In the past few weeks, the 45th President of the United States has displayed public behaviors that have led many to believe he is suffering from some form of dementia and that this is a root cause of his recent bizarre acts and statements.

On the first point, this President is behaving as if cognitively compromised and recent signs of impaired decision making, whether limited to single moments or as part of a pattern of confused behavior, have been evident in:

· His departure from an Executive Order signing ceremony prior to signing the Order on March 31st of this year

· His statement during an interview with Fox Business Network, while recalling the decision to send 59 Tomahawk missiles into Syria, that “We have just launched 59 missiles, heading to Iraq”

· Apparently forgetting to place his hand over his heart during the national anthem at Monday’s White House Easter Egg Roll

· Appearing to refer to Speaker of the House Paul Ryan as “Ron” twice during an event in Wisconsin on Tuesday

· Conflating the two most recent leaders of North Korea (father and son, the late Kim Jong -il and the currently presiding Kim Jong-un) in an interview with Fox News on Tuesday

CNN First lady Melania Trump appears to nudge the President to remind him to place his hand over his heart during the playing of the national anthem at the White House Easter Egg roll on Monday April 17, 2017.

Is the 70-year old sitting President showing signs of dementia?

The truth is it is difficult to determine the causal factors for his strange, confused, and often bizarre behavior. To be honest, this man has a mental “bowl of goulash” swimming inside his skull that could influence his daily activities:

· this President shows clear narcissistic behaviors including a distorted sense of reality in which facts and fiction are routinely interwoven and his first inclination is self-preservation – severe narcissists can display a delusional state (separation from reality) that rivals psychotic disorders

· the President lies repeatedly in the face of conflicting evidence. When a person repeatedly lies and maintains deceptions for a long time, it is going to take a toll on his mental capacities. There is an increased need for mental resources when he must navigate the border between what is fact and what he is saying is true. At any moment, there lies the possibility for a crack or complete collapse of the lie. In other words, a 70 year old man, who would be expected to have age-associated mental lapses, has to simultaneously monitor what he is saying, what his body language is showing, and what the interviewer might ask next.

· The 45th Commander-in-Chief is inexperienced and has no muscle or mental memory for doing the tasks associated with being the leader of a nation of approximately 330 million people. There are going to be times when an ill-equipped, novice leader shows signs of confusion and disarray simply because he has no reference base of knowledge upon which to lean on when necessary

· The man, by many reports, does not like to read and prefers bullet points and pictures. By limiting his access to multifaceted, wide ranging sources of further information, the President is also working from a half empty deck when playing the real life game of poker that domestic and international relations can involve on a daily basis.

At this point, it is impossible for outside mental health experts to pinpoint a specific diagnosis or to single out a main root cause for the President’s mental lapses but one thing remains clear (and has for years), his ability to govern the American people safely and effectively is compromised....and it has been since well before the November 2016 election and before we had any whiff of the Trump/Russian ties.

GETTY IMAGES The President leaves the Oval Office without signing an Executive Order during a ceremony set up to do just that on March 31, 2017.

It may be tempting to chalk up his most recent missteps to dementia but this is:

· an oversimplification of the previously discussed factors (that he has been unfit for the office for decades notwithstanding),

· can do a disservice to the millions of Americans and their families who are dealing with dementia, and

· presents a potentially malicious defense down the line for this President when some of the ongoing investigations play out in Congressional hearings and the Court systems.