John Gartner

Opinion contributor

If Donald Trump were your father, you would run, not walk, to a neurologist for an evaluation of his cognitive health. You don’t have to be a doctor to see something is very wrong. “He reminds me of Uncle Bruce in so many ways,” said my aunt, who nursed her brother through Alzheimer’s disease. Joe Scarborough, who has known Trump for years, said in 2017 that Trump's mental confusion reminded him of his mother, who had Alzheimer's for 10 years. “It's getting worse, and not a single person who works for him doesn’t know he has early signs of dementia,” he said of Trump last year on his MSNBC show.

To mental health professionals like me, the red flags are waving wildly. In January 2018, over 70 of us wrote a letter to the president’s physician, Dr. Ronny Jackson, urging him to administer a cognitive exam during the president’s physical because we had seen a marked deterioration in his verbal functioning, possibly due to cognitive decline.

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In fact, Dr. Jackson did administer the Montreal Cognitive Assessment, a screening tool for dementia, and Trump passed. But while Trump bragged that this proved his superior intelligence, this 10-minute screening test, where one must identify a camel, draw a clock and repeat three numbers backwards, only ruled out full-blown dementia.

We argued in a subsequent op-ed that these findings did not rule out the early stages of dementia. We also predicted that if this was organic cognitive decline, it would continue to get worse. And since that op-ed, more than a year ago, it has gotten worse.

Confusing people and generations

Memory loss is the symptom most closely associated with Alzheimer’s. While Trump famously forgets the names of people (as he did recently when he called Apple CEO Tim Cook “Tim Apple”) and places (as when he called Paradise, California, “Pleasure”), one could make allowances for such gaffes. More troubling, Michael Wolff reported in "Fire and Fury" that at the end of 2017, Trump failed to recognize "a succession of old friends" at Mar-a-Lago.

Trump, 72, seemed to hit a new inflection point last week when he said, “My father is German. Right? Was German. And born in a very wonderful place in Germany.” In fact, his father was born in the Bronx and it was his grandfather who was from Germany.

Dementia Care International says a "person may start to mix up relationships and generations” in the second stage of dementia.

One day, when my Uncle Bruce was agitated, he cried out for me saying, “Call John. He’s a rich lawyer. He’ll know what to do” — even though it was my father who was the lawyer, not me. That was not in the early phase of the illness. That incident took place a few months before Uncle Bruce was forced to enter the nursing home.

Capsicles and mishiz and midtowm elections

In Alzheimer’s, as language skills deteriorate, we see two types of tell-tale speech disorders, or paraphasias:

Semantic paraphasia involves choosing the incorrect words. For instance, after Attorney General William Barr released a letter on the Mueller report, Trump said: “I hope they now go and take a look at the oranges, the oranges of that investigation, the beginnings of that investigation."

Phonemic paraphasia, which is linked to the moderate to severe stages of Alzheimer’s, is described as "the substitution of a word with a nonword that preserves at least half of the segments and/or number of syllables of the intended word.” For example, Israeli Prime Minister Benjamin Netanyahu becomes “Betanyahu,” big league becomes “bigly,” anonymous becomes “enenamas” or "anenomynous," renovation becomes “renoversh,” missiles become "mishiz," space capsule becomes “capsicle,” midterm elections become "midtowm" and "midturn" elections, and Christmas becomes “Chrissus.”

Trump’s speech patterns appear even more disordered when you go beyond the sound bite and look at a whole speech. He careens from one thought to the next in a parade of non sequiturs, frequently interrupting himself in the middle of a sentence to veer into another free association. When commentators described his two-hour speech at the Conservative Political Action Conference last month as “unhinged,” they were referring in large part to this quality.

CPAC speech underscored need for assessment

At its extreme, this is called tangential speech. As psychologist Ben Michaelis told Stat, doctors evaluating for Alzheimer’s listen for tangential remarks and non sequiturs and whether the patient can stay on topic.

You had to listen to Trump's whole CPAC speech to realize just how tangential it was. “Those who learned about the speech from glancing at mainstream news headlines the next morning would have no idea how flat-out bonkers the whole thing was … even by Trumpian standards,” Amanda Marcotte wrote in Salon. The Washington Post's Eugene Robinson said Trump “gave a rambling and incoherent two-hour speech in which he raved like a lunatic.”

Americans have a right, indeed an urgent need, to know whether their president is suffering from dementia. We see clear signs that he is, but the only way to find out for sure is to give him a full neuropsychological evaluation and share the results with the American public. The need is more screamingly obvious now than it was a when we first called for it over a year ago.

John Gartner is a psychologist and a former assistant professor at Johns Hopkins University School of Medicine.