Is Joe Biden mentally fit to run for US president? What’s the cognitive test that many want him to take?

Is Joe Biden fit to run for president? Does he have Parkinson’s? Or is it Alzheimer’s? The buzz around the incumbent US president’s mental fitness is only growing louder after his disastrous debate performance against Donald Trump on June 27.

It was evident that Biden was losing his train of thought when facing Trump on stage in the CNN debate , leaving even Democrats worried. However, this is not an isolated incident. The 81-year-leader has grabbed headlines for his many verbal gaffes and has even been incoherent during speeches and interviews, often lacking expression.

Now reports have emerged that a Parkinson’s expert visited the White House at least eight times in eight months. With this, there will be only added pressure on Biden to take a cognitive test.

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What are cognitive tests?

Cognition is defined as the state or process of being able to perceive and judge reality effectively. It involves intellectual activities like thinking, learning, understanding and using language, remembering, paying attention, reasoning, making decisions and applying judgment, according to the Cleveland Clinic, a non-profit academic medical centre.

Cognitive tests determine if you have any issues with cognition, known as cognitive impairment. They assess memory, mental awareness, and reasoning abilities. They also check for concentration, short-term recall and memory, abstract thinking and ability to use and comprehend language, reports Axios.

The assessment is usually conducted if there’s a suspicion of mental decline or impairment.

Cognitive screening involves simple, quick and basic tests. They do not require preparation or study.

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What do the tests involve?

Three tests are used most commonly by doctors including the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Exam, and the Mini-Cog.

The MoCA is a 15-minute test that involves memorising short lists of words, naming objects in pictures, copying shapes in pictures and other tasks.

The Mini-Mental State Exam includes counting backwards and identifying objects around the patient, stating the date and other well-known facts. It takes around 10 minutes.

The Mini-Cog is the shortest and simplest evaluation and takes three minutes to complete. It includes memorising and recalling a three-word list of unrelated words, drawing a circle clock with time points, and then showing the hands for a specific time, according to a report in USA TODAY.

What can the tests help determine?

The results of the assessment help determine if a person has cognitive impairment, dementia or pseudo-dementia. It can help in further screening for Alzheimer’s. Detecting possible cognitive impairment is the first step in determining whether or not a patient needs further cognitive tests and evaluation, according to the Alzheimer’s Association.

MoCA is meant to assess cognitive performance and screen for early signs of Alzheimer’s, dementia and other neurological diseases, reports Axios.

Dr Ziad Nasreddine, a cognitive neurologist and the creator of the MoCA test, was quoted by the publication as saying that it is “definitely not normal to fail on this test”. “If the person fails on a cognitive test like the MOCA, it clearly sends a signal that there’s an issue with their cognition,” he added.

People who are becoming forgetful, have difficulty remembering things, suffer from memory deficits or have trouble focusing or in judgement should take these tests.

However, age plays a role. The risk of cognitive impairment is high at an older age.

Can cognitive tests help determine the fitness of future presidents?

From critics to medical experts, more and more people are calling for a cognitive test not only for Biden but also for Trump, who is 78. The two are the oldest major candidates running for the presidency in US history.

After the debate, high-profile neurosurgeon Dr Sanjay Gupta said that Biden needed to undergo neurological testing and release the results to the public, adding that this was the opinion of other brain specialists too.

“From a neurological standpoint, we were concerned with his confused rambling; sudden loss of concentration in the middle of a sentence; halting speech and absence of facial animation, resulting at times in a flat, open-mouthed expression,” Gupta wrote in a CNN article. He said that the suggestion was based on “only observations, not in any way diagnostic of something deeper”.

Lawrence K Altman, a physician and former New York Times medical correspondent, wrote last week that Biden should take a cognitive test, like the MoCA. “Biden last gave a full report of his health in February. Trump’s last full report was when he was president. The public deserves full reports of their most recent medical examinations,” he wrote.

However, Jamie Reilley, a professor of speech-language neuroscience in the College of Public Health at Temple University in Philadelphia, had told USA TODAY earlier that there is no perfect way to judge someone’s mental fitness for office.

Accusing either candidate of having dementia or lacking mental competence may score political points with some voters but could worsen existing stigma against older people and prevent those with legitimate concerns about their memory and language from seeking help, he said.

What does Biden have to say? Has he taken a cognitive test in the past?

After the president’s poor performance in the debate and amid renewed concerns about his cognitive abilities, Biden in an interview with news anchor George Stephanopoulos attributed his “bad night” to a cold and exhaustion and said he has regular medical assessments.

When asked whether he had specific cognitive tests or a neurological examination, he responded, “No. No one said I had to. No one said. They said I’m good.”

The president was later asked if he was willing to undergo an independent medical evaluation that included neurological and cognitive tests and release those results to the American people. “Look. I have a cognitive test every single day,” he replied, according to ABC News.

“Every day I have that test. Everything I do,” he continued. “You know, not only am I campaigning, but I’m running the world. Not – and that’s not hi – sounds like hyperbole, but we are the essential nation of the world.”

Biden has been dismissing questions about taking a cognitive test since August 2020, when he was 77 and was running for president. Since winning the White House, nothing has changed.

His aides have said that he has never taken one as president – not in the three annual physical exams, according to a report in The Washington Post.

Interestingly, Kevin O’Connor, the physician to the president, who has been Biden’s personal doctor since 2009, has never recommended that the president take a cognitive test, a White House official told the publication.

What about Donald Trump?

While campaigning in New Hampshire in January, Trump boasted about how he “aced” a cognitive test with questions including identifying animal shapes that progressively “got harder,” and included complex math problems, reports Forbes. He had said that he’s “cognitively better now” than he was 20 years ago.

However, it is unclear if he has taken the test recently. In 2020, Trump had made similar claims about his performance on a screening test.

In 2018, Trump was given the MoCA under Dr Ronny Jackson, the former White House physician, and at the time had scored a perfect 30 out of 30.

With inputs from agencies