On January 17, 2018, Donald Trump’s results from a cognitive screening tool developed in Montreal were front-page news. The 45th president’s performance on this cognitive screening seemed sufficient, and many believed it confirmed the integrity of his cognitive health, as well as his ability to hold office.
The MoCA has been validated by several scientific studies and can identify problems with higher mental functions like memory and attention, which are found in various diseases related to aging, like Alzheimer’s. However, this tool was not designed to identify the contribution of personality traits or psychological disorders that may also interfere with functioning.
Other nuances are needed to better understand the scope and limitations of cognitive screening tools. For example, in Quebec, screening is defined as “separating people likely to have a disorder from those who are likely to be free of disorders” (Bill 21). In no case is the result of one screening tool sufficient, on its own, to conclude the presence or absence of a cognitive disorder or to comment on the achievement of a specific cognitive function, like memory or attention. Like any form of screening, the primary goal is to direct individuals to appropriate services.
In order to confirm or deny the integrity of specific cognitive functions, a thorough neuropsychological evaluation, based on a clinical interview and several objective data points, is necessary. This type of assessment is based on standardized, validated tests with large samples of individuals and allows for the evaluation of various complex cognitive processes such as planning, judgment and decision-making that are not targeted by cognitive screening tools.
Mr. Trump’s performance on a screening tool makes it likely that there is no significant cognitive impairment, but it does not rule out the possibility of a neuropsychological problem or answer the question asked in the media about whether he does or does not have the cognitive abilities to be president of the United States. Just as an exhaustive psychiatric or psychological assessment would be required to make a formal pronouncement on the 45th president’s mental health, a full neuropsychological assessment would be just as necessary to decide on his overall cognitive health. As in all areas, a thorough investigation is necessary to answer a particularly complex question.
In closing, we emphasize that the clinical precision of cognitive screening tools is greatly reduced by their public dissemination, and we strongly encourage the media not to publish their content. A health professional even reported a screening situation where an individual already knew the words he had to memorize — he’d read them in the news that week. This invalidates the tool’s utility. The development of a cognitive screening tool is labor-intensive and costly because it requires extensive validation studies. Dissemination of these tools on a large scale may invalidate the results and directly harm the population.