Sudden shouting and blank stares: The key signs that reveal Biden’s mental decline

As the US president ends his re-election bid, we set out the main indicators of the 81-year-old’s cognitive impairment

Joe Biden has always been a gaffe-prone politician.

Over his decades in Washington, the US president has developed a reputation for causing problems when he opens his mouth – mixing up “millions” and billions”, asking paraplegics to “stand up”, and even plagiarising speeches in his first run at the White House.

But allies have been shocked in recent months by the decline of the 81-year-old, who no longer simply mis-speaks but sometimes fails to form complete sentences.

He repeatedly struggled to articulate himself at the presidential debate in June, losing his train of thought and freezing while more than 50 million Americans watched him flounder on a primetime TV slot.

The response of the Biden campaign has been to throw Mr Biden into a flurry of speeches, interviews and press conferences.

But even as he fought to save his re-election bid, he displayed the same telltale tics that bedevilled the first debate performance. Here, The Telegraph sets out the key signs of Mr Biden’s cognitive decline.

‘Anyway’

“Anyway” is a word that is constantly being used by Mr Biden – seemingly when he senses he is starting to lose track of what he is saying.

The US president sometimes uses it as a filler, giving himself time to marshal his thoughts before returning to the subject. More disconcertingly, he often uses it to change subject abruptly or trail off altogether.

The president at the recent Nato summit press conference, steadying himself with one hand on a lectern, said: “For the longest time it was Biden’s not prepared to sit with us unscripted, Biden’s not to – and anyway.”

He tried again. “I think we’ve done over 20 major events from Wisconsin, to North Carolina – anyway.”

In total, he used the word 10 times in the hour-long press conference.

The effect is particularly jarring when the 81-year-old seems to be building up to a climax before performing a rhetorical reverse ferret.

“You know there’s only two presidents in American history who have come to office and left with fewer jobs than when they came to office,” he said in a recent interview, setting him up to use his nickname for his Republican opponent: Donald “Herbert Hoover” Trump.

However, Mr Biden struggled to remember the name of the 31st president, who presided over the start of the Great Depression. “Anyway,” he said.

At a speech to the National Association for the Advancement of Colored People (NAACP) last week, he used the phrase as a segue to cover apparently losing his train of thought several times in quick succession.

“Y’all told me I couldn’t pass the Inflation Reduction Act,” he says. “You’ll told me I couldn’t face the - anyway - we did it.”

He also appeared to lose track of a key policy announcement – announcing a cap on rent increases so “corporate landlords can’t… guard – anyway”, without later clarifying what he meant.

He added “I’m going to get very upset,” suggesting he was too angry to finish his thought – a common piece of rhetoric from the president.

‘Look’

Mr Biden uses “look” in a similar manner to “anyway” – to throw himself a lifeline when he cannot remember how a sentence is meant to end.

The tactic, if not elegant, puts a stop to the long silences that marred his debate performance and stops him wandering up a rhetorical blind alley.

In a recent NBC News interview, he was asked about his “first reaction” to the assassination attempt on Donald Trump at a rally in Pennsylvania.

“My first reaction was, “My God. This is –” Mr Biden said, and promptly lost track of the sentence. “Look, there’s so much violence now and the way we talk about it.”

He went on to use the word repeatedly in the interview while being pressed about his comments on putting Trump in a “bullseye”.

“I was talking about focus on – look,” he said, blinking rapidly and holding out his hands as if trying to physically grasp his answer. “The truth of the matter was what I guess I was talking about at the time was there was very little focus on Trump’s agenda.”

In another interview this month, Mr Biden seemed surprised to find himself abruptly changing the subject from his medical condition to the presidential debate.

“I made a serious mistake in the whole debate and er –,” he said and stalled. Then, after a couple of seconds: “Look.”

Mumbling

A younger Mr Biden could speak with clarity, force and vigour. In his vice presidential debate with Paul Ryan in 2012, he launched into confident monologues while keeping his 42-year-old opponent off-balance with well-timed heckles.

But recently his speech has become less distinct, as he slurs his words and mumbles to the point where it is impossible to work out what he is saying.

In his NBC News interview, this happened when he was asked whether he would drop out of the race if he repeated his disastrous debate performance.

“What happened…” Mr Biden said before tailing off. NBC’s transcribers gave up at that point, marking the rest of the sentence “INAUDIBLE”.

“I don’t plan on having another performance on that level,” he said when the question was repeated, slurring his answer so badly that it sounded like one word. For many viewers, it will have been disconcertingly close to the Biden they saw on the debate stage.

The US president spent the 90-minute debate sounding hoarse and delivering mumbling answers that were punctuated by sharp intakes of breath.

At one point, Trump seemed sincerely baffled with Mr Biden’s answer on border security.

“I really don’t know what he said at the end of that sentence – I don’t think he knows what he said either,” he said.

Sudden shouting

Mr Biden has started raising his voice and shouting at his audience when he wants to emphasise a point.

The intention is surely to show that he is still passionate at the age of 81, and to stop him slipping into the feeble mumble that he failed to shake off during the debate.

The tactic worked in his State of the Union address earlier this year, when Mr Biden spent most of the night shouting in a largely gaffe-free speech. Trump seemed so taken aback by it that he accused the US president of taking performance-enhancing drugs.

But now the outbursts seem more clunky – and the sudden shifts in volume jarring, even erratic.

At the Nato press conference, he suddenly became animated by the subject of school shootings, which had not even been mentioned by his questioner.

“More children are killed by a bullet than any other cause of death,” he shouted in an apparent fury, making stabbing motions with one hand while the other clenched his lectern.

His voice raised and brows tightly knitted together, he continued: “The United States of America. What the hell are we doing?” A few seconds later, he clenched his fist and waved it in the air.

In a speech to the NAACP, he became feverish when talking about investing in “things that affect people’s lives, like childcare, elder care and so much more – that grow the economy,” shouting the last four words while his outstretched hands shook.

“And help people,” he added, suddenly quiet.

Whispering

Abrupt changes in volume have become a hallmark of Mr Biden’s speeches.

While he is prone to suddenly start shouting, at other times he will break into an exaggerated stage whisper without warning.

The habit is more common in press conferences than set-piece speeches, where the president seems to be suggesting to reporters that – even though up on stage with a microphone – he is confiding in them.

The effect can be slightly eerie, however. Unfriendly news outlets have dubbed it the “creepy whisper”.

He did it constantly at the Nato summit. In fairness to Mr Biden, he may have been rusty – it was his first solo news conference in eight months.

“We had the Treasury department do a study,” he said at one point, leaning forward onto the lectern with his forearms and dropping his voice into a husky whisper. “When unions do better, everybody does better.”

He did so throughout the event, as he batted away questions on whether he would end his re-election bid in the wake of the debate performance.

“If all of a sudden [primary delegates] show up at the convention everybody says we want somebody else, that’s the democratic process,” Mr Biden said. Opening his arms with his eyes wide, he whispered: “It’s not going to happen.”

“I love my staff,” he said at another point, before slipping into a whisper – as if they were out of earshot rather than listening intently and bracing themselves for a gaffe.

“But they add things [to his schedule], they add things all the time. I’m catching hell from my wife for that. Anyway.”

Staring

In his first presidential debate with Trump in 2020, Mr Biden barely looked at his opponent and treated him as an irritating side-show.

While the Republican hectored, heckled and interrupted him, the Democrat stuck to his scripted remarks, addressing them to the studio audience or speaking directly to the camera.

The positions were reversed in their latest showdown in June. Mr Biden spent much of the night in profile as he turned over to stare at Trump, his eyes wide and his mouth hanging open in a permanent expression of befuddlement.

The effect was disastrous. Trump ignored him for most of the night, except when the ageing presidential contenders squabbled over their golf handicap.

Recently, the Democrat has developed a habit of appearing to stare off blankly into space at public events.

At a “Juneteenth” concert in the grounds of the White House, Mr Biden appeared frozen, grinning vaguely while his arms stuck rigidly at his side. The impression was likely not helped by his spinal arthritis.

He appeared wide-eyed in a recent NBC News interview, as he defended himself from accusations of cognitive decline.

“My mental acuity’s been pretty damn good,” he insisted, sliding out of his chair towards interviewer Lester Holt, while staring at him unblinkingly. “I’ve gotten more done than any president has in a long, long time.”

Blinking

A key sign that Mr Biden is struggling to recall something is that he will blink rapidly when he is trying to respond.

He spent much of the presidential debate struggling to dredge up various facts and figures, blinking constantly as he cast his mind back to practice sessions at Camp David.

The most excruciating example of this came when the 81-year-old launched into a long answer about taxation, strewn with various numbers and percentages.

He started strongly but stumbled, then pulled his answer back on track by sheer force of will – before it went completely off the rails.

“We’re able to make every single solitary person eligible for what I’ve been able to do with the – with the Covid, excuse me, with dealing with everything we had to do with,” he said, blinking constantly before breaking off.

He then closed his eyes altogether and put his head down, seemingly trying to collect himself.

“Look,” he said, resurfacing. “We finally beat Medicare” – referring to the US health insurance system for over-65s. Mercifully, he was then cut off by moderators.

During his NBC News interview, he blinked rapidly at the start of virtually every question as he tried to marshal his thoughts.

“The truth of the matter was what I guess I was talking about at the time was there’s very little focus on Trump’s agenda,” he said at one point, blinking 17 times in the space of a few seconds.