During his presidency, Joe Biden’s cognitive and physical abilities became a subject of intense scrutiny and debate. But, according to Jake Tapper and Alex Thompson’s book Original Sin, the signs of Biden’s decline appeared much earlier than the public knew—and were deliberately hidden from view.
The authors interviewed over 200 sources to piece together a troubling timeline: Biden’s struggles began after his son Beau’s death in 2015, worsened throughout the 2020 campaign, and accelerated during his time in office. Read on to examine what was really happening behind closed doors.
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Biden’s Decline
In their book Original Sin, CNN anchor Jake Tapper and Axios reporter Alex Thompson report was happening behind the scenes: Biden experienced significant cognitive and physical decline that began years before his presidency and worsened during his time in office, making him increasingly unable to perform the functions of the presidency. Tapper and Thompson conducted interviews with more than 200 sources, building the case that Biden’s decline had been carefully managed and concealed from public view. We’ll explore the timeline of his deterioration and the specific limitations this placed on his presidency.
The Timeline of the Decline
Tapper and Thompson contend that Biden’s decline began much earlier than most observers realized. The first signs of deterioration emerged after the death of his son Beau of brain cancer in 2015. Insiders told the authors that Biden never fully recovered after Beau’s death. By 2017, Biden was struggling significantly. The authors cite recordings from that year of Biden speaking with his memoir ghostwriter, Mark Zwonitzer, in which Biden found it hard to remember things, experienced difficulty speaking, and often lost his train of thought. These recordings suggested to those who later heard them that Biden’s cognitive capacity was already failing him several years before he ran for president.
(Shortform note: Research suggests that grief can accelerate cognitive and physical deterioration in older adults. Studies show that losing a loved one, particularly a child, can trigger changes that make the brain age more quickly and impair mental functioning. Grief rewires the brain, suppressing higher-order thinking while the limbic system—which governs emotions and survival responses—takes control. This neurological reorganization can cause symptoms such as those heard in Biden’s conversations with Zwonitzer: difficulty remembering names and dates, trouble concentrating, and disorientation. For older adults who lose a child, research indicates these effects are particularly severe and long-lasting.)
The problems became more apparent during the 2020 campaign, though they were largely hidden from public view. Tapper and Thompson report that campaign staff had to provide Biden with teleprompters for what were supposed to be spontaneous local news interviews, and his aides complained they couldn’t rely on him to stay on message due to his short attention span. The authors also describe campaign videos in which Biden was supposed to interact with voters over Zoom, but in the raw footage, Biden struggled to follow conversations and seemed confused. The material was so troubling that Democrats brought in a special editing team to salvage just a few minutes of usable footage from hours of recordings.
(Shortform note: Campaign staff may have struggled to convince voters of Biden’s suitability for another term in the Oval Office, but experts say presidential campaigns may be poor tests of presidential fitness. Political journalists argue campaigns prioritize the performance of authenticity, or appearing genuine and unscripted, over the complex decision-making, team-building, and crisis management that define the presidency. The shift toward longer campaigns favors candidates who are skilled at generating excitement and raising money, but these abilities bear little relationship to governing effectively.)
The authors argue that Biden’s condition continued to deteriorate during his presidency, and his decline became particularly pronounced in 2023. They report that sources close to Biden noticed that his struggles intensified during periods of extreme stress, particularly around his son Hunter’s legal troubles in 2023 and 2024. According to Tapper and Thompson, the stress of potentially losing another child—whether to overdose, suicide, or prison—contributed significantly to Biden’s mental and physical decline during this period.
(Shortform note: Hunter Biden faced an array of legal challenges during his father’s presidency. He was convicted on federal gun charges for lying about his drug use when purchasing a firearm in 2018, pleaded guilty to failing to pay at least $1.4 million in taxes from 2016 to 2019, and faced investigations into his foreign business dealings. Beyond the legal troubles, Hunter struggled with addiction, an acrimonious divorce, paternity disputes, and significant debt. In line with Tapper and Thompson’s narrative, research confirms that parental stress over an adult child’s well-being can trigger deterioration in older adults through physiological stress responses, including elevated cortisol levels, which can accelerate cognitive decline.)
Biden’s Cognitive Limitations
Tapper and Thompson paint a picture of a president who struggled with fundamental mental functions. They report Biden frequently couldn’t remember the names of top aides, sometimes calling National Security Advisor Jake Sullivan “Steve” and referring to his communications director simply as “press.” Biden also failed to remember people he’d known for decades, such as actor George Clooney, whom Biden didn’t initially recognize at a major fundraising event Clooney hosted for him. Only after an aide prompted him with Clooney’s name did Biden seem to remember who he was talking to. Similar incidents occurred with other longtime associates, unsettling those who witnessed them.
| What Does Not Remembering Names and Faces Signify? Research shows that recognizing faces and recalling names are two distinct processes that rely on different brain systems. The incidents Tapper and Thompson report suggest Biden struggled with both processes. Face recognition (the ability to identify whether you’ve seen someone before) uses specialized neurons in the temporal lobe that can process hundreds of faces automatically. On the other hand, name recall requires retrieving stored verbal information from memory, which is more cognitively demanding. National security advisors typically interact with presidents frequently, sometimes daily. Jake Sullivan denied that Biden ever forgot his name—but if Biden did, this would suggest problems with name recall. The George Clooney incident represents a failure of face recognition. Clooney is not only someone Biden knew personally for years, but one of the most recognizable faces in the world. Researchers say that even as cognitive function declines with age, face recognition and name recall tend to be remarkably resilient. Even patients with Alzheimer’s disease often retain some ability to recognize familiar faces long after other memory systems fail. Research shows that face recognition problems may indicate damage to brain regions involved in visual processing rather than simple memory loss. |
The authors report that Biden would frequently lose his train of thought during conversations, trailing off mid-sentence or abruptly changing topics. In meetings, Biden would sometimes appear to freeze up or stare blankly, leaving others in the room uncertain whether he was processing information or had lost focus. The authors describe instances when Biden needed cue cards not just for complex policy discussions but for basic social interactions, including prompts for what to say when asked what he was thankful for at Thanksgiving dinner. At times, Biden couldn’t remember basic facts about his own life, including when his son Beau had died, a loss that had been central to his identity and political narrative.
(Shortform note: The symptoms Tapper and Thompson describe are what multiple neurologists identified as potential signs of Parkinson’s disease following Biden’s June 2024 debate. Experts noted that Biden’s blank expression, difficulty with speech rhythms, and fixed gaze might be consistent with progressive supranuclear palsy, a Parkinson’s variant. The discovery that a Parkinson’s specialist had visited the White House eight times fueled further speculation. But other medical experts argued Biden’s symptoms could stem from his documented spinal arthritis and normal aging rather than a progressive neurological condition—and emphasized that diagnosis requires extensive in-person testing that goes beyond observing public behavior.)
Biden’s Physical Decline
Tapper and Thompson also document Biden’s significant physical deterioration. His once-booming voice had become a whisper, and his confident stride had deteriorated into what sources described as a shuffle. This led staff to have him use shorter stairs to Air Force One and provide him with special black Hoka sneakers designed to help stabilize his gait. Despite these measures, the risk of falls remained a constant concern, and by late in his presidency, some staff members were reportedly considering whether Biden might need to use a wheelchair if he won a second term.
(Shortform note: The focus on Biden’s physical decline reveals how biased ideas about disability shape US politics. American presidents have successfully served with various physical limitations: Franklin D. Roosevelt led the country from a wheelchair for more than a decade. The emphasis on Biden’s need for accommodations raises questions about whether similar limitations would disqualify younger candidates with disabilities. As scholars note, the language of being “fit for office” serves to exclude people who move, think, or function outside narrow norms that have little to do with competence in the job. More than one in four American adults has a disability, yet representation in politics remains low, partly due to discriminatory attitudes.)
Biden’s declining energy also limited his schedule. The authors report that his effective working hours were restricted to roughly 10 a.m. to 4 p.m., with staff pushing as much of his schedule as possible to midday, when he was typically at his most alert. By late afternoon, sources told Tapper and Thompson, Biden would often appear drained and confused. Anything requiring urgent presidential attention outside these narrow hours became problematic.
(Shortform note: Biden’s 10 a.m. to 4 p.m. working window was unusually restrictive for a modern president. Analysis of presidential schedules shows that most recent presidents have worked much longer days: George H.W. Bush averaged nearly 15 hours between his first and last appointments, while Donald Trump, who in his first term had the shortest office hours since Harry S Truman, still averaged over six hours of scheduled time daily. Barack Obama typically had six to seven hours of policy meetings per day and was known for working until 1-2 a.m. The presidency is designed around the expectation of demanding hours, and the role requires being available for urgent decisions at any time.)
The Impact on Presidential Functions
Tapper and Thompson argue that Biden’s limitations affected his ability to perform basic presidential duties beyond just public appearances. They suggest that his reduced capacity for sustained attention and complex reasoning impacted his ability to process information, make decisions, and provide leadership during critical moments. The authors present accounts from Cabinet secretaries who told them that by 2024, they didn’t believe Biden could handle the hypothetical 2 a.m. phone call needed during a national security crisis.
From early in Biden’s presidency, his mumbling delivery and need to have even internal discussions extensively scripted made Cabinet meetings awkward and uncomfortable. These meetings became increasingly rare, with one occurring in October 2023 and then not another until September 2024, after Biden had already dropped out of the race. According to Tapper and Thompson’s sources, this isolation was deliberately designed to limit who could observe Biden’s condition firsthand.
(Shortform note: Biden’s isolation from his Cabinet and need for scripted internal discussions represent a departure from normal presidential operations: The members of the Cabinet have a constitutional mandate to advise the president on matters related to their departments. Trump held 25 cabinet meetings during his first presidency, and Obama held 19 during his first term, and. In contrast, Biden held only nine Cabinet meetings over four years, with an 11-month gap between his penultimate and final meeting. The need to extensively script even private Cabinet discussions also breaks from precedent—Trump’s Cabinet meetings, for example, feature lengthy unscripted exchanges with press and Cabinet members lasting up to 90 minutes.)
Explore Further
To understand Biden’s decline in the broader context of his presidency and the 2024 campaign, read Shortform’s comprehensive guide to Original Sin.
