There is no data to support the allegation that he is in cognitive decline.

Walter Hammerwold/Flickr

During a town hall on Fox News Thursday night, Trump once again alluded to the idea that Biden is unfit for office. While the lies about the Bidens and Burisma will likely continue, the Daily Caller reports that this new line of attack will be a focus for Republicans and the Trump campaign.

This issue, however, is not simply being raised by Trump and his enablers. Steve Friess reports that a memo about Biden’s “cognitive decline” is circulating among Sanders’ supporters.

The Bernie Sanders presidential campaign is disavowing a list of post-Super Tuesday talking points distributed to supporters and surrogates on Wednesday morning that suggest Sanders partisans attack a resurgent Joe Biden on his “record and obvious cognitive decline.” The material, seen by Newsweek, was posted on various social media sites and on internal WhatsApp groups for supporters of the independent Vermont senator as an official campaign communique, but Sanders communications director Mike Caspa said he’d never seen it before. “That’s not a real document,” he told Newsweek. “It’s not ours.” “This is now a 2-person race, and there will be heightened scrutiny on Biden’s record and obvious cognitive decline,” the document reads.

The message is obviously getting out there.

The steadfast, wilful refusal of Dem political & media elites to address what is increasingly visible to the naked eye — Biden’s serious cognitive decline — is frightening indeed, not only for what it portends for 2020 but what it says about the ease of snapping them into line: https://t.co/InZzCja99x — Glenn Greenwald (@ggreenwald) March 5, 2020

Democratic insiders know Biden has cognitive decline issues. They joke about it. They don’t care. — Matt Stoller (@matthewstoller) March 6, 2020

The GOP is already diagnosing Biden with dementia. Full stop. And all he's doing is giving them more material. This is like an electoral asteroid hurdling towards the Earth, and people are pretending it doesn't exist. It exists.pic.twitter.com/97R8tdFvKd — Samuel D. Finkelstein II (@CANCEL_SAM) March 5, 2020

All of this feels very familiar. During the 2016 election, both Trump and the Sanders camp attempted to paint Hillary Clinton as corrupt. Now, both sides have teamed up on an attack against Biden.

We’ve all watched Biden stumble with words during debates and extemporaneous speeches. So as people committed to examining facts and evidence, it is important to gather what we know about this particular attack and not simply dismiss it because of the sources from which it is emanating.

The first thing that is important to do is to define the terms. Here is how the Mayo Clinic defines cognitive impairment.

Mild cognitive impairment (MCI) is the stage between the expected cognitive decline of normal aging and the more serious decline of dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes. If you have mild cognitive impairment, you may be aware that your memory or mental function has “slipped.” Your family and close friends also may notice a change. But these changes aren’t severe enough to significantly interfere with your daily life and usual activities. Mild cognitive impairment may increase your risk of later developing dementia caused by Alzheimer’s disease or other neurological conditions. But some people with mild cognitive impairment never get worse, and a few eventually get better.

The second piece of evidence to consider is that in December, Biden released a three-page summary of his medical history in which “his doctor declared he is a ‘healthy, vigorous’ 77-year-old fully capable of taking on the role of president.” Here is what Stuart Jay Olshansky, a professor of public health at the University of Illinois at Chicago who analyzes the longevity of presidents, said about cognitive abilities after reviewing the report.

“The only test that hasn’t been done is the cognitive functioning test,” Olshansky added. “But the fact that he’s on the campaign trail and meeting a rigorous travel and meeting schedule probably would suffice as a replacement for the formal test for cognitive functioning.” He said that cognitive tests are typically not required unless problems are detected.

In the January/February issue of The Atlantic, John Hendrickson writes that “[Biden’s] verbal stumbles have voters worried about his mental fitness. Maybe they’d be more understanding if they knew he’s still fighting a stutter.”

A stutter does not get worse as a person ages, but trying to keep it at bay can take immense physical and mental energy. Biden talks all day to audiences both small and large. In addition to periodically stuttering or blocking on certain sounds, he appears to intentionally not stutter by switching to an alternative word—a technique called “circumlocution”—­which can yield mangled syntax. I’ve been following practically everything he’s said for months now, and sometimes what is quickly characterized as a memory lapse is indeed a stutter. As Eric Jackson, the speech pathologist, pointed out to me, during a town hall in August Biden briefly blocked on Obama, before quickly subbing in my boss. The headlines after the event? “Biden Forgets Obama’s Name.” Other times when Biden fudges a detail or loses his train of thought, it seems unrelated to stuttering, like he’s just making a mistake. The kind of mistake other candidates make too, though less frequently than he does.

As a stutterer himself, Hendrickson critiques Biden for suggesting that he overcame his stutter.

Emma Alpern is a 32-year-old copy editor who co-leads the Brooklyn chapter of the National Stuttering Association and co-founded NYC Stutters, which puts on a day-long conference for stuttering de­stigmatization. Alpern told me that she’s on a group text with other stutterers who regularly discuss Biden, and that it’s been “frustrating” to watch the media portray Biden’s speech impediment as a sign of mental decline or dishonesty. “Biden allows that to happen by not naming it for what it is,” she said, though she’s not sure that his presidential candidacy would benefit if he were more forthcoming. “I think he’s dug himself into a hole of not saying that he still stutters for so long that it would strike people as a little weird.” Biden has presented the same life story for decades. He’s that familiar face—Uncle Joe…He’s the dependable guy, the tenacious guy, the aviators-and-crossed-arms guy. That guy doesn’t stutter; that guy used to stutter.

That is the data we have available about Joe Biden’s cognitive capabilities. What it all comes down to is that there is an alternative explanation for his verbal stumbles and his medical records did not indicate a cognitive impairment.

Brandy X. Lee, one of the mental health professionals who has been very vocal about Trump’s unfitness for office, explained why a declination to diagnose Biden is in keeping with professional standards.

I do not diagnose without examination and do not speak about public figures in general, unless there is evidence of such profound danger to public health and well-being because of serious signs of mental instability in a public servant, that it would be a public disservice not to share the knowledge and training that I have. Biden has not risen to this threshold… I never spoke up about a president or a presidential candidate either before or after Donald Trump, and neither have thousands of mental health professionals who have come forth with similar concerns in ways that are unprecedented in U.S. history, for any president of any party. I only speak up when there is a medical need of such great magnitude as to risk the survival of the human species. This is definitively Donald Trump, not Biden. Nor is it Bernie Sanders, Hillary Clinton, or any other false equivalences people wish to create for political purposes.

Here is how another mental health professional described the comparison to David Knowles.

Biden “digresses and gets tangential, that’s not cognitive decline,” Lynne Meyer, a California psychologist told Yahoo News. “Trump’s cognitive decline or problems are that he doesn’t even seem to have comprehension of reality. That’s what it looks like.”

We are about to be subjected to a massive disinformation campaign against Joe Biden, and this one will be particularly pernicious. But for those of us who are fact-based, it is important to keep in mind that there is no data to support the allegations that are being made.

UPDATE 3/8/20: As this disinformation campaign grows, more people are weighing in. Here is an informative thread from Twitter: