Dr. Marc Siegel: Presidential Fitness Concerns Grow as Biden’s Cognitive Health Questions Emerge
May 17, 2025
Concerns about former President Joe Biden’s cognitive health have intensified, prompting renewed scrutiny of presidential fitness and transparency, according to Dr. Marc Siegel, Fox News Channel’s senior medical analyst and a professor of medicine at NYU Langone Medical Center. In a recent Fox News opinion piece, Siegel highlighted Biden’s medical history and the lack of detailed neurological disclosures, raising questions about whether the public was adequately informed about the former president’s ability to execute the duties of the nation’s highest office. These concerns, amplified by Biden’s public appearances and a controversial debate performance in June 2024, underscore broader issues about transparency in presidential health assessments.
Biden’s Medical History and Cognitive Concerns
Siegel points to Biden’s medical history as a potential contributor to cognitive challenges. In 1988, Biden underwent two craniotomies to repair brain aneurysms, one of which involved a brain bleed. These procedures, performed via an open surgical method, carry risks of long-term cognitive impairment, as noted by Siegel and neurosurgeon Dr. Brett Osborn, who commented, “When the air hits your brain, you’re never the same.” Additionally, Biden has been diagnosed with chronic atrial fibrillation, a condition linked to an increased risk of vascular dementia and mini-strokes, which can exacerbate cognitive decline. Recent studies also suggest that Biden’s sleep apnea, for which he uses a CPAP machine, may contribute to a 50% increase in cognitive problems.
Public observations of Biden’s behavior—marked by frequent disorientation, meandering speech, and memory lapses—have fueled speculation. During the June 27, 2024, presidential debate against Donald Trump, Biden’s halting delivery, unclear train of thought, and reliance on notes were described as “troubling indicators” of cognitive decline by Siegel and Osborn. Siegel noted that Biden’s speech often mixed up terms like “trillions” and “billions,” and he struggled with spontaneity, describing the debate as a “psychiatric or cognitive stress test” that highlighted Biden’s limitations. The White House attributed Biden’s performance to a cold, but Siegel dismissed this explanation, stating, “It’s hard to believe this is all from a cold. We need someone who is sharp despite a cold.”
Lack of Cognitive Testing and Transparency
A central point of Siegel’s critique is the absence of comprehensive neurological evaluations in Biden’s medical reports. Despite annual physicals conducted by White House physician Dr. Kevin O’Connor, no cognitive tests, such as the Montreal Cognitive Assessment, or brain MRIs were included in reports from 2021 to 2024. O’Connor’s February 2024 report described Biden as “healthy, vigorous” and free of neurological disorders like Parkinson’s or stroke, based on an “extremely detailed” exam. However, Siegel argued that without an MRI or neuro-cognitive testing, these assurances lack substance, especially given Biden’s history of brain surgery and atrial fibrillation.
Siegel has repeatedly called for full transparency, including disclosure of neurological results, to address public concerns. In a July 2024 Fox News segment, he criticized O’Connor for “dancing around” Biden’s condition and urged the White House to stop “obfuscating the truth.” He suggested that Biden’s stiffened gait, attributed by O’Connor to spinal arthritis and mild peripheral neuropathy, could indicate underlying neurological issues, such as normal pressure hydrocephalus, which is associated with cognitive loss. Siegel emphasized that American voters have a right to know about their leader’s fitness, citing historical precedents like Woodrow Wilson’s stroke and Franklin Roosevelt’s concealed health issues during their presidencies.
Public sentiment, as reflected in polls, aligns with Siegel’s concerns. A September 2023 CNN poll found that 73% of Americans, including 56% of Democrats, expressed serious concerns about Biden’s physical and mental competence. High-profile incidents, such as Biden stumbling on Air Force One stairs in March 2021, appearing to fall asleep at a 2021 climate summit, and repeating stories at a 2023 fundraiser, further amplified doubts about his mental acuity.
Biden’s Withdrawal and Health Implications
Biden’s decision to drop out of the 2024 presidential race on July 21, 2024, following his debate performance and pressure from Democratic allies, was seen by Siegel as beneficial for the former president’s health. “The stress of the race could have definitely made cognition worse,” Siegel told Fox News Digital, noting that cognitive issues, if present, would likely progress regardless. He also warned that Biden’s recent COVID-19 infection could exacerbate cognitive decline due to neuroinflammation, as post-COVID syndromes have been linked to memory and attention difficulties.
Siegel argued that Biden’s withdrawal should have been accompanied by a full health disclosure to reassure the public about his ability to serve out his term. He and Osborn stressed the need for thorough health evaluations for sitting presidents and candidates, given the presidency’s demands for clear thinking, effective communication, and crisis management.
Broader Implications for Presidential Fitness
Siegel’s commentary extends beyond Biden to the broader issue of transparency in presidential health. He contrasts Biden’s case with historical examples, such as Roosevelt, who served effectively from a wheelchair during World War II despite concealing his condition, and Wilson, whose stroke left his wife and aides managing the presidency. Siegel argues that modern media scrutiny and the presidency’s global responsibilities demand greater openness. He has also noted that physical ailments, like Biden’s gait or potential wheelchair use, are less concerning than cognitive fitness, which is critical for decision-making in high-stakes environments.
The Biden administration’s approach—downplaying age concerns with humor, as Ronald Reagan did, or dismissing journalists’ questions as “gaslighting”—has drawn criticism for evading accountability. White House press secretary Karine Jean-Pierre’s claim that Biden “passes a cognitive test every day” through his duties was met with skepticism, as Siegel and others argued that the presidency’s rigors do not substitute for formal testing.
Looking Ahead
As Biden completes his term, Siegel’s call for transparency remains unanswered. He wishes Biden well but emphasizes that the country deserves an era of greater disclosure, especially for the presidency. The debate over Biden’s cognitive health has also shifted focus to other leaders, with Siegel previously commenting on Donald Trump’s cognitive abilities in 2020, describing him as “very cognitively advanced” after an in-person interview. However, Siegel has consistently maintained that cognitive fitness is “fair game” for public discussion, regardless of the individual, given the presidency’s demands.
The controversy underscores the need for standardized protocols for assessing presidential fitness, including mandatory cognitive and neurological evaluations. As Siegel noted, “We need to know how much cognitive reserve our president really has,” a sentiment that resonates as the nation navigates an era of heightened scrutiny over leadership capacity.
Sources: Fox News, The Hill, NPR, CNN, Mediaite, Wikipedia, YouTube, The Independent.