What we know about the cognitive test Trump says he aced

WASHINGTON — President Donald Trump has taken up the strategy of attacking former Vice President Joe Biden's mental status, while defending his own, during the 2020 election, and in a new round of criticisms is touting his results of a standard cognitive functioning test.

In a contentious interview with Fox News' Chris Wallace that aired Sunday, Trump again claimed he got a perfect score on a test of his cognitive ability and said that former Biden "could not answer those questions."

Wallace cited a recent Fox poll of voters that found Biden has a slight edge over Trump when it comes to perceived mental soundness for presidency.

"Let's take a test right now. Let's go down, Joe and I will take a test. Let him take the same test that I took," Trump said.

What is the cognitive test Trump continues to brag about acing? What is it used for? And what does Trump's result mean?

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The Montreal Cognitive Assessment

The test Trump took, as described by his physician in early 2018, was the Montreal Cognitive Assessment, or MoCA, a tool used by health professionals to identify signs of dementia or cognitive impairment.

It is a one-page assessment that typically takes about 10 minutes to complete and can yield a score of up to 30 points.

The test poses a series of questions and challenges, including drawing a copy of a given shape, naming images of animals and repeating a series of words from memory.

"Well it's not the hardest test. There's a picture and it says, 'What's that?' And it's an elephant," Wallace said to Trump.

"No, no, no," Trump said. "See, that's all misrepresentation."

Trump went on to say that while the first few questions are easy, the last five are "very hard." "I'll bet you couldn't even answer the last five questions," he said.

"Well, one of them was count back from 100 by seven," Wallace responded.

What is the test for?

The test, according to the Montreal Cognitive Assessment website, is "a proven and useful cognitive screening tool for many illnesses," including Alzheimer's disease.

The questions test a number of functions such as memory, attention and visual skills that can deteriorate with certain conditions. A score of above 26 indicates a person has normal cognitive function, while a score under that may indicate mild to more severe dysfunction.

Mild cognitive impairment, or MCI, is present in up to one-fifth of individuals older than 65, according to the Alzheimer's Association. Those with MCI have a higher risk of developing Alzheimer's or other forms of dementia.

"The test is supposed to help physicians detect early signs of Alzheimer’s, and it became very popular because it was a short test, and very sensitive for early impairment," Dr. Ziad Nasreddine, who developed the test, told MarketWatch.

"It is supposed to be easy for someone who has no cognitive impairment," Nasreddine said.

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"The purpose is to detect impairment; it’s not meant to determine if someone has extremely high levels of abilities," Nasreddine said. "I think there’s misinformation on both sides of the political divide."

Trump boasts about test result

Trump asked to take the test as part of his physical in January 2018, according to Dr. Ronny Jackson, who served as White House physician to the president between 2013 and 2018. Trump has referred to himself as a "very stable genius," describing his mental abilities as one of his greatest assets.

These claims have been renewed during the 2020 presidential election as Trump and his campaign attack Biden, accusing him of mental decline without any medical proof.

Trump's campaign frequently highlights footage of Biden stumbling over words, though Biden is known to have had a lifelong stutter, a speech disorder that does not necessarily indicate any cognitive dysfunction.

"This president talks about cognitive capability," Biden said during a press conference on June 30. "He doesn't appear to be cognitively aware of what's going on."

The Biden campaign does not, as of yet, have any ads targeting Trump's mental or physical fitness.

"Biden can't put two sentences together," Trump said in his interview with Wallace.

Earlier this month Trump brought up a cognitive test he said he took "recently," without specifying a timeline, but his latest known assessment was during his January 2018 physical.

In a Fox News interview with Sean Hannity, Trump claimed that he was told by health professionals at Walter Reed Medical Center, "That’s an unbelievable thing. Rarely does anyone do what you just did."

But the Montreal Cognitive Assessment is meant to detect signs of cognitive decline; a perfect score indicates there is no decline, and that cognitive functioning is normal.

Pushback on campaign attacks about mental fitness

The use of perceived mental or physical decline to attack a political opponent is harmful, disability advocates have argued, because it positions disability as disqualifying for office.

Rather than focus on substantive issues that disqualify Trump, according to lawyer and activist Matthew Cortland, many have resorted to attacks that further stigmatize disabilities.

"The ableism that's been directed at Trump has made it extremely difficult to have a non-ableist discussion of whether he has the requisite cognitive capacity to discharge the office of the presidency," Cortland said.

When Trump appeared to struggle to walk down what he described as a slippery ramp and lift a glass of water for a drink at a public event, mockery and questions about his fitness for office that ensued only hurt disabled people, according to Center for American Progress Disability Justice Initiative Director Rebecca Cokley.

"But the answer to Trump’s ableism can’t be to outdo him. Ableism hurts people with disabilities regardless of who pushes it," Cokley wrote in the Washington Post.

Experts have also wagered that Trump's tactic of targeting Biden's mental fitness for office may also alienate elderly voters, a demographic the former vice president has an edge within polling.

Trump told Wallace that Biden "doesn’t even know he’s alive." He said he doesn't think Biden is "senile," but he is "not competent to be president."

This article originally appeared on USA TODAY: Trump boasts about acing Montreal Cognitive Assessment. What we know