The creator of the Montreal Cognitive Assessment, given to President Donald J. Trump as part of his annual physical told Big League Politics how the test works and why it is so popular.
“The test has been used to mostly to detect cognitive impairment, memory dysfunction and difficulty finding your words or difficulty having to orient yourself in a space–mostly to detect Alzheimer’s Disease,” said Dr. Ziad Nasreddine, a neurologist and the founder and director of the Montreal’s MoCA Clinic & Institute.
Shortly after Tuesday’s White House press briefing with Navy Rear Adm. Ronny L. Jackson, the President Donald J. Trump’s official physician, Nasreddine said he got a phone call from a Canadian reporter asking if he knew that Jackson had the test to evaluate the president.
In the briefing, Jackson, who served in Iraq and is a member of the American Academy of Emergency Medicine, he interacts with the president every day and he never felt that a cognitive test was necessary. “He has absolutely not cognitive or mental issues whatsover–he is very sharp.”
Trump scored 30-out-of-30 on the test, the doctor said.
Despite the admiral’s confidence in the president’s state of mind, he told reporters that Trump requested that some test be done to counter the media reports and rumors about his mental state. Much of the controversy about the president’s mental health was stirred up by the Michael Wollf book Fire and Fury.
The doctor said he was with colleagues and conversation turned to the president’s physical and the controversy surrounding Wollf’s book.
“I was making a joke last week, because I heard about it–I was talking to colleagues–telling how the president is supposed to run some tests, some physical tests on him, I told them that maybe they would be running some memory tests and they might use my MOCA test,” he said. “It was only a joke. I didn’t think they do it actually.”
Nasreddine said it is possible to have a perfect score.
“It is not usual, though,” he said.
“Not everyone can reach 30-out-of-30 on this test, but it is possible if you concentrate and you are in a calm environment, you are able to perform well,” he said.
The results are good news about the president, he said.
“The test has limitations in terms of detection of cognitive impairment and it does not rule out completely the possibility of cognitive impairment,” he said. “But, it does make us more comfortable about the president’s cognition, though, he was able to get a perfect score on it.”
The test does not measure judgment or personality, he said. “It is not a personality test. It is meant for executive function, organization, planning, abstract thinking, calculation, memory, language, spatial skills–it does not assess all the behaviors of the president, obviously.”
Jackson was also asked by a reporter about the clean bill of health given to President Ronald W. Reagan, even though it is clear now that his mind was starting to falter in the last years of his term.
Click here for the Summary of President Donald J. Trump’s Jan. 12 Medical Exam
The admiral said he was not versed in the details of Reagan’s condition or records of his examinations beyond what he saw in the news, but even in the case of Reagan, the Montreal Cognitive Assessment would have been helpful. “I think the folks in the mental health community would back me up on that if he had some kind of mental cognitive issues then that this test is sensitive enough and would pick up on it–he wouldn’t have gotten 30-out-of-30.”
Nasreddine said testing for Alzheimer’s was the primary motivation for him to develop the test.
“I developed it in 1996, but it was published in 2005,” he said.
“Because the test takes only 10-to-12 minutes to administer, it became very popular, but it is more sensitive than the existing test,” he said.
The Montreal Cognitive Assessment detects 90 percent of mind impairment and the old test that had been around for 40 years detected only 20 percent, he said.
It was more efficient to run this quick test, so as to catch mild cognitive impairment in patients in a shorter amount of time, he said.
After his neurological training was completed, Nasreddine said he chose to take more advanced studies at the medical school at UCLA with a particular focus on Alzheimer’s.
“There, I realized the screening measures that were available were very, very not-efficient to detect early impairment and they could not assess multiple domains of cognition–they could assess language and memory–and this is why I decided to develop something more sensitive,” he said.
The speed of the test is a key advantage to the test, he said. “When I came back to Canada, we were a first-line neurology clinic, so we had to see a lot of patients and if I had to run lengthy tests? I would only be able to see two or three patients a-day–because of the test, I can now see 10-to-15 patients per day.”
The doctor said the test is meant to be administered and graded by medical professionals.
“It takes a professional, who is used to understanding what the cognitive problems might be and what could affect cognition,” he said.
“I sometimes wonder about giving it to myself,” he said.
“It is a hard test, it is not as simple as it looks, the test is only a 30-point test–you have to remember five words–it is a sensitive test,” he said.
“I would recommend that people would do it with their doctors, if they are concerned about their memory,” he said.
“If they are not concerned about their memory, I don’t think it is useful,” he said.
The doctor said he understands that families, concerned about a loved one, could find the test helpful. “If the patient is not aware that he is forgetting or that he is repeating himself, missing appointments, we can run the test for anyone who is concerned.”
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