President Trump recently underwent his annual physical checkup. At Trump’s apparent insistence, the physician also administered a test of cognitive ability, the Montreal Cognitive Assessment (MoCA).
Some are citing this test to demonstrate that Trump does not have a mental illness or any other personality disorder. However, what does this test really tell us about the president’s mental health?
Developed in the early 2000s at Montreal’s McGill University by a group of researchers, the Montreal Cognitive Assessment (MoCA) is a simple paper-and-pencil test meant to detect mild cognitive impairment and cognitive degenerative diseases such as Alzheimer’s. It takes about 10 to 12 minutes to complete and is indicated for people where a physician may have reason to suspect possible cognitive deficits or dementia.
That is, MoCA tests to see if a person is having significant thinking or memory problems.
Most healthy adults have no problem with this test and can easily do well on it — a score of 26 and higher generally indicates normal cognitive functioning. In the validity study of the MoCA, healthy subjects who had no cognitive deficits had an average score of 27.4. People with Mild Cognitive Impairment (MCI) had an average score of 22.1, and those with Alzheimer’s disease averaged only 16.2. ((The scoring of MoCA is as simple as the test itself: Visuospatial and Executive Functioning: 5 points; Animal Naming: 3 points; Attention: 6 points; Language: 3 points; Abstraction: 2 points; Delayed Recall (Short-term Memory): 5 points; Orientation: 6 points; and Education Level: 1 point is added to the test-taker’s score if he or she has 12 years or less of formal education.)) While the Cochrane Collaboration review of the test showed it detects 94 percent of people with dementia, it is not very accurate:
…[T]he test also produced a high proportion of false positives, that is people who did not have dementia but tested positive at the ‘less than 26’ cut-off. In the studies we reviewed, over 40 percent of people without dementia would have been incorrectly diagnosed with dementia using the MoCA.
Does This Mean Trump is Mentally Healthy?
To be clear, this is not a general test of a person’s mental health or personality. There are psychological assessments that can test for those things — this is not one of them. This test can no more tell us about the general mental health or personality traits of an individual than a monkey could.
The fact that our president scored well on this test is to be expected. It would be highly unusual — not to mention disturbing — if he had anything less than 27 or 28. Chances are, nearly every single person reading this article would score similarly high on it. If someone scored under 26 on the MoCA, you would be concerned and send them for a further neuropsychological assessment to better understand what’s going on with them.
So no, we don’t know whether Trump is mentally healthy or not. All we learned is that he’s not suffering from mild cognitive impairment or Alzheimer’s. I would hope that no sitting president would ever suffer from either.
Can We Trust the Person Who Administered It?
In general, this test is usually administered by a healthcare professional who has had training in understanding how to administer and score the test properly. This group includes many physicians, because it’s something that can be given during an annual checkup.
While I believe Trump scored well or even perfectly on the test, there’s reason to suspect the validity of the president’s checkup.
Why? Because the physician who examined Trump — Dr. Ronny Jackson — apparently stretched the truth about the President’s height — 6′ 3″ — and weight — 239 lbs. (Prior to this checkup, Trump’s height was reportedly listed by New York State as 6′ 2″. Did he suddenly grow an inch at 70 years old?) President Obama’s height is listed as 6′ 1″, which means Trump would clearly be taller than Trump. But tell me what your eyes tell you — does it look like there’s a significant difference between the two presidents’ heights?
Press down on Trump’s comb-over and he looks to be the same height as Obama — 6′ 1″.
Why did the physician fib about these measurements? One possible explanation is so that Trump wouldn’t be classified as being medically “obese.” If the physician listed his actual height, Trump would have carried a medical label of “obese” — which I suspect wouldn’t sit well with Trump, known for his vanity.
If he would stretch the truth about these kinds of basics, it makes you wonder how much you can believe from this checkup.
We live in odd times. In the more than 22 years of publishing and writing for Psych Central, I’ve never had to focus on a leader’s mental health as much as I’ve had to over the past 2 years.