Dr. Ziad Nasreddine, a neurologist who invented the gold standard cognitive test, says he would be more than happy to perform the test for Joe Biden or Donald Trump.
The neurologist who invented America’s gold-standard cognitive test is urging Joe Biden to take the assessment after their disastrous debate last week.
Dr. Ziad Nasreddine had been reluctant to comment on the president’s health despite widespread concerns about the 81-year-old’s episodes of slurred speech, stiffness and freezing during his time in the White House.
But last Thursday, that changed. Dr. Nasreddine said he had serious concerns about Biden’s mental acuity after watching his performance against Trump.
Dr. Nasreddine invented the Montreal Cognitive Assessment Test, or MoCA.
You probably know it best as the test that Donald Trump, 78, often boasts he passed with flying colors during his presidency.
The test is a simple 11-question exam and takes between ten and fifteen minutes to complete. (scroll to the bottom of this article if you want to try it yourself).
It involves asking patients to identify pictures of animals, repeat a list of numbers and words or complete a pattern. The lower the score, the greater the risk of cognitive decline, a precursor to dementia.
Dr Nasreddine, who is based in Montreal, Canada, said: “A neurological evaluation of the President is necessary to rule out neurodegenerative symptoms.”
Shortly after Biden began debating Trump last week, his team claimed the president had a cold, in an attempt to explain his shaky voice, pale skin and ambiguous answers.
But Dr Nasreddine said: ‘President Biden’s symptoms – slurred speech, confusion, stiffness and freezing episodes – were present long before the debate.
“This is unlikely to be caused solely by the flu or sedative drugs used to combat it.”
President Joe Biden’s shaky performance at Thursday’s debate has raised concerns in many Democratic circles. But for now, his family insists he will keep fighting.
The White House has repeatedly refused to let Biden take the MoCA test, despite calls from Trump, Republican Nikki Haley and medical professionals.
The test measures memory and cognition, and patients can score up to 30 points (the average score is 27.3 for older adults taking the test, typically age 70).
Any value below 26 would be considered mild cognitive impairment, which can be a precursor to diseases such as Alzheimer’s.
But if it falls below 18, then this suggests moderate deterioration, a warning sign of disease. Any value below 10 indicates severe deterioration.
The test is usually performed in a distraction-free clinical setting with a physician.
If someone scores below 26, they are sent for further analysis.
This may include an MRI, which can detect fluid in the brain, or a blood test, which can detect proteins in the blood that signal the buildup of beta amyloid or other proteins in the brain that are linked to Alzheimer’s disease.
Like many doctors, and given the sensitive nature of the issue, Dr. Nasreddine declined to question Biden’s doctors, who said in February that the president was “fit for duty” and did not need a cognitive test.
But last week’s debate changed his mind.
He said: ‘During the debate, I saw many people struggling to answer questions, freezing up, not completing sentences, mumbling and sometimes saying things that didn’t make sense.
‘So I thought, “My God, this is exactly what has been going on for a few months, many months; I suspect probably a bit longer.”
“This is worrying and shows that cognitive testing should be done.”
He added that it is important to carry out the test early in order to be able to start treatments for diseases such as Alzheimer’s.
There are drugs such as Lecanemab that can slow the progression of the disease, but they only work in the early stages.
Biden appeared to distance himself from other world leaders at the G7 summit last month (pictured). The White House has insisted he was moving to greet the skydivers who were photographed off-screen, but his movements were unusual.
There have also been a number of Biden freezing episodes, including at this Juneteenth celebration at the White House (pictured), where he stood motionless as others clapped and danced around him.
Biden also appeared to freeze at a star-studded fundraiser in Los Angeles last month, before being ushered off the stage by former President Barack Obama.
President Biden today began facing official calls to drop out of the 2024 presidential race, after two Democrats broke ranks and publicly called for his resignation.
The White House has scheduled a meeting with Democratic governors on Wednesday to reassure them about Biden’s ability to win the election.
But with five months to go until the election, many Democrats initially hoped his family would convince Biden to step aside.
But instead he appears to be planning to stay in the race, buoyed by his wife Jill and son Hunter, who are among his staunchest supporters.
Dr. Nasreddine developed the test in 2005 because of the difficulty in diagnosing cognitive decline, as patients often had to sit through hours of testing.
Since then, more than 6,000 studies have been conducted on the test and it has been translated into 100 languages around the world.
It is also recommended in the US by the American Academy of Neurology, which says that everyone over 65 should be tested annually.
Dr Nasreddine said he believes everyone should get tested once at age 50, but should aim to get tested every two years starting at age 60.
This is to capture a baseline level for someone’s brain and then track any decline in cognition over time.
It is best to take the test with a doctor, who can correctly interpret the results, but there is also an online version available for patients called MoCA XpressOwhich can be done online from home.
Dr. Nasreddine is also working on a MoCA Solo, or a version of the test that people can perform on their own in a clinic without needing a doctor present.