Trump’s cognitive test was created by a Lebanese immigrant to Canada
In 1996, the year President Donald Trump took over the skyscraper at 40 Wall Street and blazed a new trail in the casino business, a young Lebanese-Canadian doctor named Ziad Nasreddine created a pioneering way to screen people for early signs of dementia.
Nasreddine’s evaluation was called the Montreal Cognitive Assessment, or the MoCA test. Using a series of simple questions, it was designed to help doctors detect mild cognitive impairment that could signal the onset of Alzheimer’s disease or other problems. It has proved so effective over the past two decades that it has been translated into dozens of languages and is used by physicians in well more than 100 countries.
Last Tuesday, Trump and Nasreddine’s worlds converged in the strangest of ways when the White House’s top doctor announced that the president had achieved a perfect score of 30 points on the MoCA test as part of his first formal medical exam.
Trump received the assessment as release of the book “Fire and Fury,” a gossip-laden inside account of his presidency, stirred questions about his mental fitness that the White House has struggled to contain. Trump responded by claiming on Twitter that he is “like, really smart” and “a very stable genius.”
Nasreddine was apparently unaware that the president had taken the MoCA test until last Tuesday, when a reporter from the Canadian Press asked him for a reaction.
“It’s really an honor for me,” Nasreddine told the news agency. “I’m really thrilled and happy they decided to use it over other tests.”
But the news was not without irony for the doctor, who said he was well aware of the sweeping crackdown on immigration Trump has pursued in his first year in office.
Nasreddine immigrated from Lebanon to Canada when he was 15 years old, along with his widowed mother and two sisters, fleeing civil war and sectarian violence in their home country, he told Canadian media.
After staying with an uncle in 1983, they received permanent residency, and Nasreddine went on to attend medical school at the University of Sherbrooke. He later completed a post-doctorate fellowship in neurobehavior from the University of California, Los Angeles, then returned to Canada to practice medicine and teach. He was certified by the Medical Board of California and the American Board of Psychiatry and Neurology.
He currently works as director of the MoCA Clinic and Institute in Quebec and is affiliated with McGill and Sherbrooke universities.
Nasreddine told the Canadian Press that he hopes Trump, having aced his cognitive test, will reconsider some of his hard line views on border security, refugees and attempts to restrict travel from Muslim-majority countries.
“I think immigrants can be proud that they are contributing,” he said. “And this is a good example, I think, that will be helpful to change views about immigration. And maybe for Mr. Trump himself to consider immigrants as contributors to advancing science, advancing our societies.”
He added in an interview with CTV: “I’m very happy to see that immigrants such as myself that came to the country at age 15 were able to contribute to the society… . Even for Mr. Trump’s opinions about immigrants, I think this should be something to look at and to be happy that immigration is actually contributing to the society very positively, I hope.”
The MoCA test itself is one-page long and typically takes about 10 to 12 minutes to administer. Patients are given a series of prompts designed to evaluate their short-term memory, visuospatial abilities, executive functions, language, and time and place orientation. Some of the assessments include identifying animals by pictures, drawing a clock with the hands at a certain time and repeating phrases such as “the cat always hid under the couch when the dogs were in the room.”
Patients receive a score of zero to 30 points, with 30 being perfect. A score of 26 or higher is considered normal, but anything less than that indicates signs of cognitive impairment that could lead to dementia, as Nasreddine said in 2009 interview.
Speaking to news media last Tuesday, Nasreddine stressed that while Trump’s perfect score was generally good news with regard to the president’s memory, it didn’t offer anything near a complete psychological profile.
“It’s not a psychiatric assessment. If you’re worried about mental illness, it has to be a psychiatric exam with a psychiatrist,” he told CTV. “This is mostly for Alzheimer’s type of problems that we use the MoCA test. So this is what it’s used for. It does not assess abilities to judge or make decisions. But it does assess if the person has memory disorders which could be the first signs of Alzheimer’s.”
He added that when he first developed the test he never imagined it would one day be used on the president of the United States.
“I was joking with my colleagues last week,” he told CTV. “I told them that next week Mr. Trump is gonna be tested, physical exam, and I was wondering if they were going to run the MoCA test on him, jokingly. But I was surprised to see it happen today.”