(Bloomberg) -- President Joe Biden’s doctor said he continues to be “fit for duty” following an annual physical exam Wednesday amid voter doubt about his age and ability to serve a second term.

“The president is a healthy, active, robust 81-year-old male, who remains fit to successfully execute the duties of the presidency, to include those as chief executive, head of state and commander in chief,” his longtime physician Kevin O’Connor said in a letter released by the White House.

“This year’s physical identified no new concerns,” O’Connor wrote. 

The president, already the oldest in US history, has faced growing questions about his physical and mental health, intensified by a special counsel report questioning his memory, a series of incidents in which he mixed up the names of world leaders, and the news that he uses a continuous positive airway pressure, or CPAP, device to treat sleep apnea.

O’Connor detailed some of the conditions the president suffers from, including atrial fibrillation — an irregular heartbeat — spinal arthritis, sensory neuropathy in his feet, seasonal allergies, and acid reflux. 

The physician also said the results of a detailed neurological exam were “reassuring in that there were no findings which would be consistent with any cerebellar or other central neurological disorder, such as a stroke, multiple sclerosis, Parkinson’s or ascending lateral sclerosis.”

White House Press Secretary Karine Jean-Pierre earlier Wednesday pushed back on questions about whether the president would undergo a cognitive test, saying his “doctor doesn’t believe he needs one.”

“The president passes, again, a cognitive test every day,” she added. “He’s able to do the work every day that is rigorous, that is more rigorous than it would be for any 15-minute clinical appointment.”

Biden and former President Donald Trump, 77, have accused each other of declining mental fitness ahead of an expected general-election rematch. Republican presidential candidate Nikki Haley has called on both men to undergo cognitive tests, saying they are each too old to serve as president.

Biden has aggressively parried questions about his mental fitness, saying in an appearance on NBC’s Late Night with Seth Meyers broadcast early Tuesday that Trump often misspeaks and that what matters is the policies each aims to implement.

That has done little, however, to dissuade Republican attacks over his age or to calm voter unease. An NBC News poll taken in January showed three-quarters of voters, including half of Democrats, say they have concerns about his age. Less than half harbor such worries about Trump, even though the Republican is only four years younger.

Health Exam

O’Connor detailed some of Biden’s conditions, noting that his frequent throat-clearing is in part a result of acid reflux. And he provided an update on the president’s stiffer gait, which was noticed in prior physicals. O’Connor said the president’s gait has not worsened since last year. 

He noted that “much of his stiffness” is the result of “wear and tear” and osteoarthritic changes to his spine, adding that the changes — while moderate to severe — did not result in any nerve root damage significant enough to warrant specific treatment.

O’Connor also discussed Biden’s use of a CPAP device, saying the president initially had difficulties falling asleep while wearing the mask but had stuck with the therapy and routinely uses it for most or all of the night. The White House disclosed in June — after it was reported by Bloomberg News — that Biden had started using a CPAP machine.

O’Connor said Biden needed new prescriptions for vision correction. “Current optometric refraction was obtained and contact lens prescriptions were updated,”  he wrote. 

The president is taking a number of medications to treat his conditions, including Eliquis, Crestor, Fluticasone nasal spray, Allegra, Pepcid and Nexium, O’Connor said.

Special Counsel

The issue of Biden’s age received more scrutiny after Special Counsel Robert Hur’s report into the president’s handling of classified documents, which described him as a “sympathetic, well-meaning elderly man with a poor memory.” One of the most startling claims in the report was that Biden did not remember the timeframe for when his son Beau died.

The president reacted angrily to that assertion in conversations with House Democrats and in an impromptu prime time press conference where he insisted his “memory is fine.” Yet he undermined his case during those remarks by referring to Egypt’s president as the leader of Mexico.

Biden told reporters earlier Wednesday his health was “great.” 

Asked if there is anything from the exam Americans should be concerned about, Biden quipped, “They think I look too young.”

--With assistance from Stephanie Lai.

(Updates with additional details, context from ninth paragraph)

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