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July 23, 2020, 10:28 a.m. EDT

The doctor behind a cognitive test Trump took says ‘it’s supposed to be easy’

The Montreal Cognitive Assessment, or MoCA, test discussed by President Trump and Chris Wallace is ‘not an IQ test,’ Dr. Ziad Nasreddine tells MarketWatch

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By Nicole Lyn Pesce


MarketWatch photo illustration/Getty Images, iStockphoto

The doctor who developed a widely used test that screens for early signs of dementia and Alzheimer’s disease says that cognition is “a pertinent question” during a presidential election with presumptive candidates over age 70. Problem is, both sides of the political divide are interpreting this test incorrectly.

Dr. Ziad Nasreddine in 1996 developed and copyrighted the Montreal Cognitive Assessment (MoCA) test , which is a 10-minute examination usually performed with pen and paper that measures the strengths of different areas of the brain related to cognitive domains, such as short-term memory, spatial awareness and executive functioning. (Remote testing, including via an app on the Apple /zigman2/quotes/202934861/composite AAPL +3.75%  iPad, has been expanded during the pandemic.)

And he tells MarketWatch that the MoCA Clinic & Institute has been inundated with calls and emails over the past week or so, ever since President Donald Trump bragged in a phone interview with Fox News host Sean Hannity several days ago that he had recently “aced” a cognitive test at Walter Reed National Military Medical Center. Trump also said that medical staff were “very surprised” by how well he did. “They said, ‘That’s an unbelievable thing. Rarely does anybody do what you just did.’ ”

While the White House did not release any details of this most recent test, the president did take the MoCA exam in 2018, when he was said to have gotten a perfect score of 30 , which has put this particular test in the spotlight. What’s more, during a second Fox News interview aired on Sunday, Chris Wallace told the president that the MoCA is “not the hardest test” and even posted graphics of one of the questions, which asked the test taker to identify drawings of animals. Trump responded by challenging his presumptive Democratic rival Joe Biden to “take a test right now.” What’s more, Trump said that the test questions get harder and that the MoCA exam question that Wallace shared was a “misrepresentation.”

Related: Trump describes his recent cognitive test: ‘Person. Woman. Man. Camera. TV’

And during yet a third Fox interview on Wednesday, he described the test (which sounds like the MoCA) in more detail -- particularly a memory question that asks to recall five words.

“It’s, like, you’ll go: Person. Woman. Man. Camera. TV. So they’ll say, ‘Could you repeat that?’ So I said, ‘Yeah. So it’s: Person. Woman. Man. Camera. TV,’” he said.

But as many doctors and armchair critics have been quick to argue on Twitter /zigman2/quotes/203180645/composite TWTR +1.62%  and Facebook /zigman2/quotes/205064656/composite FB +2.12% , the MoCA exam should not be difficult for someone who is not cognitively impaired.

“This is not an IQ test or the level of how a person is extremely skilled or not,” Nasreddine agreed in a call with MarketWatch. “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.”

‘It is supposed to be easy for someone who has no cognitive impairment.’

Dr. Ziad Nasreddine

Nasreddine explained that each question is related to a different part of the brain. He declined to share a sample test page, as he and his peers are growing increasingly concerned that the test might not be as accurate anymore, because too many elements have been shared online. This allows people to potentially practice the questions to perform better on the exam. In fact, MoCA expressly notes on its website that “it is prohibited to publish the MoCA test and/or instructions and/or a link leading to these in newspaper and magazine articles (including electronic articles).”

But he did walk MarketWatch through a few questions, and how they can raise red flags about cognitive impairment.

One asks the test taker to draw an analog clock, including the numerals for each hour, and to then draw the minute and hour hands set to a specific time. “You need planning and executive function and spatial skills to space the numbers on the clock correctly,” Nasreddine said. But the patient might confuse the hour and the minute hands in setting the time in their picture, or they might not place the hands in the center of the clock. “There are ‘traps’ that patients who have cognitive impairments fall into with this test,” he explained.

In fact, Mandy Moore’s character on the NBC /zigman2/quotes/209472081/composite CMCSA +0.98%  drama “This Is Us” was shown struggling with this very test last season. Her character was eventually diagnosed with mild cognitive impairment.

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