Trump has brought up his cognitive test repeatedly as a way of questioning the mental acuity of the presumptive Democratic presidential nominee, Joe Biden. Photo / Doug Mills, The New York Times
The president said on Fox News that he had to remember those words as part of a test that he said demonstrated his mental acuity. But the test, the Montreal Cognitive Assessment, is meant to detect signs of dementia, Alzheimer's disease or other conditions.
Presidents and those who would be president often boast of their qualifications — their education, their experience, their achievements. And then there is President Donald Trump, who is boasting about his dementia test.
Even for a president who has rewritten the political rulebook so many times before, the spectacle of a commander in chief repeatedly touting his performance on a cognitive examination to prove that he has not lost a step paves new ground in the history of campaigns for the highest office in the land.
Rather than dispensing with the issue, Trump drew new ridicule this week when he declared it nothing short of "amazing" that he did so well on a test that, among other things, required him to identify an elephant. To demonstrate just how hard he said the test really was, he went on television to recite, over and over, the words that he had been asked to remember in the right order: "Person. Woman. Man. Camera. TV."
Cable television played the president's performance on a virtual loop Thursday, and those five words trended online. A group of anti-Trump Republicans instantly produced an online ad mocking the president. T-shirts, sweatshirts, hoodies and other clothing with "Person. Woman. Man. Camera. TV." emblazoned on them were quickly offered for sale. They have in effect become the haiku of the 2020 campaign.
The reaction was not quite what the president was seeking. In repeatedly bringing up his cognitive test in recent weeks, he has been trying to bolster his strategy of questioning the mental acuity of his presumptive Democratic presidential opponent, former Vice President Joe Biden, whom he has portrayed as a doddering old man propped up by his staff.
But in doing so, the president who has called himself a "very stable genius" reinforced concerns about his own capacity, leaving voters who are already confronting the oldest matchup of presidential candidates in American history to decide which septuagenarian is still with it — Trump at 74 or Biden at 77.
Biden has sought to fend off questions about his state of mind for months, going back to the primary campaign when fellow Democrats pointed to gaffes, misstatements and stumbles over words. At one debate, an opponent jabbed him by suggesting he could not remember something he had said only two minutes earlier.
In the months since, Biden has been less visible than a challenger normally would be because of the coronavirus pandemic that has forced lockdowns and canceled traditional campaign rallies. But Democrats privately express concern about the potential for embarrassing moments once the campaign ratchets up in the fall.
Biden sought to dismiss any concerns at a news conference three weeks ago, telling reporters that he was up to the rigours of the campaign trail and the presidency when asked if he had taken a cognitive test. "I've been tested, and I'm constantly tested," he said. "Look, all you've got to do is watch me, and I can hardly wait to compare my cognitive capability to the cognitive capability of the man I'm running against."
In fact, Biden's answer was misleading. Aides have since said that his reference to being tested did not mean that he took a cognitive test like Trump has but that he has been tested by the challenges of a national campaign.
Biden's camp was happy to jump Thursday on the president's latest comments. Kate Bedingfield, Biden's deputy campaign manager, pointed out that Trump recently suggested injecting disinfectant to counter the coronavirus and he has been reported to once ask aides about using nuclear weapons to disrupt hurricanes.
"He has shunned the advice of doctors, medical experts and scientists throughout the pandemic and promised that the virus will magically 'disappear,' " she said. "His erratic and unstable leadership has given Americans tremendous doubts about his fitness to hold the office before you even get to him continually and pointedly raising doubts about his own cognitive ability."
Biden has the edge upstairs in the view of the public. In a poll by The Hill newspaper with the HarrisX research firm released this week, 56 per cent of voters said the former vice president was mentally fit to lead the nation, while just 45 per cent said that of Trump.
Other American presidents have struggled with cognitive or psychological issues but rarely addressed them publicly the way Trump has. A Duke University study in 2006 found that nearly half of presidents suffered from mental illness at some point in their lives. Nearly 25 per cent of presidents met the criteria for depression, according to the study, including James Madison, Abraham Lincoln and Calvin Coolidge. Ronald Reagan's aides were concerned enough that he was slipping late in his presidency that they secretly considered whether to invoke the 25th Amendment to remove him for incapacity before deciding he was still fit enough to finish his tenure.
Trump has been unclear about when he took the cognitive test he has recently been eager to discuss. Dr. Ronny L. Jackson, who was then his White House physician, reported in 2018 that the president had taken the Montreal Cognitive Assessment, or MOCA, and scored a perfect 30 points. Lately, Trump has said he took a test "a little less than a year ago," but White House officials would not clarify whether he took a second test or was referring imprecisely to the one Jackson reported two years ago.
In unscripted moments before the camera, the president sometimes wanders from topic to topic without completing a train of thought, repeating himself or falling back on the same familiar phrases when questioned. He makes statements that defy common sense, like insisting that if there were not so many coronavirus tests conducted, there would not be so many cases of the virus, which as skeptics have pointed out is roughly equivalent to saying that there would not be as many pregnancies if there were not as many pregnancy tests administered.
The Montreal Cognitive Assessment is meant to test for signs of dementia, Alzheimer's disease or other conditions, but the president talked about it on Fox News on Wednesday night as if he had aced an IQ test proving his intelligence. Experts said that reflected a misunderstanding about the purpose and value of the exam.
"It is good that he has a good score, and it's very good that he has a higher than average score, so this is reassuring in terms of cognitive dysfunction," Dr. Ziad Nasreddine, the neurologist who created the test, said in an interview. "It obviously does not measure whether a person is fit to be president."
Nasreddine said about 10 per cent of those in their 70s get a perfect score of 30, but it is meant to detect fading capacity, not intelligence. For those suffering from a degenerative condition, summoning the word for elephant when shown a drawing of it can be frustratingly difficult, and Nasreddine expressed concern that the mockery the president had experienced might discourage patients from taking the test.
On a sample exam, those tested are asked to draw a clock; to count backward by sevens from 100; to name the date, month, year and place; and to identify drawings of animals like a lion or camel. They are also read a list of five words and asked to repeat them in order twice, then asked that again five minutes later to see if they still recall them.
"They said nobody gets it in order," Trump boasted on Wednesday on Fox. "It's actually not that easy, but for me, it was easy. And that's not an easy question. In other words, they ask it to you, they give you five names, and you have to repeat 'em. And that's OK. If you repeat 'em out of order, it's OK, but, you know, it's not as good. But when you go back about 20, 25 minutes later, and they say go back to that — they don't tell you this — 'Go back to that question and repeat 'em, can you do it?' And you go: 'Person. Woman. Man. Camera. TV.'"
Trump insisted that the doctors were blown away by his ability to remember them and suggested that Biden take it as well. "They say, 'That's amazing. How did you do that?'" the president said. "I do it because I have, like, a good memory, because I'm cognitively there. Now, Joe should take that test, because something's going on. And, and, I say this with respect. I mean — going to probably happen to all of us, right? You know? It's going to happen."
As many of his critics quickly noted, recalling the five words in order has no relevance to the mental conditions Trump is often accused of having, such as narcissistic personality disorder. His estranged niece Mary L. Trump, a clinical psychologist, published a scathing book about her uncle's troubled family and has been on television in recent days saying that he has "so many pathologies" and "demonstrates sociopathic tendencies."
Appearing on Stephen Colbert's The Late Show on Wednesday, Mary Trump was not ready to accept her uncle's account of the results of his cognitive test. "So you know, we don't know how he did on it," she said, "but as far as I'm concerned, his talking about it the way he's talking about it is failing the test."
"Bragging about passing a cognitive test is one of the ways you fail a cognitive test," Colbert said.
"Yeah," she responded.
Written by: Peter Baker
Photographs by: Doug Mills
© 2020 THE NEW YORK TIMES
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