The Letter

Not going to lie, this was a difficult one to research and write. I remember the events from the latter half of the Reagan administration, and the speculation that was running rampant at the time (and even some regrettable and inappropriate jokes).

Alas, having lived through my father's diagnosis, and the 12 year decline until he passed was tough on me.

Series: The Fulcrum, Book Three: The Canonization, Act one: The Long Goodbye, Episode 2

On November 5, 1994, a former president announced his own decline, in his own hand, before anyone else had to.

“At the moment I feel just fine.”

Ronald Reagan wrote those words himself, dated November 5, 1994, in a letter he chose to release to the public. He explained that he and Nancy had been open before, about her breast cancer in 1987 and his own cancer surgeries, and that they hoped the same openness now might help others facing the disease notice it sooner. He said he planned to keep doing what he loved, time outdoors, time with family. He asked for prayers for Nancy, who would carry so much of what was coming. He closed it this way:

“I now begin the journey that will lead me into the sunset of my life.”

Then he thanked the country for the honor of letting him serve it.

What the Doctors Said

Five names, faxed the same afternoon, with the one fact that matters most.

Alongside the letter, five physicians released a joint statement: Oliver Beahrs and Ronald Petersen of the Mayo Clinic, Leslie Weiner of USC, James Blake of St. John’s, and Gen. John Hutton. The Reagans had taken annual physicals their whole adult lives, memory testing included, and continued at Mayo after leaving Washington. The doctors wrote that over the preceding twelve months, his results had begun to show symptoms consistent with early-stage Alzheimer’s. Further testing and several weeks of observation led to the diagnosis.

That single detail, over the past twelve months, is the most solid thing anyone will ever be able to say about the timeline. It places detectable symptoms at roughly late 1993, nearly five years after he left office. The statement does not address what, if anything, his doctors saw while he was president. It simply isn’t about that period at all.

The Argument That Followed

What we know and what people have claimed are not the same thing, and this book is only interested in holding them apart.

That gap, between the documented twelve months and the eight years in office before it, became its own small industry of dispute.

In his 2011 memoir, Ron Reagan wrote that he’d sensed “something beyond mellowing” in his father roughly three years into the first term, and he later told the Times he believed the disease was likely present before the formal diagnosis. He was careful to add he wasn’t claiming dementia in office, and he is not a physician.

His brother Michael rejected the claim outright, saying there was no evidence anywhere to support it. Douglas Brinkley, who edited Reagan’s presidential diaries for publication, said the entries never changed in tone or format across eight years, and that he’d go with no signs of Alzheimer’s absent real medical evidence.

In 1997, the Times quoted Reagan’s four main White House physicians on the record. One, Dr. Lawrence Mohr, called his cognitive function and judgment “totally and completely intact” throughout. No cognitive tests were given while he was in office itself.

Against that sits Lesley Stahl’s account from a 1986 visit, in her 2000 memoir, of a moment where Reagan seemed not to know who she was, before, in her words, he “snapped out of it.” She wrote that White House aides privately told her they’d seen similar moments. A 1987 New Republic piece had already asked the question outright: was he senile. That headline alone is worth noting, not because it answers anything, but because the suspicion existed in real time, not only in hindsight.

None of this resolves. It isn’t supposed to. What’s documented is documented. What’s remembered is remembered, by people with every reason to remember it differently.

A Study, Twice Hedged

The closest thing to hard data here still isn’t a diagnosis.

In 2015, Arizona State researcher Visar Berisha analyzed decades of Reagan’s press conference transcripts and found measurable speech pattern changes, of the kind associated with dementia, appearing years before the 1994 diagnosis. It’s the single most concrete piece of evidence in this whole dispute.

Berisha himself hedged it twice. The method, he said, cannot support a retrospective diagnosis. And the same changes could just as easily reflect a public figure simplifying his language over time for a different reason entirely, to be better understood by a wider audience. Worth citing, not worth more than that.

Two Men Who Didn’t Get a Letter

Reagan had two predecessors who lost this same fight, except the fight was never theirs to have.

In October 1919, Woodrow Wilson suffered a stroke. His wife, Edith, and his physician, Dr. Cary Grayson, kept the public and Congress from learning its true extent for the rest of his term. Grayson’s own private notes, unsealed decades later, reportedly said plainly that Wilson could not fulfill his duties and would not meaningfully recover. None of that reached the country while it mattered.

In March 1944, FDR was diagnosed with advanced congestive heart failure. His cardiologist was sworn to secrecy. The public was told bronchitis. FDR himself was reportedly never given the real prognosis. He ran for and won a fourth term that November, and died three months into it, a death the press at the time called sudden and unexpected. It wasn’t.

Two presidents, two concealments, managed by the people closest to them. Neither man got to write his own letter.

Two Men Who Did, More or Less

The instinct to conceal didn’t end in 1994. The instinct to disclose anyway remains the rarer one.

It’s worth saying plainly that this pattern didn’t retire with Reagan.

In February 2024, special counsel Robert Hur’s report on Biden’s handling of classified documents stated that his memory “appeared to have significant limitations,” including that he could not place, within several years, when his own son had died. Biden’s lawyers called the characterization inaccurate and unfair. That June, his debate performance against Trump was widely described as halting and confused, and on July 21, 2024, he withdrew from the race.

In July 2025, the White House released a physician’s note attributing visible leg swelling in Trump to a benign vein condition and hand bruising to aspirin and handshaking. The explanation came only after photographs of both had already spread publicly for days. An earlier report that spring had separately declared him in excellent health.

Say what actually happened in each case, nothing more. Biden’s team disputed a characterization of his memory. Trump’s team explained his body after the public had already seen it. Reagan told the country himself, before anyone made him.

He’s OK

In January 2001, Reagan fractured his hip. Nancy stayed with him at the hospital, day and night. When reporters asked how he was doing, in the years that followed, her answers got shorter. He’s OK, she’d say, and not much more.

That’s the whole of it. No lesson sits on top of this one. He wrote that he was beginning a journey. What’s left to say is only that someone walked it with him, and didn’t have the words for it either, by the end.