The Letter from Joe Biden's Neurologist and What it Doesn't Say

Kevin O'Connor, D.O, FAAFP, President Biden's personal physician, issues a letter

So this happened.

… and there’s been a lot leading up to this letter as well.

VERY URGENT: A Parkinson's disease specialist has visited the White House residence medical clinic at least nine times since July 2023

The story that led to this letter was originally broken by Substack sensation and arguably White House public enemy #1 on the “disinformation” front, the indispensable Alex Berenson, who revealed that based on White House visitor logs, Joe Biden has apparently been visited nine times by Parkinson’s disease specialist Kevin R. Cannard (no relation, apparently, to Kevin O’Connor, Biden’s official White House physician, who signed the letter above).

This was just four days ago, right after the debate - yikes!

After some tense press conferences, and on the heels of Joe Biden’s disastrous debate performance and some appearances after the fact that did very little to quell concerns raised in the debate (such as the above), the White House eventually got Dr. O’Connor, who is a neurologist, to write the above letter, obviously to try and reassure everyone that Biden is not, in fact, neurologically ill.

So what does the letter say?

Honestly, not a whole heck of a lot. The first three paragraphs are essentially honorifics and reminding us what an expert Dr. O’Connor is (and honestly, I’m sure he is). The fourth paragraph is where we have some detail, where O’Connor talks about a letter detailing the results of Biden’s most recent medical exam:

“An extremely detailed neurologic exam was again reassuring in that there were no findings which would be consistent with any cerebellar or other central neurological disorder, such as stroke, multiple sclerosis, Parkinson’s or ascending lateral sclerosis, nor are there any signs of cervical myelopathy. This exam did again support a finding of peripheral neuropathy in both feet. No motor weakness was detected. He exhibits no tremor, either at rest or with activity. He demonstrates excellent fine motor dexterity. But a subtle difference in heat/cold sensation could be elicited as it was last year. This heat/cold sensation deficit was detected a couple of inches higher on his ankle/calf this year, which is not unexpected. There may; in fact, be day to day subjective variation of these findings, as during last year’s exam, this area of sensation deficit was actually found to be smaller than the year before.”

Bottom line, while this is all well and good and of course reassuring in some ways, this is basically not addressing the main concern:

Sourced from alzint.org

For the last however many months / years, the American public and the world have been subjected to increasingly frequent episodes of Biden displaying any number of the “warning signs,” above - and I don’t think I need to go through these examples.

So, people are concerned - and the way the warning signs concept is supposed to work is that when people (family, friends, etc.) are concerned enough by the sheer number of warning signs that have stacked up, you get the loved one a dementia diagnostic examination.

So with that in mind, let’s review what Dr. O’Connor reports in his letter, in no particular order:

• He notes Biden has peripheral neuropathy in both feet (not uncommon in older people), with no motor weakness detected. This is not particularly useful information, as it really doesn’t address cognitive issues in any direct way whatsoever (I commonly see peripheral neuropathy in my older folks with diabetes).

• His fine motor dexterity is good, and he has some deficits in heat / cold sensation noted in his ankle / calf. Again, doesn’t address concerns about cognitive health in any direct way.

• The letter broadly states there were “no findings that were consistent with any cerebellar or other central neurological disorder, such as stroke, multiple sclerosis, Parkinson’s or ascending lateral sclerosis, nor are there any signs of cervical myelopathy.” Boldface emphasis mine.

The last bullet point, above, is a bit surprising since most of the chatter I’ve heard is opining that Biden has Parkinson’s disease (which, if you’ve been visited by a PD specialist 8 times over the past year - seems to be a reasonable thing to wonder about).

What Wasn’t Addressed in the Letter

While the results of a physical examination by a neurologist are a potentially important part of a standard dementia diagnostic exam, and can be critical in identifying conditions like stroke, multiple sclerosis, and Parkinson's disease that can impact cognitive health, they are not sufficient. What was missing?

• Lab tests (a “dementia panel”)

  • Tests for things like thyroid function, vitamin B12 deficiency, inflammatory markers, liver and kidney function, and also screens for drug and alcohol use.

• Brain Imaging:

  • Typically includes either MRI or CT scans to assess brain structure and rule out other causes of cognitive impairment, and sometimes PET scans to detect amyloid plaques and assess brain activity

• Functional / Behavioral Assessments

  • How is the patient managing his daily activities (AKA “ADLs / IADLs”)? Do they require assistance in any of these areas, and if so, how much? This is actually a critical area to assess - and this information is missing from the letter.

• Psychiatric Evaluation

  • Obviously, if a person is displaying any of the dementia warning signs - we need to make sure any symptoms that might be causing these warning signs are not better explained by, say, a psychiatric disorder like major depression (which can often present with cognitive symptoms in older adults that look similar to Alzheimer’s Disease or other ‘organic’ dementias).

• Review of Medical History and Family History

  • This, of course, depends on family that are able (and willing) to give an honest take on a loved ones’ symptoms, and also depends on the availability of a medical record - but reviewing both can give critical longitudinal information as to how a person’s functioning may have changed over the preceding months and years.

• Cognitive Screening or Neuropsychological Assessment

  • We would expect a person who has been displaying dementia warning signs to be administered a SLUMS or a MoCA, or perhaps more extensive neuropsychological testing with a board-certified neuropsychologist, so that a person could have their language, memory, frontal lobe functioning, attention, orientation etc. carefully assessed to see if they perform within the ranges expected for a person their age.

Of all of the missing elements from the letter, the fact that there was no discussion of cognitive or neuropsychological screenings or assessments was the most glaring.

Let’s Keep things Simple

I don’t know whether Joe Biden is suffering from a dementing illness, like Alzheimer’s disease, or vascular dementia. It is worth noting that the letter from Dr. O’Connor does say that at least based on Biden’s neurological exam, it does not appear that Biden is suffering from Parkinson’s disease.¹

However, this letter woefully falls short, and basically answers a bunch of questions which, while at least superficially reassuring, completely miss the point.

Joe Biden has been for months, if not years now, been displaying seriously concerning “dementia warning signs” and everyone knows it.

On June 27th, 2024, Joe Biden faced off with Donald Trump and provided a 90 minute display to the world of multiple of these warning signs, a dense culmination, almost a symphony of the warning signs he’s been displaying to the world at an increasing frequency over the previous several months and years.

The responsible thing to do is to get Joe Biden a competent dementia diagnostic exam. Dementia lab panel, MRI / CT scan, psychiatric eval, functional exam (e.g. ADLs / IADLs), an honest family history (if that’s even possible), and a full, unredacted review of his medical history.

If “democracy is at stake,” because of Donald Trump’s run for the president, then why would we want someone potentially critically impaired running against him?

This is crazy!

1. A related, almost ‘kissing cousin’ of Parkinson’s Disease, which only sometimes leads to dementia in it’s sufferers, is Lewy Body Disease - which by definition leads to dementia in it’s sufferers. Also note that because of this close relationship, Lewy Body Disease is also something you would expect a movement disorders specialist, like Dr. Cannard, to treat! (Just keep that in mind).