I think Biden has a well-managed case of Parkinson’s disease, a disease I also have. He holds his arms and hands awkwardly and walks with an odd gait. Now and then you can see his hands tremble and I’ve seen him do the Parkinson’s “pill-roll” with his fingers. It would explain his fatigue and his early bed time.
With Alzheimer’s the decline is consistently downward when not plateauing. People with vascular dementia have some parts of the brain that still work while other parts do not. Biden is still quite good at reading unless it has numbers. He simply cannot keep numbers straight even reading them.
These mini strokes can also affect motor skills, especially something like balance.