A psychologist who spent nearly three decades on the faculty at one of America’s most prestigious medical schools made an argument in December 2025 that deserves closer examination: when a patient takes the same cognitive screening test three separate times, the purpose is no longer to find out whether they have dementia. The purpose, he argued, is to track how fast it’s progressing.
That psychologist is Dr. John Gartner. A former professor at Johns Hopkins Medicine’s Department of Psychiatry and Behavioral Sciences, Gartner has appeared repeatedly on The Daily Beast Podcast to discuss what he describes as Trump’s cognitive trajectory. His December 2025 comments cut to a point that most political coverage glossed over: not whether the tests were passed, but why they keep being given.
Gartner told The Daily Beast Podcast that Trump’s claim to have “aced” three Montreal Cognitive Assessments could be more than simple routine screenings for the degenerative disease. Bragging about passing a test designed to detect dementia, he suggested, misses the more revealing question entirely. One screening makes clinical sense. Three screenings, given in rapid succession, points to something else.
What Happens When You Give the Same Test Three Times
The Montreal Cognitive Assessment is a 30-point test completed in approximately 10 to 15 minutes, covering seven cognitive domains including memory, attention, language, executive function, and orientation. It was originally developed to detect mild cognitive impairment but is now frequently used as a screening tool for the dementias. According to Gartner, the frequency of these assessments suggests something far more troubling than routine age-related monitoring: the tracking of a progressive decline.
His exact words, as reported by The Daily Beast, are precise: “You could maybe justify giving someone the MoCA once, just on their age, just as part of a physical. If you’re giving it to him three times, that means you’re not assessing dementia. That means you’re monitoring dementia.”
The clinical logic behind that argument is not fringe thinking. Research from UC San Diego found that repeated testing of middle-aged men produced a “practice effect” that obscured true cognitive decline. The more familiar a patient becomes with a test’s format, the better they perform regardless of their actual cognitive state. After correcting for these practice effects, diagnoses of mild cognitive impairment doubled from 4.5 to 9 percent in that study’s population. In other words, standard repeated administration of a cognitive screener can systematically undercount real impairment. Research published in a peer-reviewed journal has also documented the MoCA’s susceptibility to a learning effect with repeated measurements in people with dementia specifically.
That is the backdrop against which Gartner’s argument operates. If a doctor suspects early dementia and gives the MoCA once, they’re screening. If they keep returning to it every few months to re-check how the patient is doing, they’re monitoring a trajectory, not ruling out a diagnosis.
The MRI That Raised More Questions Than It Answered
Trump had an MRI in October, just six months after his April physical. According to CNBC, Trump’s physician, Dr. Sean Barbabella, confirmed the imaging evaluated his cardiovascular and abdominal health, with results described as “perfectly normal.” The president’s October visit was described by the White House as a “routine yearly checkup,” though Trump had already undergone his annual physical in April. After telling reporters he’d received an MRI, Trump said they should ask his doctors why he received the scan, but no reason was provided.
Then came the detail that drew the most attention. When asked which part of his body the MRI had examined, Trump said he was unaware. “I have no idea,” he told reporters aboard Air Force One. “It was just an MRI – what part of the body?”
That claim stands out for anyone familiar with how MRI procedures work. MRI machines produce sounds that can exceed 110 decibels, comparable to a rock concert held inches from the ear. Patients are typically briefed on what to expect before the procedure begins, including the duration of the scan and the noises they will hear. The coil placed on or around the patient’s body also makes clear which area is being imaged. Claiming no knowledge of which body part was scanned is, at minimum, a difficult thing to reconcile with how the procedure actually works.
Gartner’s conclusion from the pattern: “I think they’re giving him cognitive tests and MRIs every six months to monitor the progress of his dementia, and/or strokes.”
For readers wondering why a stroke reference is medically relevant here, the connection is direct. A brain MRI can detect the signs of stroke and help pinpoint when the stroke may have occurred. Brain MRI with diffusion-weighted imaging (DWI) has the highest sensitivity and specificity available for diagnosing acute stroke. The Trump dementia stroke framing that Gartner uses isn’t rhetorical: strokes and dementia share overlapping risk profiles, and brain imaging is a primary tool for detecting both.
Why Frequency of Testing Matters Clinically
Standard medical practice doesn’t call for repeated cognitive screenings in patients who have previously passed one cleanly. According to the US Preventive Services Task Force, dementia affects an estimated 9.9% of persons aged 75 to 84 years and 29.3% of those 85 years or older. That age-related prevalence is precisely why a single MoCA at an annual physical makes sense as a precaution for any patient in their late 70s. What clinical guidelines don’t routinely recommend is administering the same short screener every few months to a patient who has reportedly scored a perfect 30 each time.
Gartner’s argument is that the frequency of the assessments suggests a reality far more concerning than routine monitoring: the tracking of a progressive decline. His position, stated plainly, is that clinical teams don’t keep re-administering a screening tool out of curiosity. They do so when the clinical picture gives them ongoing reason to check.
The White House has pushed back sharply on Gartner’s characterization, with a spokesperson branding him a “deranged leftist” with “zero credibility.” That response is worth noting alongside its limitations: it dismisses Gartner’s credentials without addressing the clinical reasoning he put forward. Gartner is not an anonymous commentator. He taught in the Department of Psychiatry at Johns Hopkins Medicine and has written and spoken publicly about presidential fitness for years.
Gartner has described observing a “major deterioration” in Trump’s language skills, motor skills, and impulse control across public appearances. He’s explained that “the main way to diagnose dementia is that we see a deterioration from someone’s own baseline in these four areas: language, memory, behavior, and psychomotor performance.” That framework, assessing against an individual’s own prior baseline rather than against an age-averaged norm, is standard clinical practice in dementia assessment.
It should be stated clearly: Gartner has not examined Trump personally, and his conclusions are drawn from public behavior, not a clinical evaluation. The White House’s official position, delivered by Trump’s physician, Navy Capt. Dr. Sean Barbabella, the president, is in exceptional health. No diagnosis of dementia or stroke has been formally disclosed.
If you’re interested in what the broader public record says about Trump’s health disclosures, read our look at early signs of cognitive decline and how medical assessments compare to real-world observation.
What the Science Says About the MoCA’s Limits
The broader clinical picture that Gartner’s argument touches on involves a genuine debate in cognitive medicine: what does a passing MoCA score actually tell you? The MoCA should not replace a detailed history, physical examination, and full clinical workup. The score identifies the presence or absence of cognitive impairment but does not diagnose a specific condition – additional workup to determine the cause of any impairment is usually warranted.
The MoCA is generally better than older tools at detecting mild impairment and early Alzheimer’s disease because it’s a more sensitive and more challenging test. Studies have shown the MoCA correctly identifies dementia at approximately a 90% rate. That’s a meaningful detection rate for a 10-to-15-minute paper test. But a perfect score doesn’t constitute a clean bill of cognitive health. It means the screener didn’t detect signs of impairment at the time of testing. That’s different from a full neurological evaluation, which would involve detailed neuropsychological testing, biomarker analysis, and brain imaging.
The practice-effect problem adds a layer of complexity. A patient retaking the same test every few months learns the format. Clock-drawing, list recall, verbal fluency exercises – these tasks become more familiar with repetition, and scores can improve or hold steady even as underlying cognition deteriorates. This is precisely what research from UC San Diego found: correcting for practice effects revealed MCI rates that were twice as high as uncorrected scores had suggested.
Read More: Trump Turned 80 – Here’s What His Health Record Actually Shows
What This Means
The medical debate around Trump’s cognitive health surfaces a broader clinical point that applies to anyone managing an aging parent, spouse, or their own health: a passed cognitive test is not the same thing as a clean cognitive bill of health, and the frequency with which tests are ordered tells you something the scores alone don’t.
If someone in your family is being given cognitive screening repeatedly at short intervals, that’s a conversation worth having directly with their doctor. Ask specifically whether the re-testing is to rule out impairment or to track its progression. Ask whether there’s a practice-effect correction being applied. And ask whether imaging such as an MRI has been ordered or discussed, given that brain MRIs are the most sensitive available tool for detecting both stroke and early dementia-related changes in brain structure.
The Bottom Line
Gartner’s core argument may be contested, and reasonable people can disagree about what Trump’s test frequency actually indicates. But the underlying clinical framework he’s invoking is real and well-supported by the research: when doctors keep checking, there’s usually a reason they keep checking.
For patients and their families navigating similar situations, the most useful thing to understand is the difference between a screener and a monitor. The MoCA was built to flag potential problems at a single point in time. When it becomes a recurring tool administered every few months, its function has changed, regardless of whether the scores themselves have. That distinction, between ruling something out and keeping tabs on it, is the clinical fact at the center of Gartner’s argument about the Trump dementia stroke pattern, and it’s one that applies far beyond any single patient or political moment.
Disclaimer: The information provided here is for educational and informational purposes only and is not a substitute for professional psychological, psychiatric, or mental health advice, diagnosis, or treatment. Always seek the guidance of a licensed mental health professional, therapist, psychologist, or psychiatrist with any questions or concerns about your emotional well-being or mental health conditions. Never ignore professional advice or delay seeking support because of something you have read here.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
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