Can you recognize a lion? How about remembering a list of five words, right away and five minutes later?
President Donald Trump can. He got all the usual tests as part of his annual physical exam as president. But he also added an extra exam — a cognitive screening test for memory loss or early dementia.
It’s not part of the usual battery of tests given to a president and may reflect an outpouring of coverage and commentary questioning whether Trump is mentally fit for office.
Trump insisted on taking the test and passed it with flying colors, Dr. Ronny Jackson, presidential physician, told reporters.
“Many of you may have picked up on the fact that we did do a cognitive assessment,” Jackson said.
“I didn’t feel it was clinically indicated,” he added. “It has been my experience that the president is very sharp and he’s very articulate when he speaks to me.”
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Trump is the first president to undergo the memory screening, Jackson said. The White House medical team chose the Montreal Cognitive Assessment (MoCA), which was designed as a rapid screening tool for mild cognitive dysfunction — a loss of memory and clear thinking ability that sometimes precedes dementia.
The 30-point test includes drawings of a lion and a rhinoceros, which patients must name. Test-takers are also asked to copy a simple line sketch of a cube; match the letter A to the number 1, the letter B to the number 2 and so on. They are asked to recall a list of five words and repeat very short lists of numbers forward and backward.
It also includes one of the best-known tests for early Alzheimer's disease -- the clock test, in which patients are asked to draw an analog clock face.
The exam assesses attention, planning, memory and visual skills, all of which deteriorate in people with mild cognitive impairment (MCI) or dementia. A score of 26 or lower indicates dementia.
A Cochrane Collaboration review of the test showed it detects 94 percent of people with dementia.
It’s one of several quick tests that can screen people for MCI or dementia.
“We picked one of the ones that was a little longer, a little more involved,” Jackson said.
“It was a more difficult one of all of them. It took significantly longer to complete, and the president did extremely well on it,” said Jackson, who is a rear admiral in the Navy.
If the president had "some type of mental, cognitive issue," Jackson said, the test is sensitive enough to pick up on it. "He would not have gotten 30 out of 30 on the test," Jackson said. "So I’m very confident at this particular stage that he has nothing like that going on.”
Alzheimer’s patients often have trouble drawing or naming objects, and the test can quickly indicate problems with short-term memory. Spatial skills also deteriorate with MCI and dementia, as does attention.
Trump took the test during the annual physical that is customary for presidents at the Walter Reed National Military Medical Center in Maryland on Friday.
Jackson, who is the official physician to the president, said he did not see anything unusual — especially not for a 71-year-old American.
Because Trump has blustered about his health before, there had been suspicions among some critics that the White House might conceal evidence that he is mentally or physically unfit for office.
Jackson, who also served as Barack Obama’s official physician, denied hiding anything.
“I can promise you there is absolutely nothing that I’m withholding from this,” Jackson said.