed he “put in the position of ending Roe vs. Wade” when talking about gun control.

As the gaffes have continued, and by some measure increased, numerous explanations have been floated by the media and political pundits. Last month, The Atlantic’s John Hendrickson speculated in a long piece, that included an interview with Biden himself, that the verbal stumbles were the lasting result of the former vice president’s childhood stutter.

When asked about that possibility during a recent interview with “Axios on HBO,” Biden dismissed the notion, but admitted he often struggles to formulate his speech when tired.

“I don’t think of myself as continuing to stutter. That doesn’t cross my mind that I’m stuttering,” the former vice president said. “But … occasionally … when I’m tired I’ll find myself searching for a second.”