If Trump, or any patient, had a copy of the test like the Montreal Cognitive Assessment Test (MoCA) in advance and practiced taking it, I do not think the results would be valid.
If I was a Trump advisor and wanted to help him put aside the rampant speculation about his being in the early stages of dementia, I would have suggested has ask to be tested during his physical.
Then I would check online to determine which were the most likely tests would be used. The MoCA is one of two commonly used tests, the other being the Mini–Mental State Examination (MMSE).
I would have the president practice both tests, hoping he’d be given the MoCA because the examiner is allowed the flexibility to customize some of the questions on the MMSE (the naming objects questions for example).
Assuming that the doctor didn’t customize the MoCA,* Trump could have taken the test repeatedly until he could answer all the questions.
I would have suggested Trump get a couple of questions wrong to avoid suspicion, but of course he would ignore this advice wanting to brag about getting 30 out of 30 right.
Of course, it is possible Trump was concerned about the possibility he might actually be suffering cognitive decline and gone into the test with no prior knowledge. In this case we have evidence that his cognition isn’t as impaired as has been suggested by some observers.
……
A personal note:
As I watched the press conference I kept hoping a reporter, any reporter but especially Sanjay Gupta, would ask the simple question “if a patient practiced the test in advance would the results still be valid?” I grew so frustrated it was one of those “yell at the TV moments.” Then I Tweeted out my question to everyone I would think of on MSNBC. I couldn’t post this story on Daily Kos because I had already posted my one-a-day limit piece, on Stage Two of the Duty to Warn therapists efforts to remove Trump (which hardly anybody commented on).
Addendum
Scoring Instructions for the MoCA
* Changing the items on the MoCA, while easy to do for the examiner, would have made it much more difficult to cheat successfully (assuming the patient goal is to get a good score). However, as a non-expert I think that to do so would probably invalidate the results since all the research was done with the specific test items. It would be like a clinical psychologist changing some of the true -false questions on the MMPI which has been researched with thousands of subjects.
Wednesday, Jan 17, 2018 · 4:50:17 PM +00:00 · HalBrown
Best comment: From Ian Douglas Rushlau —I would note that this suggests it may be that this is the first time the doctor administered the MoCA. A doctor who isn’t well trained can bias the test by helping the subject by giving him extra time, subtle clues, as so on.
Yeah, and he could have decided to ‘omit unnecessary subtests’.
I’ve seen it, and seen it passed off as sufficient.
How many times has given it, but also whether he received any supervised training in its use. These make a huge difference in proper administration. My supervisees never ‘fly solo’ until they’ve done practice administrations, watched me or other licensed clinicians give tests, and then done 5 -10 supervised administrations.
Here’s what I could find on Dr. Jackson’s background with cognitive testing:
At the president's request, Jackson said that he reviewed a number of cognitive tests and then administered the Montreal Cognitive Assessment during Trump's first presidential physical exam on Friday afternoon at Walter Reed National Military Medical Center. The 10-minute exam is designed to detect mild cognitive impairment, generally in older patients. Trump answered all 30 questions correctly, Jackson said.
The test includes asking a patient to name several animals, draw a clock with the hands at a certain time, copy a cube and recall a short list of words, among others. Jackson said he has "no indication whatsoever that he has any cognitive issues."
"I find no reason whatsoever to think the president has any issues whatsoever with his thought process," Jackson said. (emphasis added)
It’s not evident from this that Dr. Jackson had ever cracked the wrapping on a MoCA before he was ‘asked to review cognitive tests’.
And given the nature of the MoCA, this is a rather amazing claim by Dr. Jackson: I find no reason whatsoever to think the president has any issues whatsoever with his thought process.
‘No reason whatsoever’ and ‘any issues whatsoever’.
That sounds a lot like Trump’s personal physician saying he would be ‘the fittest person ever to serve as president’.
But hey, maybe we’re all wrong and he’s fit as a fiddle and sharp as a tack.