The door to Dr. Bennett's office opened quietly as former President Joe Biden was ushered in by an aide. Unlike his predecessor that morning, Senator Bernie Sanders, Biden moved with a noticeably stiff gait, his steps measured and careful. Dr. Bennett rose to greet him, extending his hand.
Dr. Bennett: "Mr. President, thank you for coming. Please, make yourself comfortable."
Biden settled onto the couch, his movements deliberate. He smiled, though the expression didn't quite reach his eyes.
Joe Biden: "Appreciate you fitting me in, Doc. Jill thought it might be good to talk after... well, after everything that happened."
Dr. Bennett: "Of course. I understand it's been a challenging year for you. Senator Sanders was just here. He mentioned you might be stopping by."
Joe Biden: "Bernie's a good man. Has been for decades. Always stuck to his principles, you know? But he's got his own way of doing things. We're different that way. Different styles."
Dr. Bennett nodded and picked up his notepad.
Dr. Bennett: "I understand you're interested in discussing some of the concerns that were raised during your presidency about cognitive health and aging. Is that correct?"
Biden's expression tightened slightly, a flash of defensiveness crossing his features before he nodded.
Joe Biden: "Look, there was a lot of talk. Some fair, some not. That debate night... it wasn't my best night. I'll be the first to admit that. But there's been a lot of, you know, exaggeration about what it meant."
Timeline of Observed Cognitive Changes
Dr. Bennett moved to the screen on the wall and pulled up a timeline.
Dr. Bennett: "If you don't mind, Mr. President, I'd like to discuss some observations about your cognitive functioning over time. Not to make any specific diagnosis—that would require formal neurological assessment—but to understand the patterns that emerged and were reported by various sources."
| Time Period | Reported Signs | Sources |
|---|---|---|
| 2020 Campaign | Occasional verbal fumbles, some gaffes, but generally coherent and engaged | Media reports, campaign events |
| 2021-2022 | Reports of "good and bad days" began to emerge; White House began limiting unscripted interactions | Wall Street Journal reports, foreign leader interactions |
| 2023 | Increasing staff control of schedule; more reliance on teleprompters; Rep. Dean Phillips raises concerns | Congressional reports, House Speaker comments |
| Early 2024 | Foreign officials report increased instances of meandering speech, fatigue, confusion | Diplomatic sources, media reports |
| June 2024 | Major cognitive concerns revealed in presidential debate: slurred speech, disorientation, lost train of thought | CNN debate, neurological expert assessments |
| Post-Debate | Reports of severe decline in previous six months; White House staff efforts to conceal limitations revealed | Carl Bernstein reporting, Wall Street Journal investigation |
Biden studied the timeline, hands clasped in his lap. His jaw tightened.
Joe Biden: "A lot of that's just political talk. You know how it goes in Washington. Everyone's an armchair doctor. Everyone's got an opinion."
Dr. Bennett: "I understand your frustration. Let's focus on specific patterns that were observed rather than political interpretations. According to reporting from both sides of the political spectrum, there was a noticeable acceleration of certain signs in the months leading up to that June debate."
Neurological Signs vs. Normal Aging
Dr. Bennett switched to a new slide on the screen.
| Observed Sign | Normal Aging? | Potential Concern |
|---|---|---|
| Occasional word-finding difficulties | Yes - Common in people over 65 | Only concerning if frequent and progressive |
| Slowed speech patterns | Yes - Speech often slows with age | Severe slurring or inability to articulate is not normal |
| Stiff, shuffling gait | Partially - Some stiffness is normal | Lack of arm swing and masked facial expressions raise concerns |
| Losing train of thought | Occasionally - Especially when tired | Frequent mid-sentence confusion suggests deeper issues |
| Increased fatigue | Yes - Energy levels decrease with age | Extreme fatigue affecting basic functions is concerning |
| Flat facial expression | No - Not typical of normal aging | May indicate neurological issues requiring assessment |
Dr. Bennett: "During the debate and in the months leading up to it, several neurological specialists noted concerns about specific patterns. Dr. Sanjay Gupta and other brain specialists observed what they called 'confused rambling, sudden loss of concentration, halting speech, and absence of facial animation.' These observations go beyond what we typically see in normal aging."
Biden shifted uncomfortably on the couch.
Joe Biden: "I had a cold that night. And jet lag. We'd been in Europe the week before. I was tired, Doc. Anyone would have struggled."
Dr. Bennett: "Those factors certainly could have exacerbated any underlying issues. And to be clear, I'm not attempting to provide a diagnosis here. But it's important to note that according to reporting, these weren't isolated incidents. Carl Bernstein reported that people close to you had observed 'marked incidents of cognitive decline and physical infirmity' in the six months leading up to the debate."
The Cover-Up Dynamic
Dr. Bennett moved to a new slide.
The Protective Circle: Psychological Analysis
According to multiple reports, a small group of close advisers and family members actively worked to manage and conceal signs of cognitive decline. This created what author Chris Whipple called a "fog of delusion and denial" that prevented honest assessment of fitness for office.
Dr. Bennett: "What's particularly interesting from a psychological perspective is the dynamic that developed among your inner circle. According to multiple sources, your staff limited your schedule, reduced unscripted interactions, and managed your appearances in ways that minimized public exposure to potential cognitive difficulties."
Biden's expression hardened.
Joe Biden: "That's what staff does. They manage schedules. They keep things running. Every president has that."
Dr. Bennett: "To some extent, yes. But according to The Wall Street Journal reporting in July 2024, these efforts went beyond normal staff functions. The report indicated you were having 'good and bad days' as far back as 2021, and that foreign leaders and officials who met with you in early 2024 described you as 'increasingly frail, tired, meandering, and confused' in speech."
Biden was silent for a moment, his gaze drifting toward the window.
Joe Biden: "You know what the job is like, Doc? What the presidency does to a person? The stress, the constant decisions, the weight of it all? I challenge anyone to go through that and not have some tough days."
Comparison to Other Senior Leaders
| Factor | Joe Biden (81) | Bernie Sanders (83) | Donald Trump (78) |
|---|---|---|---|
| Speech patterns | Slurred, halting speech; frequent lost trains of thought | Generally fluent with occasional dysfluencies | Stream-of-consciousness; tangential but maintains core message |
| Physical mobility | Stiff gait, limited arm swing, careful movements | Energetic movement despite age, gestures freely | Generally mobile with occasional balance issues |
| Stamina | Limited - needed significant rest between appearances | High - maintains energy through multiple rallies | Moderate - energetic at rallies but variable |
| Response to criticism | Defensive, often dismissive of concerns about health | Addresses criticism directly with counter-arguments | Strongly emotional responses, personal attacks |
| Cognitive testing | Refused formal cognitive assessment | No reported testing but maintains complex policy discussions | Claimed to have "aced" MoCA test |
Dr. Bennett: "It's worth noting that your contemporaries in politics, despite being of similar age, showed different patterns. Senator Sanders at 83 - two years older than you were during the campaign - maintained a rigorous schedule of rallies and could speak for 45-60 minutes without notes while staying on message. This suggests that what you experienced wasn't simply a function of being in your 80s."
Joe Biden: "Everyone's different. My whole career, I've had a stutter. I've had to work harder than most to speak clearly, to find the right words. People have been underestimating me because of that my whole life."
Dr. Bennett: "That's an important point. Speech difficulties can have many causes, and your history of stuttering is certainly relevant. However, neurologists who observed your debate performance and other appearances noted symptoms beyond stuttering, including what Dr. Sanjay Gupta described as 'confused rambling' and 'sudden loss of concentration in the middle of a sentence.'"
The Watershed Moment: June 2024 Debate
Dr. Bennett: "The June 27 debate appears to have been a watershed moment in how your cognitive health was perceived. According to Wikipedia's account, you 'spoke incoherently and repeatedly appeared to lose your train of thought' during the debate. At one point, when discussing the national debt, you trailed off mid-sentence, saying 'Making sure that we're able to make every single solitary person eligible for what I've been able to...' before changing topics."
Biden's eyes flashed with a mixture of anger and sadness.
Joe Biden: "One night. One bad night, and they wanted to throw away everything we'd accomplished. All the progress we'd made. Just like that." He snapped his fingers. "That's politics for you."
Dr. Bennett: "The evidence suggests it wasn't just one night, though, Mr. President. According to Carl Bernstein's reporting, people very close to you - including some who had raised money for you - were 'adamant that what we saw the other night is not a one off' and that there had been '15, 20 occasions in the last year and a half' when you had shown similar difficulties."
The Psychological Impact of Denial
From a psychological perspective, the reluctance to acknowledge cognitive changes is both natural and potentially harmful. When a person's inner circle reinforces denial rather than encouraging assessment, it can delay appropriate interventions and create greater long-term distress.
Dr. Bennett: "One of the most concerning aspects of this situation, psychologically speaking, was the reported resistance to formal cognitive assessment. According to multiple sources, you declined to undergo a cognitive exam like the Montreal Cognitive Assessment, stating that you had 'a cognitive test every single day' in performing presidential duties. This type of resistance to objective assessment is often a red flag in cases of cognitive decline."
Biden leaned forward, a flash of his old intensity returning to his eyes.
Joe Biden: "Those tests... they don't measure what matters. They don't measure wisdom or judgment. They don't measure the ability to bring people together or to understand the pain of a family that can't afford healthcare. They don't measure character."
Dr. Bennett: "That's a fair point about the limitations of cognitive testing. But such assessments could have provided objective data to counter speculation. The absence of such testing created an information vacuum that was filled with speculation."
The Parkinson's Question
Reported Physical Signs
Multiple sources, including neurologists and foreign officials who interacted with you, noted physical symptoms that raised questions about possible Parkinson's disease or related conditions: rigid posture, lack of arm swing while walking, masked facial expressions, and speech difficulties beyond your known stutter.
Dr. Bennett: "There were also reports that raised questions about possible Parkinson's disease. The Washington Times reported that after initially denying it, White House Press Secretary Karine Jean-Pierre acknowledged that Parkinson's disease experts had visited the White House several times to examine you. Professor Nicolas Cherbuin from the Australian National University noted your 'movement difficulties' and 'rigidness of posture' as potentially concerning signs."
Biden's expression darkened.
Joe Biden: "There's a lot of speculation out there, Doc. A lot of political hit jobs disguised as medical concern. I had regular checkups with White House physicians. If there had been serious issues, they would have flagged them."
Dr. Bennett: "That brings up another concerning aspect - the reported lack of transparency from your medical team. According to multiple sources, your White House physician, Dr. Kevin O'Connor, refused to make public appearances or detailed statements about your cognitive health. The letter stating you were in 'great health' was described by one writer as 'laughable' given observable symptoms."
The Decision to Withdraw
Dr. Bennett: "Let's talk about your decision to withdraw from the race on July 21, 2024. According to reporting by Chris Whipple, in the days leading up to your debate with Trump, you were 'in a terrible state' - 'absolutely exhausted' and 'unable really to follow what was happening in the campaign.' He described an incident where you walked out of debate preparation, 'went over to the pool, sank into a lounge chair, and just fell sound asleep.'"
Biden was quiet for a long moment, staring at his hands.
Joe Biden: "That's between me and my staff. Private moments get exaggerated, taken out of context."
Dr. Bennett: "What's particularly interesting is that even after you withdrew, there were reports that you continued to govern effectively in private settings. Whipple mentioned that 'people who visited Biden in the Oval Office to talk about the Middle East said he was on top of every nuance of Middle Eastern policy' and that 'behind closed doors, Biden was governing, capably.'"
Biden's face brightened slightly.
Joe Biden: "That's right. In the room, one-on-one, doing the work - that's where I was still effective. Always have been. It's the public performance part that got harder."
Conclusion: Lessons for Political Psychology
Dr. Bennett: "As we conclude, Mr. President, I'd like to offer some thoughts on what your experience reveals about the intersection of aging, cognitive health, and political leadership."
Key Psychological Insights from the Biden Cognitive Timeline
- Earlier Detection: AI analysis of speech patterns, facial expressions, and movement could have identified concerning changes years before they became obvious to the public
- The Protective Circle Problem: When close advisers and family protect rather than confront declining abilities, it prevents appropriate adaptation
- The Transparency Paradox: Attempts to hide limitations ultimately create greater public concern than transparent acknowledgment would
- The Performance vs. Capacity Gap: The ability to govern effectively in controlled, private settings may persist even when public performance declines
- Age as Context, Not Destiny: Chronological age alone is insufficient for predicting cognitive capacity, as shown by the stark differences between you and contemporaries like Sanders
Joe Biden: "So what would you have had me do differently, Doc? Just curious."
Dr. Bennett: "From a psychological perspective, greater transparency would likely have served you better. Regular cognitive assessments with public results could have established a baseline and showed changes over time. More importantly, adapting your role to your changing abilities rather than trying to maintain the same schedule and performance style might have prevented the crisis moment of the debate."
Biden nodded slowly, a hint of resignation in his expression.
Joe Biden: "Maybe so. But that's not how we do things in politics. You show any weakness, and they pounce. The stakes were too high - Trump returning to office? I couldn't risk it."
Dr. Bennett: "Ironically, that very approach may have contributed to exactly the outcome you feared. By not addressing concerns openly, you created the conditions for the debate performance that ultimately led to your withdrawal and Trump's eventual victory."
Biden stood up slowly, straightening his jacket.
Joe Biden: "History will judge us all, Doc. I did what I thought was right for the country. Always have."
Dr. Bennett rose and extended his hand.
Dr. Bennett: "No one doubts your commitment or your decades of service, Mr. President. The lesson here isn't about your intentions but about how our political system handles the natural process of aging and cognitive change. Perhaps your experience will help future leaders navigate these waters more effectively."
As Biden moved toward the door, he turned back with a wistful smile.
Joe Biden: "You know, they say Bernie's sharp as a tack at 83. Different brain chemistry, I guess. Some people just age differently."
Dr. Bennett: "Indeed. That's one of the most important insights from modern cognitive science. Age is just one factor among many. It's not deterministic. Some show significant decline in their 70s, while others remain sharp well into their 90s."
Joe Biden: "Too bad the voters don't have time for those nuances. Politics isn't that patient."
With a final nod, the former president walked out, his movements still stiff but his shoulders squared with the dignity of a man who had occupied the highest office in the land - and who had ultimately made the difficult decision to step aside.
Dr. Bennett returned to his desk, making final notes on the session that would never actually take place. The hypothetical conversation had illuminated much about how cognitive decline intersects with political power - and how the personal struggle with aging can have profound consequences for a nation.