After President Biden His poor performance in the debates has raised new concerns about his mental acuity, and both sides of the political spectrum have called for him to take a cognitive test.
Biden has not seen a neurologist but did have his annual physical exam in February, Dr. Kevin O’Connor, the president’s physician, said in a July 8 statement from the White House.
The doctor reiterated that Biden’s physical exam revealed no concerns about a neurological problem.
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In a recent interview with George Stephanopoulos, Biden remained evasive about formal cognitive testing, noting, “I take a cognitive test every day” — that is, while performing his duties as The president of the United States.
Many Americans, however, want greater transparency.
In a recent interview, Biden remained evasive about formal cognitive testing, noting, “I take a cognitive test every day” — that is, while serving as president of the United States. (Andrew Caballero-Reynolds/AFP via Getty Images)
“I am writing to you today to ask that you urge President Biden, in the strongest possible terms, to undergo a cognitive and neurological exam and share the results with the American people.” Senator Lindsey Graham (R-S.C.) wrote to Dr. O’Connor on July 12.
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The United States Preventive Services Task Force (USPSTF) states on its website that there is insufficient evidence to recommend screening for cognitive impairment in the elderly.
However, Medicare’s free annual wellness visit does cover screening for cognitive impairment, according to the Centers for Medicare & Medicaid Services website.
What exactly is a cognitive test?
Fox News Digital spoke with leading neurologists to determine how cognitive tests work, as well as what they can and cannot identify.
None of the doctors who commented have evaluated or treated President Biden.
According to experts, there are three main types of cognitive tests: the MMSE (Mini-Mental State Examination), the MoCA (Montreal Cognitive Assessment) and neuropsychological tests. (iStock)
“Cognitive tests are designed to measure a range of mental functions and abilities, targeting specific areas such as memory, attention and concentration, language and processing speed,” Dr. Fred Cohen, assistant professor of medicine and neurology at the Icahn School of Medicine at Mount Sinai in New York, told Fox News Digital.
These tests are divided into three types: screening tests, mental status examinations, and neuropsychological tests.
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“The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and neuropsychological testing are all important tools that physicians and neuropsychologists can use to assess a person’s behavior and thinking ability,” said Dr. Michael S. Okun, medical advisor to the Parkinson’s Foundation and director of the Fixel Institute for Neurological Diseases at the University of Florida, told Fox News Digital.
The first step is often a screening test, but this cannot diagnose a specific disease – it can only suggest the possibility of cognitive impairment, experts say.
Further testing is needed to identify the underlying cause.
What is dementia?
Dementia describes a group of conditions in which people have an impaired ability to remember, think, or make decisions, which interferes with their daily activities, according to the U.S. Centers for Disease Control and Prevention (CDC) website.
There are many types of dementia, but Alzheimer’s disease is the most common.
“Cognitive tests are designed to measure a range of mental functions and abilities, targeting specific areas such as memory, attention and concentration, language and processing speed,” one expert said. (iStock)
“There is compelling evidence that 5 to 8 percent of people over the age of 60 will later develop dementia,” Okun said.
Those data partly explain why Congress passed a law banning commercial pilots from flying past age 65, he noted.
The risk of dementia increases with age: By the time people reach their 80s or 90s, the risk is between 10 and 30 percent, Okun says.
What is MMSE?
The MMSE (Mini-Mental State Examination) is a 30-item questionnaire that assesses various cognitive functions, including memory and orientation.
It can be used to monitor changes over time, Cohen said.
The 11-question test, introduced in 1975, is a quick test dementia screening It typically takes between five and 10 minutes to administer, experts say.
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Some questions ask the person to perform specific tasks, such as providing the current date and year, subtracting 7 from 100 repeatedly, recalling three unrelated objects after three minutes and following a three-step command, such as “take a piece of paper in your right hand, fold it in half and place it on the floor,” Cohen said.
What is MoCA?
Like the MMSE, the MoCA (Montreal Cognitive Assessment) is scored out of 30 points, but takes a little longer to administer, Cohen said.
It includes tasks such as drawing a clock, naming animals, remembering lists of words or numbers and making “abstractions” — such as saying “fruit” when given an apple and an orange.
Most cognitive tests don’t take into account an individual’s mood, so if a person is depressed, their score may be lower, experts warn.
“Former President Trump mentioned that he took a cognitive test that included animal identification, indicating that he likely received MoCA,” Cohen said.
People are awarded points for correct answers to both tests — lower scores indicate greater concern for cognitive impairment.
““The MoCA takes about 10 minutes to administer, and it’s a little better than the MMSE, especially if your goal is to screen for mild cognitive impairment,” Okun added.
The first step is often a screening test, but this cannot diagnose a specific disease – it can only suggest the possibility of cognitive impairment, experts say. (iStock)
These tests can only reveal what is happening at a given moment; they cannot determine how a person functions in their daily life, experts say.
Screening tools can identify potential cognitive problems, but more comprehensive testing is needed if impairment is suspected, Cohen cautioned.
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“Both the MoCA and the MMSE are considered by experts to be broad and superficial tests, and should therefore only be applied for screening and triage purposes,” Okun added.
People can score perfect or near-perfect on a MoCA or MMSE but still have significant cognitive impairment, he noted.
The tests also do not take into account the individual’s mood – so if someone is depressedthis person might get a lower score, according to previous research.
Language barriers, physical disabilities or lower education levels can also affect results, experts say.
What is a neuropsychological test?
This type of test, which takes several hours, is a truly comprehensive assessment that can be applied to the diagnosis of cognitive disorders, Okun said.
A neuropsychologist adapts the test to the symptoms presented by the person.
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“Neuropsychologists spend a lot of time putting together a detailed story that goes far beyond what a general story doctor, neurologist or psychiatrist “They may have time to find out during their usually brief consultations,” he added.
The specialist may ask if the person has difficulty searching for words in a conversation or pronouncing the wrong words or sounds in a word.
After President Biden’s lackluster debate performance sparked renewed concerns about his mental acuity, both sides of the political spectrum called for him to take a cognitive test. (Getty Images; iStock)
Experts may also wonder if someone forgets important events or repeats the same comment, misplaces objects, bumps into things, or gets lost in thought.
“People need to be aware that MoCA and MMSE are not a replacement “Neuropsychological testing is mandatory, even if a person scores perfectly or near-perfectly,” Okun advised.
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He recommends considering this test when family and friends notice any changes, no matter how small, in their loved one’s behavior or work performance.
Okun added: “The comprehensive testing will form the basis of a treatment plan and provide a critical baseline performance, which can be used to track disease progression.”
