President Biden faces calls to undergo cognitive testing and release the results after his disastrous debate last month, and amid a series of reports about his apparent decline in recent months.
Concerns only grew when public records drew attention to the fact that a neurologist specializing in Parkinson’s disease had visited the White House. The administration has since he said that the doctor in question has been a neurology consultant at the White House Medical Unit for more than a decade.
Rep. Adam Schiff (D-Calif.) has called for Biden and former President Trump to undergo cognitive testing, and former GOP presidential candidate Nikki Haley has suggested that such tests should be required of politicians above a certain age.
Trump, who is approaching 80, has often boasted about his own performance on cognitive tests. However, author Ramin Setoodeh recently claimed that Trump struggled with his memory in multiple post-presidential interviews, often forgetting previous conversations and confusing the chronology of certain events.
To clarify what cognitive tests are, The Hill spoke with Carla Perissinotto, professor in the division of geriatrics at the University of California, San Francisco.
Types of tests
There are a variety of tests that can be performed to check health and cognitive function.
A simple screening test often used to detect signs of dementia is the Mini-Cog. This test involves asking participants to listen to and repeat three words listed for them and draw a clock.
If the results of this screening are abnormal, this would be a signal for the patient to undergo more advanced testing, such as the Mini Mental State Examination or the more recently developed Montreal Cognitive Assessment (MoCA).
Trump had already boasted of passing the MoCA test with a perfect score. Kevin O’Connor, physician to the president, wrote in February that Biden underwent an “extremely detailed neurological exam” during his annual physical, which produced “reassuring” results. He did not mention whether any cognitive testing was involved.
Both tests assess mental impairment by asking patients questions, assessing different areas of cognition such as language, memory and attention.
“When you think about cognitive health, there are different domains of cognitive functioning,” Perissinotto said. “And what I mean by that is most people only think about memory, but it’s actually not just about memory. It’s also about your visual spatial function, your executive function, your abstraction, your memory and your orientation.”
Sanjay Gupta, CNN’s chief medical correspondent and neurosurgeon, recently he wrote that “MoCA is not the same level of cognitive testing that the medical experts I spoke to would like Biden to do.”
Who can perform tests
Media scrutiny increased this week after reports emerged that Kevin Cannard, a neurologist and Parkinson’s specialist, repeatedly visited the White House recently.
The government has not yet specified the reason for Cannard’s recent visits, although it has repeatedly said the president is not being treated for Parkinson’s or any neurological disorder.
Perissinotto noted that experts are not needed to perform such cognitive tests.
“Primary care doctors can do screening tests. And certainly, given the number of elderly people, this is something that should be done by all primary care doctors,” Perissinotto said.
She noted, however, that training for this type of testing is not always ubiquitous.
“I think what’s sad is that, historically, in medical training, we’re not very well trained in this subject and so there are certainly some deficits in terms of getting people to do these tests,” Perissinotto said.
Who should take the test
According to Perissinotto, a big misconception about cognitive tests is that they should only be performed when patients suspect something is wrong.
“I would say no, that’s not true. In fact, it’s important to perform them even on healthy people to get a sense of the baseline,” she said.
“Because people can hide their cognitive impairment very well. So people who are very social and who, you know, have higher education – they can mask things. And then I had patients I wouldn’t suspect, and it went unnoticed because they have great social qualities. And then you ask them to draw a clock and it’s completely off, for example.”
Cognitive testing is recommended during annual Medicare wellness visits, and according to Perissinotto, having an early baseline between the ages of 65 and 70 is extremely helpful in tracking signs of cognitive decline.
“What’s difficult for me, in my practice, is when I have someone who comes in maybe almost 70 or 80 years old and I do one of these tests. And they are harmed and I don’t know when it started.”
Changes in memory are not the only indicator of cognitive decline, the geriatrician emphasized.
Certain types of dementia may manifest primarily through behavioral changes. And some changes are simply natural as we age.
She explained that as we age “we process things more slowly. We may have a harder time remembering things, which means you’re trying to think of the word and it’s harder to get out of your brain, but it’s still there. These are normal signs of aging.”
Perissinotto also emphasized that there is a difference between mild cognitive impairment and dementia, defining the former as cognitive changes that do not affect daily life.
“Dementia occurs when it is really affecting your ability to carry out your activities of daily living and your instrumental activities of daily living,” such as shopping, paying bills or answering the phone.
This story originally appeared on thehill.com read the full story
