US President Donald Trump has spent the last few weeks bragging about his performance on a cognitive test, and challenging his opponent in the upcoming presidential election, Joe Biden, to take it as well.
"The radical left were saying, is he all there? Is he all there? And I proved I was all there, because I got – I aced it. I aced the test," Trump told Fox News host Sean Hannity earlier this month.
"I took it at Walter Reed Medical Centre in front of doctors. And they were very surprised. They said, 'That's an unbelievable thing. Rarely does anybody do what you just did.'"
He has repeatedly argued that Biden should take the same test, strongly implying the Democratic Party's presidential nominee couldn't pass it.
"Well I tell you what, let's take a test. Let's take a test right now. Let's go down – Joe and I, we'll take a test. Let him take the same test that I took," Trump said during another interview with Fox News over the weekend.
When the interviewer, Chris Wallace, suggested the test was "not the hardest", Trump insisted that "the last five questions" get "very hard".
"Let me tell you. You couldn't answer, you couldn't answer many of the questions. I guarantee you Joe Biden could not answer those questions," he said.
So how hard is this test, really?
It's called the Montreal Cognitive Assessment, and it is used as a screening tool to identify cognitive dysfunction, including signs of early Alzheimer's disease.
"This is not an IQ test or the level of how a person is extremely skilled or not," the man who developed the test in the early 1990s, Dr Ziad Nasreddine, told MarketWatch.
"The purpose is to detect impairment. It's not meant to determine if someone has extremely high levels of abilities.
"It is supposed to be easy for someone who has no cognitive impairment."
But Dr Nasreddine also called out critics of Trump for going overboard in "ridiculing" the test and making it sound "too simple", as though it were "a kindergarten test for five-year-olds".
"I think there's misinformation on both sides of the political divide," he said.
The best way to illustrate the test's difficulty is to show you exactly what it entails. The whole thing only takes about 10 minutes to complete.
The highest possible mark is 30 points. Trump says he got that perfect score. How would you fare?
1. ALTERNATING TRAIL MAKING (1 POINT)
The examiner instructs the subject to draw a line going from a number to a letter, in ascending order.
"Begin here (point to the number one) and draw a line from one to A, then to two, and so on. End here (point to the letter E)," the subject is told.
One point is allocated if the subject draws the correct pattern, without any lines that cross. The point is lost if the subject draws a line connecting the final point (E) to the beginning (one).
2. VISUOCONSTRUCTIONAL SKILLS, SHAPE (1 POINT)
The subject is instructed to copy a drawing as accurately as they can.
In some versions of the test, the drawing in question is a cube. In the example we have here, it's a chair.
Correctly copying the image earns the subject one point, as long as all these criteria are met:
• The drawing must be three-dimensional;
• It's not missing any lines;
• All the lines meet with little or no space;
• No extra lines are added;
• The lines are relatively parallel and their length is similar;
• The chair's orientation in space is preserved.
3. VISUOCONSTRUCTIONAL SKILLS, CLOCK (3 POINTS)
The subject is told to draw an analog clock, with the hands pointing to a specific time.
This task must be performed without the subject looking at their watch, and with no clocks otherwise in sight.
In the version of the test below, the goal is to draw a clock indicating it's 10 minutes past nine.
There are three points up for grabs here – one for each of the following criteria.
• Contour: The clock's contour must be drawn. Only slight imperfections are acceptable;
• Numbers: All of the clock's numbers must be present and in the correct order, with no additional numbers added. They must be arranged in a circular manner. Roman numerals are acceptable;
• Hands: The hands must indicate the correct time, which means the hour hand must be clearly shorter than the minute hand. The hands must be centred within the clock face, with their junction close to the clock centre.
4. NAMING (3 POINTS)
The subject is shown drawings of three different animals – for example, a snake, elephant and crocodile. They must correctly name each one.
One point is given for each correct answer.
5. MEMORY (NO POINTS YET)
The examiner reads out a list of five words, at a rate of one word per second.
"This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn't matter in what order you say them," the instructor says.
Once the subject has recalled as many words as they can, the test is repeated.
No points are awarded yet. The examiner informs the subject that they will be asked to recall the words again later.
In this version of the test, the words in question are hand, nylon, park, carrot and yellow.
Part 1 (2 points)
The examiner reads out five numbers at a rate of one per second, and then asks the subject to repeat them, in order.
Then the subject is asked to repeat three numbers, but in reverse order.
Each task is worth one point.
Part 2 (1 point)
The examiner reads out a list of letters, again at a rate of one per second. The subject must tap their hand every time the letter A is said.
Tapping on any other letter is considered an error, as is any failure to tap on the letter A.
One point is allocated if the subject commits one error or fewer.
Part 3 (3 points)
The subject is asked to count backwards by subtracting seven from the starting number. In this example of the test, that number is 70; in others it is 100.
There are three points available here. The subject gets one point for one correct subtraction, two points for two or three correct subtractions, and three points for anything better than that.
Each subtraction is evaluated independently – so if, for example, the subject answers 62 instead of 63 for the first subtraction, but subtracts correctly from that point onwards (55, 48, etc), they are only penalised for one error.
7. SENTENCE REPETITION (2 POINTS)
The examiner reads out a sentence, and asks the subject to repeat it back to them.
"The robber of the grey car was stopped by the police," for example.
This happens with two sentences. Each correct, word-for-word repetition earns a point.
8. VERBAL FLUENCY (1 POINT)
The subject is asked to come up with as many words as they can starting with a specific letter. They get one minute.
In the version we're using here, the letter in question is S.
One point is allocated if they name at least 11 words.
9. ABSTRACTION (2 POINTS)
The subject must explain "what category" each pair of words belongs to.
For example, the words "bed" and "table" are both examples of furniture, while "letter" and "telephone" are both forms of communication.
There is a practice pair, followed by two pairs that each come with a point.
10. DELAYED RECALL (5 POINTS)
This is the point at which the subject has to repeat the five words they memorised earlier.
"I read some words to you earlier, which I asked you to remember. Tell me as many of those words as you can remember," the examiner says. At first, no other cues or hints are given.
If the subject is unable to recall one or more of the words, the examiner then proceeds to give a "category cue".
For example: "I will give you some hints to see if it helps you remember the words. The first word was a body part."
If the subject still can't remember the word, the examiner proceeds to multiple choice.
For example: "Which of the following words do you think it was – hand, shoulder or face?"
The scoring gets a little complicated here. The examiner attributes points according to when the subject was able to recall each word.
So, the number of words recalled without any cues is multiplied by three; the number recalled after the category cue is multiplied by two; and the number recalled after the multiple choice prompt is multiplied by one.
You end up with a total score out of 15, which the examiner then converts to be out of five.
For instance, say the subject recalls three words without prompting, one with the first cue, and then the last one with the multiple choice hint. That would yield a score of 12/15, which becomes 4/5.
11. ORIENTATION (6 POINTS)
The subject must identify the current date – including the month, year and day of the week – along with the place and city they're in.
Each of those six answers earns one point.
THE FINAL SCORE
Add up the scores from each section. If the subject is someone with 12 years or fewer of formal education, one extra point is added to their total.
Any score of 26 or above is considered normal.