For the Hur Interview, did Biden have Mild Cognitive Impairment (MCI) or Dementia?
MCI sufferers can function at work at a normal level, just need extra effort to do so. Despite Biden's lapses during the Hur interview - was this him?
Back when I was a lowly trainee, I first encountered the work of a geriatrician named Ronald Peterson.
In around 1999 he and his colleagues at Mayo in Rochester, Minnesota outlined diagnostic criteria for something called “mild cognitive impairment,” or MCI.
The unique thing about this idea of MCI is that it’s something that it’s essentially a clinically sub threshold diagnosis by definition.
It’s not pathological per se, but it’s not normal either. The diagnostic criteria as Peterson laid it out was this:
memory complaint, preferably corroborated by an informant;
objective memory impairment for age and education;
largely normal general cognitive function;
essentially normal activities of daily living; and
not demented
Peterson and his colleagues clearly hit on something conceptually powerful - identifying a meaningful transitional stage between normal cognitive functioning and clearly pathological functioning - a borderline zone between dementia and normality, much akin to the clinically significant, but not-yet-pathological state of prediabetes - essentially where you have blood sugars abnormally elevated and some degree of insulin resistance, but there’s a real potential for meaningful reversibility of the condition (with diet and exercise) - which, in full-blown diabetes, particularly in the more advanced stages, is much less the case.
MCI - or what it’s known as now in the current edition of the “psychiatric bible” - the DSM-5 - as the much more dry and clinical-sounding Mild Neurocognitive Disorder (mNCD) also too has an element of reversibility to it - the rule of thumb I understood about MCI was that after about 5 years, on average, about 50% of MCI sufferers converted to full-blown dementia.
Of the remainder, a certain percentage remained mildly cognitive impaired, and some just converted back to normal functioning for whatever reason (they reversed their underlying health issues - perhaps discovered exercise, solved their clinical depression, whatever).
There is some variability by subtype of MCI as well - with amnestic, multi-domain MCI subtypes (e.g., where people have problems with memory but also have issues with other cognitive domains like executive or visuospatial functions, attention, language, etc.) tending to have poorest outcomes, and people with single-domain MCI doing better.
This gets to the problem of Joe Biden in 2023.
I’ve spent quite a bit of time harping on the above infographic, over and over, when it comes to Joe Biden - on Twitter / X (which is currently down right now, again), I felt like I was screaming this out loud. It was obvious to me and to so many, yes, you can’t responsibly diagnose a person with dementia based on just observing them on video, that doesn’t make sense - but isn’t everyone seeing what we’re all seeing?
There was something seriously wrong here - wouldn’t any normal person, seeing how Joe Biden acts and sounds in public, have taken him to the doctor for a full dementia workup - a full neuropsychological testing battery, dementia lab panels, a meeting with a geriatric psychiatrist, interviewing key collaterals and family members, etc? But yet - they didn’t.
Anyways, you can re-read some of my earlier rantings about the bizarre “emperor wears no clothes” craziness that we’ve been living through for years.
This gets to the Robert Hur Interview.
Robert Kyoung Hur is an attorney with a huge pedigree - was US Attorney for the District of Maryland from 2018 to 2021, was “Principal Associate Deputy Attorney General” at the DoJ.
As we all may recall, Hur was appointed (no doubt very reluctantly) by Attorney General Merrick Garland in 2023 as Special Counsel to investigate President Joe Biden - something Garland had to do because, surprise surprise, the same thing Garland’s DoJ was raided Trump at Mar-A-Lago for on August 8, 2022 was something Biden had apparently been doing as well (supposedly improperly handling classified documents).
All of this, of course, was avoidable - but the left really wanted to “get Trump.”
The fun part really started when Robert Hur, after interviewing Biden for five hours on October 8 and 9, 2023, said that for a number of reasons, prosecuting Biden for the same thing that the Garland DoJ was trying to go after Trump for was a no go.
Former presidents have a long history of keeping notebooks and documents after their terms have ended and while, sure, it’s certainly conceivable that classified documents may end up where they shouldn’t be from time to time - but the idea this is a criminal matter (e.g., which means criminal intent needs to be proven) rather than simply an innocent or honest mistake is critical here.
In the case of Biden, Robert Hur went a bit further than just saying that Biden made an innocent mistake about all the classified docs he apparently had strewn around his personal residence: Hur wrote that, if prosecuted, "Biden would likely present himself to a jury...as a sympathetic, well-meaning, elderly man with a poor memory," and that his "diminished faculties in advancing age" would make it difficult to prove criminal intent beyond a reasonable doubt.
In other words, Hur said that it wasn’t just that Biden lacked the mens rea (e.g., guilty mind) required to bring criminal charges because his document retention violations were simply honest mistakes - it was that he basically suspected dementia.1
Quick and predictable narrative-spinning from the former White House staff and Garland’s DoJ resulted, with a sanitized transcript released, which many argued was edited to make Joe Biden sound much more intact than he actually was.
Fast forward to a week and a half ago, the Robert Hur raw audio has finally been released to the public. Although I have not listened to the five hours of audio myself, my understanding is that yes, the Biden White House did in fact alter the transcript of the interview - and while it is true that the transcript they released did not substantially alter the content of what was talked about - what was edited out were things that I tend to look for myself when clinically interviewing a person with suspected progressive neurocognitive decline. Things like
Anomia: in the Hur interview, Biden is described as struggling to recall specific words (e.g., needing assistance with terms like "fax machine" and "poster board.”) Word-finding difficulties are a common issue in dementia. From what I understand this was not apparent in the official trancript.
Verbal repetitions: these were definitely removed from the official transcript, but apparently in the interview. Perseverative speech is not uncommon in dementia.2
Evidence of slowed processing, hypophonia, and other “audio nuances”: These were also not evident in the transcript - the long pauses before Biden would speak, or in between thoughts. Moreover, he was reportedly at times hypophonic, where he seemed unable to stop himself from whispering for no apparent reason. These are also common issues that denote cognitive decline or other progressive neurocognitive issues.
Does any of this by itself mean Joe Biden, at the time of the Hur interview, had dementia?
No - but one thing is clear, Biden should have had a dementia evaluation several years ago, and this was never done.
This is, in my opinion, criminal and should have happened long ago. And we all knew it - even thought some people pretend they didn’t.
That’s right. Fuck you Joe Tapper.
the word dementia comes directly from the Latin dēmentia - and basically translates as “being without a mind”
Yes, Biden’s handlers have blamed his speech issues on a longstanding “stutter” but it’s not hard to find clips of Biden when he was a young politician speaking extemporaneously with zero indication this was an issue, such as