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I invented America's gold-standard cognitive test. This is why I'm calling on Biden to take it and make his results public
Dr Ziad Nasreddine, a neurologist who invented the gold-standard cognitive test, says he would be more than happy to do the test for Joe Biden or Donald Trump
The neurologist who invented America's gold standard cognitive test is urging Joe Biden to take the assessment after his disastrous debate last week.
Dr Ziad Nasreddine had been reluctant to comment about the President's health despite widespread concerns about the 81-year-old's slurring, stiffness and freezing episodes during his time in the White House.
But last Thursday, that changed. Dr Nasreddine said he had serious concerns about Biden's mental acuity after watching his performance against Trump.
Dr Nasreddine invented the Montreal Cognitive Assessment, or MoCA, test.
You'll probably know it best as the test that Donald Trump, 78, often brags about acing during his presidency.
The test is a simple 11-question examination and takes ten to 15 minutes to complete (scroll down to the bottom of this article if you want to try it for yourself).
It includes asking patients to identify pictures of animals, repeat a list of numbers and words or complete a pattern. The lower the score, the higher the risk of cognitive decline — a precursor for dementia.
Dr Nasreddine — who is based in Montreal, Canada — said: 'A neurological evaluation for the President is warranted to rule out neurodegenerative symptoms.'
Shortly after Biden began debating Trump last week, his team claimed that the president was suffering a cold — in an attempt to explain his shaky voice, pallid skin and meandering answers.
But Dr Nasreddine said: 'President Biden’s symptoms of slurred speech, confusion, stiffness, and freezing episodes were present a long while before the debate.
'It's unlikely that this is caused only by flu or sedative medication to fight it.'
President Joe Biden's unsteady performance at the debate last Thursday has prompted concerns in many Democrat circles. But, at present, his family insists he will keep fighting
The White House has repeatedly declined for Biden to take the MoCA test, despite calls from Trump, Republican Nikki Haley and medical professionals.
The test measures memory and cognition, with patients able to score up to 30 points (the average score is 27.3 for older adults who take the test, normally in their 70s).
Anything below 26, would be considered mild cognitive impairment — which can be a precursor to conditions like Alzheimer's.
But if it drops below 18, then this suggests moderate impairment — a warning sign for conditions. Anything below ten shows severe impairment.
The test is normally completed in a clinical setting where there are no distractions — alongside a doctor.
If someone scores below 26, they are sent for further analysis.
This may include an MRI, which can detect fluid in the brain, or a blood test, which can detect proteins in the blood that signal the build-up of amyloid beta or other proteins in the brain that are linked to Alzheimer's disease.
Like many doctors, and given the sensitive nature of the issue, Dr Nasreddine did not want to second guess Biden's doctors — who said in February that the President was 'fit for duty' and did not need a cognitive test.
But the debate last week led him to change his mind.
He said: 'During the debate, I saw a lot of trouble answering questions, freezing, not completing sentences, mumbling and sometimes saying something that doesn't make sense.
'Then I thought, "My god, this is exactly what has been going on for a few months, many months — I suspect probably a bit longer."
'This is concerning, and shows that he should get a cognitive test.'
He added that it was important to do the test early so that treatments for conditions such as Alzheimer's can be started.
There are drugs like Lecanemab which can slow down the disease's progression, but only work in the early stages.
Biden appeared to walk off from other world leaders at the G7 summit last month (pictured). The White House has insisted he was moving to wave to paratroopers who were pictured off screen, but his movements were still unusual
There have also been a number of Biden freezing episodes, including at this Juneteenth celebration at the White House (pictured) where he was stock still while others clapped and danced around him
Biden also appeared to freeze at a star-studded fundraiser in Los Angeles last month, before being led off the stage by ex-President Barack Obama
President Biden started to face official calls to quit the 2024 presidential race today, after two Democrats broke ranks and publicly called for him to resign.
The White House has scheduled a meeting with Democrat governors Wednesday to reassure them about Biden's ability to win the election.
But with five months to go until polling day, many Democrats had initially hoped that Biden would be convinced to step aside by his family.
But, instead he appears to be planning to stay in the race — spurred on by hiw wife Jill and son Hunter who are among his strongest supporters.
Dr Nasreddine developed the test in 2005 because of the difficulty in diagnosing cognitive decline, with patients often having to go through hours of testing.
Since then, more than 6,000 studies have been carried out on the test and it has been translated into 100 languages globally.
It is also recommended in the US by the American Academy of Neurology, which says everyone over 65 years old should do the test annually.
Dr Nasreddine said he felt everyone should do the test once at the age of 50 years, but that they should look to do the test every two years from the age of 60.
This is to capture a baseline level for someone's brain, and then track any declines in cognition over time.
It is best to do the test with a clinician, who can correctly interpret the results, but an online version is also available for patients called the MoCA XpressO, which can be taken online from home.
Dr Nasreddine is also working on a MoCA Solo, or a version of the test that people can take on their own in a clinic without having a doctor present.