U of T researcher on how media coverage of Trump's cognitive exam may have compromised test itself

University of Toronto researchers are warning the medical community that a popular cognitive test may be compromised due to the extensive publicity it received after U.S. President Donald Trump took it. 

Recently, Trump’s physician announced that the president achieved a perfect score on the Montreal Cognitive Assessment (MoCA), a test for mild cognitive impairment that's often the first step toward dementia. Media covered the story extensively, leading U of T Faculty of Medicine researchers to investigate the impact this exposure could have on test-takers. One of the authors, Dr. Eric Coomes, a third-year medical resident in internal medicine, spoke with U of T writer Heidi Singer about the study.

Why were you concerned about coverage of the MoCA?

Watching the news stories on the MoCA in relation to President Trump’s cognitive evaluation, we were impressed by the mass dissemination of information about this test, which was primarily only known to the medical community. As readers were exposed to the test, and in some cases even being invited to self-administer the test online, we wondered if there could be an effect down the road. We wanted to quantify the degree and nature of the [impact of the] test’s dissemination. 

We searched the news cycle for a period in January and found 190 articles discussing the MoCA in association with President Trump. Of those, we found over half revealed either parts of or the full content of the MoCA questionnaire to the general public. More than one in six articles invited people to take the test, many posed as a self-challenge. A smaller proportion even provided answers so people could see how the test is graded. 

How problematic is that?

Previous studies have demonstrated a potential for a learning effect on the MoCA. It may be that your previous exposure will strengthen your future scores. The impact would likely be greatest among people with very mild cognitive impact. People with more severe cognitive impairment would be unlikely to remember having seen the answers to the test previously. But with people who are healthy or at the very earliest stages of cognitive impairment, there may be some effect. At this point, however, the risk associated with media dissemination is hypothetical. It would be interesting if future tests looked at this. 

Is it best for health providers to avoid this test for the short term?

There’s an easy way out. All the articles presented version one of the test. There are other versions – two and three – that have different word lists and content. We published a letter in JAMA Neurology advising providers to ask people whether they’ve been previously exposed, and for those who have, consider using alternate versions of the test. 

For how long?

It depends whether there’s ongoing media interest in this test. This was the first time an American president underwent formal cognitive evaluation while in office, with mass media coverage. Only time will tell whether this will happen in the future. Until the learning effect of media coverage is better characterized, it will be hard to know how long an effect might last.

What kind of reaction have you received to your study?

We’ve all been impressed at how much interest there’s been in the study. There’s been a really positive response among our peers. There’s been quite a bit of local and international media interest. The goal of our piece was not to infer any conclusions about the president, but rather to look at the impact of media dissemination of a cognitive evaluation. 

Why do you think there has been so much interest?

It provided an impetus for lots of outlets to discuss the topic of the president’s cognitive testing. But it also gave some media an opportunity for self-reflection. The New York Times linked to their own previous coverage, in which they published contents of the questionnaire.

It was an excellent opportunity to explore the relationship between media and medicine and show how public-sphere events have an impact on clinical practice. The interplay between medicine and the general world is often overlooked, but as practitioners we need to be aware of that interplay. This is a perfect example of how they intersect.