Donald Trump’s proclamation regarding the results of taking the Montreal Cognitive Assessment (MoCA) is a huge tell as to how this test was performed and why the results are not to be trusted.
First, and foremost, the test should be given by a physician or technician who has been appropriately trained in the various nuances involve in the administration of the test.. The fact that the test was allegedly administered by Dr. Ronny Jackson, an emergency room doctor and a known Trump sycophant with demonstrated political aspirations (VA Administrator, Tea Party Congressional candidate) casts serious doubt on the integrity of the testing process. This is the same physician who declared Trump to be in perfect health and capable of living to age 200. He also stated that Trump was 6’3” - a fact that has been disproven with multiple examples, including side-by-side photos with the 6’2” Barack Obama. This little bit of hocus pocus, allowed Dr. Ronny to conclude that Trump’s BMI was 29.9, thus allowing him to avoid the stigma attached to the diagnosis of obesity.
Now, as to the substance of the test itself, for the majority of examinees, the most challenging part of the examination is the delayed memory function. This involves repeating a string of five UNRELATED (will discuss in more detail below) nouns, twice in succession and then being asked to repeat them again after an interval of approximately 5 minutes. The most commonly used words are: Red, Face, Daisy, Velvet, Church, but there may be others at the discretion of the examiner.
There are several ways an examiner can structure the testing to allow the examinee an unfair advantage, thus invalidating the results of the testing.
The most subtle way to compromise the process is to tell the examinee, at the time the words are initially given, that he will be asked to recall those words at some later time. This allows the examinee the opportunity to place additional emphasis on remembering those words and utilize whatever cognitive skills he or she has, to store those words for later recall. A simple example of this is to silently keep repeating those words, even while completing other aspects of the testing. It may also give the examinee that opportunity to develop some word associations (e.g. red velvet) to enhance recall.
Another method to circumvent the integrity of the test is to simply give the examinee the words beforehand. In other words - cheat. This would, of course, give the examinee the opportunity to practice the words repetitively and develop memory by rote and to even construct a meaningful mnemonic (There was a red, velvet, daisy on the face of the church) This form of cheating was initially what I suspected Trump, Jackson, and their henchmen had engaged in to fudge the results.
Trump’s latest utterances in the interview with Fox TV toady, Dr. Marc Siegel suggest an even more diabolical and clever methodology. As I had mentioned earlier, the words should be relatively unrelated and relatively neutral to the examinee. However, in the case of Trump, we learn that the words were Person, Woman, Man, Camera, TV. If “bigly” and “greatest” were nouns they probably would have figured out a way to include those as well. It’s as if they were doing the MoCA on Al Capone and gave him the words: Valentine, Day, Massacre, Machine, Gun. In the case of Trump, they probably created a word cloud, selected 5 of the more commonly appearing words and then narrowed it down to those that are most relatable to him and have a high degree of association (e.g. Person;Man;Woman :: TV;Camera). Then, to seal the deal, they gave him the words a week beforehand to take home and study. The rapid-fire sequence with which he rattled them off to Dr. Siegel suggests he had placed them in automatic memory.
One final word about the significance of this test. The Montreal Cognitive Assessment is not a measure of mental acuity, IQ, or intellect. It is a test for early evidence of dementia. It is, frankly, unclear why this test would be performed on a person who is not otherwise displaying evidence of mental deterioration.
When a 74 year old man has a negative PSA (prostate-specific antigen) test, it does not mean he is particularly studly or some kind of sex machine. It simply means he’s an old guy who does not have cancer of the prostate.