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Why did Donald Trump take the Montreal Cognitive Assessment?


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Why did Donald Trump take the Montreal Cognitive Assessment?

The president got top marks, but his score should not be interpreted too broadly

The Economist explains

Jan 19th 2018

by M.D.

THE question of whether Donald Trump is mentally fit to hold the office of president has received renewed attention following the publication of Michael Wolff’s exposé, “Fire and Fury: Inside the Trump White House”. The book quotes various aides to the president expressing doubts about his competence. Mr Trump, as is his wont, responded with an attack. He called Mr Wolff deranged. Not only is mental stability one of his own greatest assets, the president tweeted—he is also a “very stable genius”. Perhaps conscious that not everyone would take him at his word Mr Trump allowed his doctor to reveal on January 16th that the president had scored 30 out of 30 on the Montreal Cognitive Assessment. What is this test and why does the score matter?

Doctors use various tests to see whether the brains of elderly patients are functioning normally. The standard used to be the Mini-Mental State Examination, a set of 11 questions created in 1975. It asked patients things like the date, whether they could spell the word “world” backwards and whether they could repeat the phrase “No ifs, ands or buts”. The test was good at identifying patients with dementia, including Alzheimer’s, but less good at detecting those who had mild cognitive impairment, which is often a prelude to dementia. The Montreal Cognitive Assessment fills this gap.

The Montreal test was developed by neurologists at the University of Sherbrooke Neuro Rive-Sud, a clinic just across the river from Montreal that specialises in memory. It asks slightly more complicated questions than the Mini-Mental test and requires the patient to do things like draw a clock showing the time 11:10, to name as many words as possible starting with the letter “F”, and to tap their hand every time they hear the letter “A” while a long string of letters is read to them. The Montreal test, or MoCA, is able to detect mild cognitive impairment about 90% of the time. Nearly three-quarters of the patients identified as abnormal by this test were classified as normal by the Mini-Mental State Examination.

Mr Trump’s doctor said the president insisted on taking the cognitive test. His perfect score should not be interpreted too broadly. It indicates he has no problems with what neurologists call  “executive” functions such as organisation, planning and abstract thinking. But it says nothing about other psychological matters, such as judgment or personality. It may have appealed also because it takes just 10 minutes to complete. Less appealing, to a president who rails against immigrants and maintains scepticism about their contributions to society, may be the background of the lead neurologist on the team that developed the assessment. Ziad Nasreddine immigrated to Canada from Lebanon at the age of 15 with his widowed mother and sisters. He studied in the United States but returned to Canada, where he developed a test that has been translated into 60 languages and used around the world. He has said that he hopes Mr Trump will draw some lessons about immigrants from his personal story.


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