What a Cognitive Test Reveals About Biden’s Presidential Fitness

President Joe Biden has declined to take a cognitive exam following his notable debate performance in June, which intensified concerns about his health. Medical experts suggest that a cognitive test alone cannot definitively determine Biden’s fitness for office and might be misinterpreted by those without a comprehensive understanding of his health.

In a recent interview with ABC’s George Stephanopoulos, Biden argued that the daily demands of his role act as a cognitive test. However, some prominent Democrats, including Reps. Adam Schiff and Nancy Pelosi, have proposed that both Biden, aged 81, and former President Donald Trump, aged 78, undergo cognitive evaluations in response to Biden’s debate performance.

Cognitive tests are not commonly administered unless a patient or their family expresses specific concerns about potential mental decline, such as frequent misplacing of items, forgetting appointments, or difficulty concentrating, experts note. When asked if he would consider taking a cognitive test, Biden responded to Stephanopoulos that “no one said I had to,” seemingly referring to his doctors.

Cognitive testing ranges from extensive neuropsychological evaluations, which involve tasks like writing and drawing, to shorter assessments like the 10-minute “Mini-Mental State Examination,” which estimates dementia likelihood and cognitive impairment severity. Several medical professionals, including former New York Times correspondent Dr. Lawrence Altman and CNN’s Dr. Sanjay Gupta, have publicly stated that Biden’s debate behavior—characterized by hesitant speech, blank expressions, and fragmented sentences—warrants a cognitive test. However, other experts caution that no single cognitive test, even the most thorough neuropsychological evaluation, can provide a complete picture of brain function. Factors such as education level and personal observations of cognitive decline are crucial for accurate interpretation. “Sometimes someone who appears impaired may actually be cognitively normal,” said Dr. Duke Han from the University of Southern California’s Keck School of Medicine. “Conversely, a person who seems fine might be impaired. Just releasing test scores doesn’t fully capture a person’s overall functioning.” Dr. Sharon Sha, a clinical professor of neurology at Stanford University, emphasized that cognitive tests alone are not diagnostic. Instead, they can suggest the need for further evaluation, such as MRIs or brain scans. “A single test score is less informative than the quality of the test results and whether they indicate a need for additional testing,” she said.

In a related note, former President Trump voluntarily took a cognitive test in 2018 due to concerns about his mental sharpness and claimed he “aced” it. His then-White House physician, Rep. Ronny Jackson, reported that Trump achieved a perfect score of 30/30 on the Montreal Cognitive Assessment, a test involving 30 questions including tasks like drawing a clock and identifying objects.

Biden has resisted calls to step down despite his debate performance raising concerns about his mental acuity and age. He has attributed his poor performance to exhaustion, his travel schedule, and a cold, describing it as a “bad night” and expressing confidence in defeating Trump in the upcoming election. Following the debate, several media outlets, prominent Biden donors, and nine House Democrats have urged him to resign. Biden recently told MSNBC’s “Morning Joe” that he believes most voters still support him and dismissed his critics as “party elites.” His annual medical report, released in February, noted an “extremely detailed neurological exam” with no signs of Parkinson’s, stroke, or other central neurological disorders, but did not mention cognitive testing, and the White House has stated that no such exam was recommended.

59% of Democrats now view Biden as too old to be president, according to a New York Times/Siena poll conducted after the debate. This represents an eight-point increase from a week before the debate. Overall, 74% of voters believe Biden is too old for the presidency.

Biden has long rejected calls for a cognitive exam. In 2020, he reacted sharply to a reporter’s question about whether he had taken such a test, comparing it to an inquiry about drug use and dismissing it as inappropriate.