What a cognitive test could (or could not) say about Biden's mental fitness

What do cognitive tests show?

Cognitive evaluations are typically quick, simple exams that can uncover signs of cognitive decline, according to Cleveland Clinic.

How it works: Some of the key functions cognitive tests — like the one Trump bragged about passing in 2020 — check for include concentration, short-term recall and memory, abstract thinking and ability to use and comprehend language.

• Three cognitive tests commonly used by doctors include the Montreal Cognitive Assessment (a test that involves memorizing words, identifying pictures and other tasks), the Mini-Mental State Exam (which includes counting backward and identifying objects around the patient) and the Mini-Cog (the shortest and simplest evaluation).

Dr. Ziad Nasreddine, a cognitive neurologist and the creator of the MoCA test, said it is "definitely not normal to fail on this test."

• "If the person fails on a cognitive test like the MOCA, it clearly sends a signal that there's an issue with their cognition," he said. If a patient were to fail, further neuropsychological testing would be required.
• The MoCA is a 30-point examination meant to assess cognitive performance and used to screen for early signals of Alzheimer's, dementia and other neurological diseases.
• It is "tailored towards the earliest changes in your cognitive function," he explained,

What they're saying: Lawrence K. Altman, a physician and former New York Times medical correspondent, wrote Wednesday that Biden should take a cognitive test, like the MoCA.

• "Biden last gave a full report of his health in February. Trump's last full report was when he was president. The public deserves full reports of their most recent medical examinations," he wrote.

'Person, Woman, Man, Camera, TV': How was Trump tested?

Trump repeatedly boasted in 2020 that he "aced" a cognitive test he was given. His doctor said at the time that he was believed to be the first president to receive such an evaluation.

That test was the MoCA.

• Nasreddine said the test reviews patients' ability to remember information, concentration levels, orientation in time and space, abstract thinking, planning and other cognitive skills "essential to function as a human."
• "The first few questions are easy, but I'll bet you couldn't even answer the last five questions. I'll bet you couldn't, they get very hard, the last five questions," Trump told then-Fox anchor Chris Wallace in 2020.
• He described the test to Fox on another occasion, infamously recalling a series of words he had to remember: "Person, woman, man, camera, TV."

The details: The MoCA presents patients with a series of questions targeting their mental and memory capacity.

• One task asks patients to draw a clock displaying a specific time, and another requires the test-taker to identify names of animals based on their picture.
• The test is not meant to be a measure of IQ, despite the former president seemingly gloating as such. Trump's normal score simply demonstrated that he was not showing signs of diseases or cognitive impairment.

The caveat: Cognitive tests, such as the MoCA, do not screen for an individual's energy or mental health status. To someone without cognitive issues, the test should be easy.

Would Biden sit for a test?

CNN Chief Medical Correspondent Sanjay Gupta, a neurosurgeon, wrote in a Friday op-ed that the president should "undergo detailed cognitive and movement disorder testing, and those results should be made available to the public."

• "The MoCA isn't the same level of cognitive testing the medical experts I spoke to would like to see Biden do, but it could serve as an initial screening tool for cognitive decline," he wrote.

Flashback: White House physician Kevin O'Connor wrote after the president's February physical exam at Walter Reed National Military Medical Center that Biden was "fit for duty." But that examination did not include a cognitive test.

• That closely watched summary of the president's health came after Special Counsel Robert Hur characterized Biden as a "sympathetic, well-meaning, elderly man with a poor memory" in the report on his handling of classified documents.

Driving the news: Speaking with ABC News' George Stephanopoulos, the president sidestepped inquiries on whether he would sit for a cognitive test following his debate performance that triggered an avalanche of anxiety within his party.

• "I have a cognitive test every single day," Biden said. "Everything I do. Not only am I campaigning, I am running the world."

Yes, but: While the president is attempting to soothe Democrats ahead of the party's national convention, even allies say he and his opponent should sit for evaluations.

• "I think they both should be willing to take a test," Rep. Adam Schiff said Sunday on "Meet the Press."

The bottom line: A 15-minute cognitive test, like the MoCA, may not prove presidential fitness, but it could help answer questions for uncertain voters.

• As noted by Mayo Clinic, "No one test can confirm that someone has mild cognitive impairment."
• These discussions come at a time where 60% of voters in a recent poll said Biden should "definitely" or "probably" be replaced as the Democrat's candidate. Meanwhile, Trump's bizarre rants about sharks, Hannibal Lecter and windmills have raised eyebrows about his mental state.
• "This step should be a good screener to be able to determine if we need to do more testing or not," Nasreddine said of MoCA results. "If it's normal, it will reassure us a lot because it's very sensitive...the likelihood of impairment is very low if they tested normal."

Go deeper: Biden staff "miserable," alarmed as pressure builds