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What the White House and the president's doctor's reports say about Biden's health

White House shares letter from Biden's doctor
Biden's doctor releases letter after questions about Parkinson's expert's White House visits 04:06

The White House continues to face questions about President Biden's health in the wake of his debate performance last month, which prompted even top Democrats to seek more information about the president's condition. 

White House press secretary Karine Jean-Pierre has told reporters that the president has never been diagnosed with Parkinson's disease, dementia or any similar degenerative neurological disorder. The White House says the president has undergone a neurological exam three times since becoming president, as a part of each of his annual physicals at Walter Reed National Military Medical Center. Those physical examinations took place in November 2021, February 2023, and February 2024. White House press secretary Karine Jean-Pierre said the president "has seen a neurologist three times — no more than that." 

But the White House has had to backtrack or correct statements several times this week. On Tuesday, Jean-Pierre said Walter Reed neurologist Dr. Kevin Cannard's January visit to the White House, as recorded in White House visitor logs, was not for the purpose of the president's health. But late Tuesday night, after the Associated Press reported that Cannard had indeed met with the president in January, she revised her statement. 

"Because the date was not mentioned in the question, I want to be clear that the January 17th meeting between Dr. O'Connor and Dr. Cannard was for the president's physical. It was one of the three times the president has seen Dr. Cannard, each time for his physical. The findings from each exam have been released to the public."  

Late Monday night, the White House confirmed Cannard is the physician who performed each of the president's three neurological exams as president, after previously refusing to comment on it. Other than that, a memo Monday night from the physician to the president, Dr. Kevin O'Connor, revealed little new about the president's current health, reiterating a summary of Mr. Biden's last physical in February. 

Jean-Pierre had a tense exchange with reporters in the briefing room Monday after news outlets reported that public White House visitor logs showed Cannard visited at least eight times in the last year. Cannard is a neurologist and expert in movement disorders, including Parkinson's disease. O'Connor noted in his letter Monday that Cannard has made regular visits to the White House Medical Unit "in support of the thousands of active-duty members assigned in support of White House operations. Many military personnel experience neurological issues related to their service, and Dr. Cannard regularly visits the WHMU as part of this General Neurology practice."

What the president's physical reports say about his neurological health 

The president's three summaries from his physicals, written by O'Connor, have said virtually the same thing about his neurological capabilities — that there were "no findings which would be consistent with any cerebellar or other central neurological disorder," such as a stroke or Parkinson's disease, a brain disorder that causes unintended or uncontrollable movements, including shaking and stiffness. 

Cerebellar disorders, related to the cerebellum, affect coordination and balance, Central neurological disorders affect the brain or spinal cord.

"An extremely detailed neurologic exam was reassuring in that there were no findings which would be consistent with any cerebellar or other central neurological disorder, such as a stroke, multiple sclerosis, Parkinson's or ascending lateral sclerosis," O'Connor's report said in November 2021. 

The February 2024 report offered similar observations. 

"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," it read. 

Neurological exams v. neurocognitive testing 

While the president has been given neurological exams during his physicals, the White House says he has not taken any extensive cognitive tests. The president told ABC News he has not undergone a cognitive test because "no one said I had to." 

An initial neurological exam is typically quite basic. It can include having a patient touch his finger to his nose, testing for arm strength, testing for sensitivity to heat and cold and other routine exercises. Although it's not clear how extensive Mr. Biden's neurological exam was, it can take as little as five or 10 minutes. 

But neurocognitive testing is much more in depth, and can last hours. This type of testing, according to the Cleveland Clinic, often involves writing and drawing, and measures cognition, communication, memory and motor skills. The White House says Mr. Biden hasn't undergone cognitive testing. 

Degenerative spine changes and nerve damage 

All three of the doctor's reports note issues with the president's stiffened gait, which O'Connor in 2021 said he noticed had become worse over the course of the year. 

"The president's ambulatory gait is perceptibly stiffer and less fluid than it was a year or so ago," his physician wrote in November 2021, during the first year of Mr. Biden's presidency. "He has several reasonable explanations for this in his orthopedic history, but again, a detailed investigation was appropriate. … He does specifically acknowledge early morning stiffness that improves throughout the day." 

The February 2024 report attributes much of the stiffness to degenerative osteoarthritic changes in his spine. The reports say the president has spondylosis, a condition that causes the spine to degenerate from wear and tear on cartilage and bones. The condition is also known as spinal osteoarthritis. 

"Spinal examination this year was clinically unchanged," the 2024 report said. "Dynamic radiographic exam demonstrates mildly decreased range of motion, consistent with his known arthritic changes." 

O'Connor said in that report that the "president's gait remains stiff but has not worsened since last year."

The president's latest report also reiterated that he has peripheral neuropathy, which is nerve damage that can cause numbness, pain and a lack of appropriate response to hot or cold in his feet. 

Biden's other health conditions

The president's 2024 physical report acknowledged his obstructive sleep apnea diagnosis, a new diagnosis since his physical a year earlier. The White House acknowledged the sleep apnea issues last summer, after reporters noticed the president had lines on his face consistent with straps from a CPAP device. 

The president's health reports have long noted that he has non-valvular atrial fibrillation, or A-fib for short. That means that he has an irregular heart rhythm that doesn't involve the heart's valves. His reports say he remains asymptomatic. 

Biden's history with aneurysms

In 1988, at age 45, Mr. Biden suffered two life-threatening brain aneurysms. What he originally thought to be a pinched nerve ended up being blood in his spinal fluid on an artery wall at the base of his brain. 

The situation was so dire that a priest was called to deliver last rites. But Jill Biden, as she told CNN in 2020, burst into the room, saying, "You're not giving him the last rites. He's not going to die." 

The president underwent two successful surgeries for two aneurysms that year. 

Medical care Biden receives regularly 

The White House revealed Monday that the president receives what Jean-Pierre described as a "verbal check-in" with his doctor about twice a week, while he's exercising. The president had such a verbal check-in Monday morning, she said. 

"The president's medical unit is literally down on the other side of the [White House] Colonnade," she told reporters Monday. "It's just down the steps from the residence. And so, a couple times a week, he does a check-in — a verbal check-in with his doctor while he's exercising. That is something that happens often."

The president also undergoes physicals roughly once a year, although the intervals sometimes vary.

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