“I am a doctor. I have serious concerns about Joe Biden's cognitive health.”

We live in a time when so much is at stake. We have a President who has made life unsafe for all of us; he ignores the reality of climate crisis, provokes tensions with dangerous foreign powers, and threatens to eliminate health care and social security to hundreds of thousands via proposed cuts to Medicare, Medicaid, and Social Security. For the safety of our country and world, we must elect a candidate that cannot only beat Trump, but can also lead our nation with moral and cognitive clarity. I'll leave the moral arguments to be debated elsewhere, but as a doctor, I have grave concerns that Joe Biden is in the early stages of cognitive decline.

Over my years of practice, I have cared for countless patients with dementia of all stages and have learned to recognize the early indicators of cognitive decline. Dementia impacts several cognitive domains, including:

communication & language skills

memory & ability to learn new information

decision-making & organizational skills

visual-motor skills

concentration

social cognition

Signs of dementia become evident and identifiable over time.

I have grown increasingly suspicious of Joe Biden's cognitive capacity as I've watched him speak at debates and town halls over the last year. Compared to video features of him from just 4 years ago, there is a striking difference in his verbal fluency, concentration, and memory/recall, all of which can decline in dementia. Biden has also had several public moments concerning for confabulation, such as his “Corn Pop” story, his story about being arrested in South Africa while supposedly attempting to visit imprisoned Mandela, and his stories about civil rights activism in his youth. All of these stories have been deemed highly suspect, retracted by his campaign, or disproved. Are these strategic attempts to lie for political gain, or are they symptoms of a declining cognition?

It has also been alarming the extent to which Biden is kept out of public. The presidential primary season is a time for public scrutiny of candidates in order to facilitate decisions for our votes. Compared to other Democratic presidential primary candidates, Biden has personally attended far less publicized events. What is worse, he has declined major media and advocacy interviews that other candidates have done. Examples include Rachel Maddow's recent plea for Biden to answer her request for a long-form interview, as well as Biden's non-answer to Ady Barkan's request to participate in his powerful series of candidate interviews on healthcare. This seeming avoidance of public cognitive engagement in combination with the high degree of cognitive blunders when Biden is present in the public eye raises a question: does Biden's campaign suspect dementia? Even worse, has it been confirmed and are they intentionally trying to conceal it from the public? We don't know because this concern is not being discussed.

Often in early stages of dementia, it is tempting to dismiss behaviors as social gaffes or personality quirks, rather than recognizing them for what they really are: signs of cognitive decline. I can understand the hesitation to raise concern about someone's cognitive ability. Our society prides itself on our intellect. It feels deeply personal and offensive to scrutinize someone's mind and highlight potential functional deficits. I personally struggled to decide whether to write my concerns. Ultimately, I returned to what is at stake: our country, our future, and potentially Biden's own health.

As Biden becomes regarded as the front-runner in our Democratic race for the presidency, the people deserve to know if these concerns are valid or invalid. The people deserve to know if Biden has the cognitive capabilities that are necessary to assume the most cognitively and emotionally demanding job in our nation, a role that bears direct consequences on the livelihood and safety of our nation and world. High stress can worsen and accelerate dementia, potentially making our country vulnerable, but also potentially robbing a man of his remaining cognitive quality of life. For the sake of the people and potentially Joe Biden himself, I call upon Joe Biden to undergo formal neuropsychological testing to assess for cognitive impairment.

I raise these concerns as a private citizen with medical expertise. I have opted to remain anonymous out of respect to my patients and to maintain a clear boundary between my personal engagement in the political process and my professional practice of medicine.