This story has been updated.
In 1996, the year Donald Trump took over the skyscraper at 40 Wall Street and blazed a new trail in the casino business, a young Lebanese Canadian doctor named Ziad Nasreddine created a pioneering way to screen people for early signs of dementia.
Nasreddine’s evaluation was called the Montreal Cognitive Assessment, or the MoCA test. Using simple prompts, it was designed to help doctors detect mild cognitive impairment that could signal the onset of Alzheimer’s disease or other problems. It has proved so effective over the past two decades that it has been translated into dozens of languages and is used by physicians in more than 100 countries.
On Tuesday, President Trump and Nasreddine’s worlds converged when the White House’s top doctor announced that the president had achieved a perfect score of 30 points on the MoCA test as part of his first formal medical exam.
Trump received the assessment as release of the book “Fire and Fury,” a gossip-laden inside account of his presidency, stirred questions about his mental fitness that the White House has struggled to contain. Trump responded to the speculation by claiming on Twitter that he is “like, really smart” and “a very stable genius.”
Nasreddine was apparently unaware that the president had taken the MoCA test until a reporter from the Canadian Press asked him for a reaction.
“I was very honored when I heard that the test was chosen by the White House,” Nasreddine told The Washington Post on Wednesday.
“The fact that the team of doctors around him decided that this was the most appropriate test gives it so much credibility,” he said, “and confirms that it is actually useful and practical and can give reassurance of someone’s cognition.”
Nasreddine emigrated from Lebanon to Canada when he was 15, along with his widowed mother and two sisters. The decision was something of an accident. The family, who lost Nasreddine’s father to a heart attack years earlier, was visiting relatives in Canada in 1983 when an outbreak of hostilities in Lebanon’s long-running civil war shut down the country’s main airport and prevented them from returning home. Soon after, they applied for and received permanent residency in Canada, Nasreddine said.
Nasreddine became a Canadian citizen in 1989 and went on to attend medical school at the University of Sherbrooke. A fascination with the functions of the brain, the body’s most complex organ, drew him to neurology, he said.
“There was so much to learn about what the brain does,” he said, “and I thought it would be intriguing to explore the brain and understand it more.”
In 1995 and 1996, he completed a post-doctorate fellowship in neurobehavior from the University of California at Los Angeles. While there, he learned that the Charles LeMoyne Hospital in the suburbs of Montreal was looking for someone who specialized in cognition and dementia, so he made that his focus.
When he started working at the hospital he noticed that the screening tests he had to use weren’t sophisticated enough to detect early cognitive impairment in patients, he said. On top of that, they took more than an hour to complete. Without a nurse to help him, he could only see three patients a day.
That was what led Nasreddine to create the MoCA test, which he fine-tuned to include tasks that could measure cognitive functions quicker and in closer detail than other evaluations. “There happened to be an important need. Other tests didn’t evaluate all the cognitive functions that were relevant to Alzheimer’s,” Nasreddine said. “Thanks to my fellowship, I was able to know which tests were the most sensitive and short.”
Nasreddine works as director of the MoCA Clinic and Institute in Quebec and is affiliated with McGill and Sherbrooke universities.
He told The Post he was well aware of the sweeping crackdown on immigration Trump has pursued in his first year in office, but said he preferred to stay “in the scientific portion of the debate.”
“I’m happy that immigrants are contributing to society, whether in science, culture, business or other aspects,” he said. “This could be a message to consider in relation to Trump’s views on immigration — it’s a nice message, but I would not be emphasizing this much.”
The MoCA test itself is one page and typically takes 10 to 12 minutes to administer. Patients are given prompts designed to evaluate their short-term memory, visuospatial abilities, executive functions, language and orientation. Some of the assessments include identifying animals by pictures, drawing a clock with the hands at a certain time and repeating phrases such as, “The cat always hid under the couch when dogs were in the room.”
Patients receive a score of zero to 30 points, with 30 being perfect. A score of 26 or higher is considered normal, but anything less warrants further examination. A lower than normal score could signal dementia, Nasreddine said, but it could also indicate something such as depression, sleep apnea or alcohol abuse. The National Institutes of Health have validated the test as a better cognitive tool for detecting dementia than the more popular Mini-Mental State Examination.
Nasreddine stressed that while Trump’s perfect score was good news with regard to the president’s memory, it didn’t offer anything near a complete profile of his or any other patient’s mental health.
“Depression, mania, schizophrenia and personality disorders are psychiatric conditions that are not assessed by the test,” he said. “Even judgment is not assessed by the test.”
He added that when he first developed the test he never imagined it would one day be used on the president of the United States.
“I was talking with my colleagues, and I said jokingly that they might do a MoCA test on him,” he told The Post. “I wasn’t expecting that. I’m really proud that the test has made it this far.”
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