I spent a year doing research with patients who had dementia (especially Alzheimer's disease).

I would administer these cognitive exams to residents to determine their mental capacity.

The fact that medical doctor's are administering this to the President is very serious.

1/n https://twitter.com/RexChapman/status/1286132416361488386

For starters, if you are receiving one of these exams, it is often because people close to you have convinced a medical professional that you might be in the early stages of dementia.

The exams themselves are incredibly easy: Try it yourself

https://www.nytimes.com/article/trump-cognitive-test.html

2/n

It is also telling the way he describes the exam: "It was 30 or 35 questions. The first questions are very easy. The last questions are much more difficult."

If you find these questions difficult, that is not usually a good sign.

https://www.politico.com/news/2020/07/23/trump-mental-fitness-cognitive-test-379622

3/n

In my experience, most patients wouldn't brag about their performance on the exam.

Indeed, it was often incredibly awkward to give the exam to patients in the early stages of dementia because it can be too easy which leads some patients to find it incredibly insulting.

4/n

The fact that Trump can't tell the difference between this test and other assessments of cognitive ability is telling.

It suggests that he doesn't realize what this test is designed to assess and can no longer tell the difference between a dementia test and, say, the SAT.

5/n

The SAT test, for instance, is completed by high school students as part of their college admissions.

Look at the items on the SAT test and ask yourself if the President of the USA could complete any of these sample questions.

https://blog.prepscholar.com/whats-actually-tested-on-sat-math-topics

6/n

It is important to note that Trump's doctor gave him the same test in 2018.

In my experience, administering the test repeatedly over time means that you are looking for cognitive decline.

Did Trump achieve the same score or is he deteriorating?

https://www.vox.com/science-and-health/2018/1/16/16899150/trump-montreal-cognitive-assement-ronny-jackson

7/n

This cognitive test is merely one diagnostic tool.

Most clinicians are looking for other symptoms. These can provide clues about the exact form of cognitive decline.

For instance, here are the symptoms of Frontotemporal Dementia.

8/n

Working in a dementia unit was eye opening. Many of the residents were wonderful and their lack of inhibition often made them irreverent and charming.

And the nursing staff was incredible and deeply empathic.

But these issues should cause anyone serious concern.

9/n

In terms of the challenges, many residents could not remember their own family members. One man forgot his wife had died and had to tragically relearn it every day.

It also led to other problems. For instance, I was regularly groped by female residents 4 times my age!

10/n

The bottom line is that his family and friends are likely already concerned (albeit behind closed doors).

And, more importantly, it places a huge number of people at risk. If insiders truly believe Trump is in the early stages of dementia that must be addressed urgently.

11/n

Anyone who has had a close family member with dementia knows how challenging this is. Caregivers and family suffer from serious burnout and severe stress.

I have experienced this at work, but also in my own family and it is a truly devastating and heartbreaking condition.

12/n