What Are Cognitive Tests and What Can They Tell Us About Biden and Trump?

Old age and mental ability have become leading issues in the race for the President of the United States

by Sededin Dedovic
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What Are Cognitive Tests and What Can They Tell Us About Biden and Trump?
© Justin Sullivan / Getty Images

Things particularly reached a tipping point after Joseph Biden's poor performance in a debate late last month, writes the BBC. Biden is the oldest president in U.S. history, and if Trump is elected, he would be the second oldest president.

During an interview with ABC News, Biden refused to commit to taking a cognitive test, saying he has a "cognitive test every day" and that his doctors say he doesn't need one. Trump said he completed cognitive tests, one while he was president and another recently.

He said he passed both. Here is what the tests are, their purpose, and how difficult they are to pass.

What is done in a cognitive test?

There are various tests and screenings to determine how well the brain functions. They help signal whether additional tests are needed for diagnosis, according to the Cleveland Clinic.

Typically, a cognitive screening might be warranted if a person has memory problems, personality changes, or balance issues, or if they repeat themselves, forget parts of their past, or have trouble understanding information.

One of the most commonly used tests is the Montreal Cognitive Assessment (MoCA), a quick way to "assess cognitive skills in people with suspected deficits," according to Sanford Medicine. The assessment tests orientation, memory, attention, and the ability to name objects, as well as to follow verbal and written commands.

It is also available online. Canadian neurologist Ziad Nasreddine told the BBC he thinks the test could be good for Biden – both as a way to reassure Americans and in case there is a problem.

What does a cognitive test look like?

In short cognitive tests, medical professionals ask patients various questions about learning and memory.

Longer clinical evaluations include cognitive tests plus a physical and neurological exam and a full patient history. The latter could provide a clearer picture of the cognitive abilities of both Biden and Trump, said Dan Mungas, associate director of the Davis Alzheimer's Disease Research Center at the University of California.

U.S. President Joe Biden (R) and Republican presidential candidate, former U.S.

President Donald Trump participate in the CNN Pr© Justin Sullivan / Getty Images

Often, medical professionals start with a short test, such as the MoCA, and if their score is lower than expected, they move on to a more comprehensive examination.

More detailed tests assess language, executive function, and visual-spatial abilities. For example, a medical professional may read a story to a patient and then ask them to recall parts of the story to test memory and learning abilities.

The patient may be asked to remember a list of words, name objects in pictures, or name items starting with a certain letter. In addition to interviewing the patient, Mungas suggests talking to people who regularly spend time with the patient to identify symptoms of cognitive decline.

Mungas said it is important to see if someone's abilities have changed over time, adding that a one-time assessment can be misleading. He notes, however, that cognitive tests are not everything. "The idea that there is a simple cognitive test that says this person will be a good president makes no sense, and I have been doing cognitive testing my entire career," said Dr.

Mungas.

What do Biden's and Trump's ages tell us about their likelihood of passing the test?

The American Academy of Neurology (AAN) recommends doctors evaluate people over the age of 65 for their cognitive abilities. That decision was made because as age increases, so does the likelihood of impairment, says Dr.

Nasreddine. By age 75, 25 percent of patients will have some type of cognitive disorder, he warned. "It becomes extremely common for cognitive impairment to be present, and sometimes it is present without people realizing it," said Dr.

Nasreddine. He said he noticed a change in Biden over the past year. In public appearances, the president moves slowly, his speech is slow, his voice is very quiet, and some words are mumbled. Few people have such an intense job at Mr.

Biden's age, he noted, and it is difficult to describe normal function for someone of that age. Dr. Nasreddine notes that, despite being only three years younger, Trump appears more vigorous.

25th Amendment: What if the president has dementia or Alzheimer's disease?

The 25th Amendment to the U.S.

Constitution sets the line of succession and procedures if the president dies or "is unable to discharge the powers and duties of his office." The amendment states that it should be used if the president is removed from office, incapacitated, dies, or resigns.

The amendment was ratified after the assassination of President John F. Kennedy, but has become a topic of debate in recent years. Members of Congress considered legislation during Trump's presidency that would amend the amendment to allow a panel of medical experts to determine the president's capacity for office.

Democrats also approved a House resolution after the 2021 U.S. Capitol riots calling on then-Vice President Mike Pence to invoke the 25th Amendment to remove Trump from office. After Biden's debate, some Republicans called on members of his cabinet to invoke that clause.

Section 4 of the amendment states that if the vice president and a majority of the cabinet or Congress believe the president "is unable to discharge the powers and duties of his office," then the vice president would take over the role.

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