Joe Biden made several of the wrong sorts of headlines during his recent trip to England and then to the NATO summit. First, there were the awkward interactions between the President, the Welsh Guards, and King Charles III. Then there were more bad visuals during the summit in Vilnius. As Karen already discussed yesterday, one of the agenda items that had a lot of people talking was Biden’s decision to skip the leadership dinner and return to his hotel room in Lithuania. A few different reasons were offered for that. There was the public excuse given by his staff who said that the President had a busy schedule over the following four days and a major speech to prepare.

Under more normal circumstances, that would seem like a somewhat reasonable explanation, though it would still be odd for a world leader to take a pass on what was arguably one of the more high-profile moments of the conference. That’s not to mention the missed opportunities for private conversations with other leaders away from all of the microphones and cameras. And besides, does anyone really believe that Joe Biden writes his own speeches at this point? Someone else was already finishing the speech and he was just going to read what he was given.

But as Karen pointed out, the reality most likely was that Joe was simply too tired from the trip and his handlers wanted to get him back to bed before he caused any more embarrassment. That’s at least part of the explanation, I’m sure. Joe keeps a very light schedule at home in the White House, to put it mildly. But I don’t think we would be venturing too far into conspiracy theory territory to suggest that there was more to it than a simple case of being tired from his trip.

A US official was reported as saying that the US .president skipped the dinner because he has four full days of official business ahead of him and is preparing for a major speech on Wednesday.

Mr. Biden, who arrived in Europe on Sunday, sent Secretary of State Antony Blinken to the dinner in his place.

The gathered leaders have offered an invitation to Ukraine to join in the defense alliance, pending certain conditions.

So was Joe tired by the time the dinner rolled around? I have no doubt about it. Joe Biden sleeps a lot, as indicated by the occasional CPAP marks on his face when he emerges from the basement. But we should also remember that those official dinners are generally scheduled for fairly late in the evening, well after the formal business of the day is concluded and the attendees have had time to go get ready for the feast.

Why is that important? As I’ve mentioned before, we’ve had to deal with issues of cognitive decline in my family and I’m familiar with the symptoms. And it’s almost impossible to argue that this is what we’re seeing with Joe Biden. But since I’m not a doctor, you don’t need to take my word for it. The NIH has long recognized that people dealing with dementia, Alzheimer’s, or other forms of cognitive decline perform noticeably worse in the evening than they do in the morning or early afternoon. Those conditions also frequently affect the patient’s sleeping patterns. The Alzheimer’s Association has documented the reality of “sundowning,” saying that it “occurs in late afternoon through the night, causing confusion and sleep issues.”

Biden’s handlers no doubt knew that Uncle Joe’s schedule had already been thrown off by the plane flight and the shift in time zones. (That dinner wasn’t scheduled to start until after midnight on east coast time.) They had to get him back to the room because he simply was not going to be up to engaging in conversations with other world leaders, the press, or pretty much anyone at that point. Biden’s public performances are frequently marginal in the middle of the day when he should be at his best. Asking him to perform that late in his day would have opened the door to a PR disaster.

I do not say any of this to be unkind or denigrate Joe Biden. Having some direct experience with family members, I honestly do sympathize with him. Cognitive decline of any sort is terrible to go through and it’s awful to observe, particularly when doctors tell you that there is little if anything they can do to help your relative. But Joe Biden sought out and accepted the position as the President of the United States. He carries a huge burden on his shoulders and it seems increasingly obvious that he is no longer able to bear that burden in full. And we simply can’t pretend this isn’t happening right before our eyes, particularly now that he’s being pushed into running for another term.