Presidential fitness is a serious matter, and we in the media are not doing the American public any favors by speculating about what is going on with President Biden, just as the White House is not doing us any favors by obfuscating the truth. 

We do know that he currently has COVID-19, with mild upper respiratory symptoms so far and his chances of a severe course markedly reduced since he is taking Paxlovid. On the other hand, recurrent COVID does increase your risk of post-COVID problems, including worsening cognition. 

Speaking of cognition, I don’t believe that Biden is suffering from Parkinson’s disease, despite the media swirl of accusations and the fact that Dr. Kevin Cannard, a movement disorders specialist from Walter Reed Medical Center, has visited the White House at least eight times over the past year.  

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First of all, Dr. Kevin O’Connor, the White House physician, has denied the president has Parkinson's disease in two yearly physical summary official letters as well as a recent update. There is no reason to believe a licensed physician would lie on an official medical document. 

So, what is the president suffering from? There are many possibilities. (Getty Images)

Plus, many neurologists I have spoken to who have observed the president on numerous videos and prolonged speeches have seen no sign of characteristic Parkinsonian features including shuffling gait, cogwheel rigidity of the upper extremities, tremors, etc. Granted, videos are no replacement for an in-person examination, even in the era of telemedicine.

So, what is the president suffering from? There are many possibilities. The public is right to be alarmed when it sees these lapses, with the inability to follow a line of thought, to speak clearly, accompanied by periods of disorientation and confusion.  

And the president did undergo a now outdated surgical repair of two brain aneurysms in 1988, and he did sustain a brain bleed at the time which can be associated with long-term cognitive impairment. But I think another explanation for his apparent neurological issues could be his longtime atrial fibrillation for which he takes blood thinners.  

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Multiple studies have now shown that patients with atrial fibrillation (irregularly irregular heart rhythm) are at markedly increased risk of cognitive impairment and dementia. Associated risks include inadequate brain perfusion, small silent strokes, tiny hemorrhages and "watershed" areas of the outside of the brain (known as white matter) which studies show can get too little oxygen in cases of permanent atrial fibrillation. Problems with insufficient blood flow to the white matter of the brain have been shown to cause cognitive problems.  

Periods of rigidity and a stiffened gait, as the president has shown, can also be due to vascular dementia or too much fluid on the brain (Normal Pressure Hydrocephalus). Is this what the president is suffering from? We simply don't know.   

Every neurologist I know would immediately perform an MRI of the brain (with diffusion) or a CT scan if an MRI is not doable because of aneurysm clips – on someone with Biden’s obvious symptoms and medical history to look for small cumulative areas of injury. An MRI might help a neurologist to make a definitive diagnosis.  

A 10–15-minute cognitive test such as the Montreal test, which examines recall, recognition, and judgment, would be helpful if the president scored low. But we also must keep in mind that cognitive problems tend to wax and wane and full-scale neuropsychological testing by an independent expert would likely reveal more.  

So, what is the president suffering from? There are many possibilities. The public is right to be alarmed when it sees these lapses, with the inability to follow a line of thought, to speak clearly, accompanied by periods of disorientation and confusion.  

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Whenever there is a sudden health concern on the part of a prominent leader, the media fills with speculation. Terms like Parkinson’s Disease and cognitive testing are being thrown around by journalists and pundits who have never used them before and really have no idea what they mean. This isn’t fair to the White House, to the president, and it isn’t fair to the public.  

What we need instead is an honest and transparent and up-to-date report from the White House physician not just in terms of the president's current COVID, but also the impact of his underlying health problems. Whether or not President Biden ends up dropping out of the race for health reasons or not, in the meantime, some transparency would be very refreshing.  

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