President Biden will face his most crucial mental acuity test on Thursday when he steps onto the debate stage in Atlanta with former President Donald Trump.
Episodes of freezing up or wandering away and sentences trailing off in gibberish have characterized several of Mr. Biden’s recent public appearances, especially those that do not allow the 81-year-old to rely on a teleprompter or support from a team of aides.
Mr. Biden won’t have any help on stage at CNN headquarters. He will face 90 minutes of questioning while standing, with only a pen, paper and bottle of water allowed on the podium. Written notes and consultations with aides during the two commercial breaks are prohibited.
In other words, Mr. Biden, who is accompanied by a half-dozen staffers just to walk across the White House lawn, will be unassisted during one of the most important events of his political career and as public confidence in his fitness for office plummets.
“This will be the most strenuous test of his mental fitness at a time when he has been showing an accelerated decline,” said Dr. Carole Lieberman, a forensic psychiatrist in Beverly Hills, California.
Critics and health professionals, including Dr. Lieberman, said Mr. Biden will need performance-boosting drugs to avoid a disaster in the debate stage. Some claim, without evidence, that he used such drugs to deliver an energetic State of the Union address to Congress in March.
Mr. Trump called this week for both of them to take a drug test ahead of the debate. Several other Republicans, including Rep. Ronny Jackson of Texas, a former White House physician, demanded a pre-debate drug test for Mr. Biden. He has regularly accused the president of suffering from signs of dementia.
“If President Biden needs to take performance-enhancing drugs in order to participate in this week’s debate, then it is imperative that he and his physician disclose that to the American people,” Mr. Jackson wrote to Mr. Biden and White House physician Kevin O’Connor.
Mr. Jackson suggested that the president might be administered Provigil to increase alertness. The drug, approved by the Food and Drug Administration in 2004 to treat narcolepsy and other sleep disorders, is nicknamed “Viagra for the brain.”
Adderall, a treatment for attention deficit hyperactivity disorder, also can help Mr. Biden, but only to a small degree, neurologists say.
One prominent neurosurgeon who requested anonymity said Adderall or Provigil would help Mr. Biden appear more alert but would do little to enhance the president’s cognition.
Given Mr. Biden’s recent public displays of mental frailty, the doctor said, “It’s very challenging to see a reliable cognitive functioning performance without a teleprompter.”
With his reelection on the line, Mr. Biden and his team of aides dropped everything this week to help the president prepare for the debate, leaving Washington for the isolation of Camp David in Maryland’s Catoctin Mountains.
Reports say at least 16 staffers have gathered to help him prepare for the debate and have outfitted a mock debate stage complete with lights and production equipment.
The debate will give Mr. Biden the best opportunity to show wary voters that he is fit for a second term after numerous polls show a majority, including critical independents, believe he is too old for the office.
Ratings are likely to be significant. The sole 2020 debate between Mr. Trump and Mr. Biden attracted 73.1 million viewers, according to Nielsen.
Mr. Biden is trailing Mr. Trump slightly in most national and battleground state polls.
Mr. Trump’s critics say the former president and his team are now trying to increase expectations for Mr. Biden ahead of the debate, which many believe is set up to favor Mr. Biden over Mr. Trump.
The CNN moderators have displayed public bias against Mr. Trump, and the rules allow them to cut off microphones, which will prevent Mr. Trump from interrupting Mr. Biden with memorable one-liners. There will be no live audience to root for the former president, who is fueled by energetic crowds.
“If Biden has a good debate on Thursday night, performance-enhancing drugs may be the Trump campaign’s excuse,” pollster Frank Luntz predicted on X.
• Susan Ferrechio can be reached at sferrechio@washingtontimes.com.
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