Doctors ramp up calls for Biden to take cognitive test after worrying new details about his mental decline

Doctors are calling for Joe Biden to take a cognitive test and make the results public after a bombshell report laid bare his mental decline.

Yesterday, the Wall Street Journal revealed a concerning picture of a President who struggles to remember meetings from one day to the next, mixes up key details of his own policies and who, at times, speaks so softly that aides struggle to hear him.

The report, which included interviews with 45 insiders, also said the 81-year-old spends long periods of times in meetings with his eyes closed.

Dr Stuart Fischer — an internal medicine physician in New York City — said the latest report once again showed that Biden needs to assure the public by taking a cognitive test.

‘We are long overdue for this type of investigation,’ he told DailyMail.com. ‘No one likes to admit or recognize the passage of time, whether it is me or the President of the United States, but in certain cases you have to.’

The report paints a picture of Biden as a man who struggles to remember meetings and is almost reliant on notes from his aides (pictured above reading notes)

Doctors have called on the president (pictured in February) to take a cognitive test in order to demonstrate that there is no issue with his mental faculties

He added: ‘We have to keep an open mind about the result, of course, but resistance from either side [doctor or Biden] is not a good sign.’

Referring to a claim in the report that Biden sometimes speaks so softly that aides struggle to hear what he is saying, Dr Fischer said that while he doesn’t normally see this among patients in his nursing home, it could also signal cognitive decline.

The White House has dismissed the report as partisan politics, and insisted the President remains sharp and a vigorous leader.

But Dr Fischer said: ‘I understand the President’s reluctance [to take a cognitive test]… but the physician’s reluctance is harder to understand.

‘He is a doctor, not a spin doctor, he is a medical doctor… who took an oath, like I did, to tell the truth, the whole truth, and nothing but the truth. His patient should come first.’

He added: ‘[Biden] is a public servant, an elected official… and does have some responsibility to the people who voted for him.’

Biden’s last physical check-up was in February this year, when his physician — Dr Kevin O’Connor — said he continues to be ‘fit, active, robust’ and there were ‘no new concerns’ over the President’s health.

He did not have any cognitive tests, but he did undergo an ‘extremely detailed neurological exam’ that ruled out ‘stroke, multiple sclerosis, Parkinson’s or ascending lateral sclerosis’.

Neurological exams include CT scans and MRIs of the brain, as well as conduction studies to test nerves, nerve function and brain activity.

Biden is pictured above apparently being supported by his wife Jill at the Human Rights Campaign national dinner in October, 2023

Biden fell over in 2023 at a USAD graduation ceremony in Colorado

He also fell over in June 2022 after he wheeled over to speak to reporters and members of the public after he was spotted on a bike ride

In her short-lived Republican primary campaign, Nikki Haley called on Biden to take the gold-standard test for dementia, called the Montreal Cognitive Assessment (MoCA).

This is a 10-minute survey created in 1996 to help medical professionals identify mild cognitive dysfunction, a precursory sign of dementia.

It assesses concentration, attention, memory and other functions through a battery of questions, including asking patients to spot patterns, name animals and recall a string of numbers or letters.

The test’s creator, Dr Ziad Nasreddube — a Canadian neurologist — told DailyMail.com that the test should be used if there are concerns over someone’s mental ability.

He said: ‘If there is concern about cognitive performance, cognitive testing is recommended.

‘If I am President Biden’s physician, I would administer the MoCA test to him if he or I were concerned about his cognitive performance.’

Donald Trump completed a cognitive test when he was in the Oval Office in 2018, and has boasted about his alleged score of 30 out of 30. It is not clear whether he has taken the test again since.

Dr S. Jay Olshansky, a public health researcher at the University of Illinois who has written reports on Biden and Trump’s age, said the bombshell report showed nothing new.

‘There are way too many armchair gerontologists weighing in on the cognitive functioning of the president and presidential candidates,’ he said.

‘The only people qualified to comment on this issue include President Biden’s personal physician and President Biden himself.’

He added: ‘Virtually everything else written on this issue is little more than partisan politics and blatant ageism.’

Biden was pictured stumbling on the stairs of Air Force One in Atlanta, Georgia, in 2021. The stairs have since been shortened

The report, published last night, also warns of a president who is allegedly becoming increasingly reliant on notes and impromptu offerings from aides.

In one meeting on funding for Ukraine back in January, the WSJ reported that the President was described as slow by sources — taking 10-minutes just to greet everyone in the room.

He was also reliant on notes, and kept making broad points such as the need to fund Ukraine — which attendees said they found odd given that everyone in the room already generally agreed to this principle.

The President was also said to have let other lawmakers lead the discussion, and to have turned to them at various points even when asked questions by Republicans.

One attendee, who was not named, said: ‘You couldn’t be there and not feel uncomfortable. I’ll just say that.’

In a meeting the following month, he was described as failing to understand his own policies during a conversation with Louisiana Republican and House speaker Mike Johnson. Sources described Johnson as being dismayed by the President during the meeting.

This is a copy of the sheet the examiner and patient fill out during the 10-minute test

And in May, sources accused him of forgetting details from meeting to meeting while negotiating the debt ceiling.

Then-House Speaker Kevin McCarthy, who led the Republican side, described the President as someone who would ‘ramble’, ‘always had cards’ and ‘couldn’t negotiate another way’.

In one case about 11 days from a possible default, Biden is described as having called McCarthy from Air Force One on his way back from a summit in Japan and appearing ‘with it’ while telling stories about the summit and how debt-ceiling talks could impact members of congress.

But, when Biden met with McCarthy the next day, he was described as lacking the spontaneity he had over the phone while on the plane and continuing to go back to ‘old stuff that had been done for a long time’.

Can YOU pass the cognitive test that experts want Biden to take?

This is how a doctor performs the test, and how a patient is graded. To test yourself, you’ll need a partner.

1. ALTERNATING TRAIL MAKING

TEST: Write the fist five letters of the alphabet and numbers (1-5, A-E) on a piece of paper.

Now connect them with dotted lines in ascending order.

RESULT: You get a point for every successful pair: 1-A; 2-B; 3-C; 4-D; 5-E. No lines can be crossed. The patient earns 0 if they make a mistake that is not immediately corrected.

2. VISUOCONSTRUCTIONAL SKILLS (CUBE)

TEST: Draw your own version of the cube in the space next to it.

It must be exactly the same as the one printed on the page.

RESULT: One point if it is drawn correctly (i.e. three-dimensional, all lines are drawn, no line is added, lines are relatively parallel and their length is similar – no point if any of those criteria are missing).

3. VISUOCONSTRUCTIONAL SKILLS (CLOCK)

TEST: Draw a clock, putting in all the numbers and set the time to 10 minutes past 11 o’clock.

RESULT: One point is allocated for each of the following three criteria:

Contour (ONE POINT): the clock face must be a circle with only minor distortion acceptable (i.e. slight imperfection on closing the circle).
Numbers (ONE POINT): all clock numbers must be present with no additional numbers; numbers must be in the correct order and placed in the approximate quadrants on the clock face. Roman numerals are acceptable. Numbers can be placed outside the circle contour.
Hands (ONE POINT): there must be two hands jointly indicating the correct time; the hour hand must be clearly shorter than the minute hand. Hands must be centered within the clock face with their junction close to the clock center.

A point is not assigned for a given element if any of the above-criteria are not met.

4. NAMING

TEST: Name each animal.

RESULT: One point for each:

Lion

Rhinoceros (or rhino)

Camel (or dromedary)

5. MEMORY

TEST:

The doctor tells the patient that they are going to read a list of words that the patient must remember. At the end the patient has to tell them as many as they remember; it doesn’t matter what order.

The doctor then reads five words, one per second:

FACE, VELVET, CHURCH, DAISY, RED

As the patient recites the words, the doctor marks a check in the box for each word said aloud.

The patient indicates when they have recalled all they can.

The doctor reads the list a second time. At the end the patient has to recall all of them again.

As the patient recites the words, the doctor marks a check in the box for each word said aloud – including the first five again.

The patient indicates when they have recalled all they can.

At the end of the test, the doctor asks the patient to recall the five words, unprompted. This is the part of the test that is scored.

SCORING: No plus points, only minus if they get it wrong.

6. ATTENTION

TEST (NUMBERS):

Recall numbers: The doctor reads a list of five numbers at a rate of one number per second; the patient recalls them exactly as they were said:

2 1 8 5 4

Recall numbers backwards: The doctor reads three numbers at a rate of one number per second; the patient recalls them backwards:

7 4 2

SCORING: One point per sequence correctly recited.

TEST (LETTERS): The doctor reads a list of letters at a rate of one per second. Every time they say the letter ‘A’, the patient has to tap their hand:

F B A C M N A A J K L B A F A K D E A A A J A M O F A A B

SCORING: One point if there is zero errors or just one error (i.e. the patient tapped their hand on another letter just once).

TEST (MATH): The patient starts at 100, then must count down by subtracting seven every time, until the examiner tells them to stop:

SCORING: Total of three points.

No points if there are no correct subtractions
One point for just one correct subtractions
Two points for two or three correct subtractions
Three points for four or five correct subtractions

If the first subtraction is wrong, but each subsequent subtraction follows the pattern of seven, they still earn every other point. For example, they may say ’92 – 85 – 78 – 71 – 64′. While ’92’ is incorrect, all subsequent numbers are subtracted by seven, meaning they only made one mistake, and would a score of three.

7. SENTENCE REPETITION

TEST:

Step one: The examiner reads this sentence, and the patient has to repeat it exactly: ‘I only know that John is the one to help today’.

Step two: The examiner then reads another sentence, with the same instruction: ‘The cat always hid under the couch when dogs were in the room’.

SCORING: One point for each correct sentence.

Exact repetition
No synonyms substituted (i.e. it must be ‘hid’ not ‘hides’)

8. VERBAL FLUENCY

TEST: The doctor reads out a letter (F), and the patient has to think of words that starts with that letter. The aim is to reach 11 words or more in 60 seconds.

The words cannot be proper nouns, like Bob or Boston
The words cannot be the same sounding word but with different suffixes (like love, lover, loving)

SCORING: One point if they reach 11 words or more in one minute.

9. ABSTRACTION

TEST: The patient has to describe what the relationship is between certain words (i.e. an orange and a banana; a train and a bicycle; a ruler and a watch).

There is one practice trial (ORANGE AND BANANA) before two scored pairs (TRAIN AND BICYCLE; WATCH AND RULER).

SCORING: One point for each of the last two pairs.

Acceptable answers: