Donald Trump’s obvious public challenges with speech, language, and thinking are continuing to get worse. At a recent rally in Ohio, the former president continued to act like a broken computer, going off on odd tangents, rambling, muddling his speech, and saying, “Joe Biden won against Barack Hussein Obama, has anyone ever heard of him? Every swing state, Biden beat Obama but in every other state, he got killed.”
This is not an example of one so-called gaffe or misstatement but rather part of a much larger pattern where Donald Trump confuses people and time. Experts have empirically shown such behavior likely indicates some type of brain disease. Dr. John Gartner, a prominent psychologist and contributor to the bestselling book "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President," has repeatedly warned in a series of conversations about Trump’s apparent challenges in cognition and communication that something seems to be very wrong with the ex-president:
Not enough people are sounding the alarm, that based on his behavior, and in my opinion, Donald Trump is dangerously demented. In fact, we are seeing the opposite among too many in the news media, the political leaders and among the public. There is also this focus on Biden's gaffes or other things that are well within the normal limits of aging. By comparison, Trump appears to be showing gross signs of dementia. This is a tale of two brains. Biden's brain is aging. Trump's brain is dementing.
Dr. Gartner’s attempts to sound the alarm about Trump’s behavior have been joined by the hundreds of medical professionals who have signed his Change.org petition, “We diagnose Trump with probable dementia: A petition for licensed professionals only.”
To deny the obvious about Donald Trump’s evidently diseased mind is to deny reality and to ignore the real possibility that a man who is already morally and ethically corrupt and now appears to be experiencing problems with his thinking could be back in the White House with the awesome responsibility and power of the presidency – including the sole authority to order the use of America’s nuclear weapons. Trump’s mind and overall behavior and character are not just a national emergency but a global crisis as well.
Because of a commitment to horserace journalism, fake objectivity and balance, self-interest and fear, the mainstream American news media – especially the elite agenda-setting news media – has largely ignored Donald Trump’s obvious struggles with communication and cognition. The Washington Post’s Jennifer Rubin is a notable exception.
"His walk appears wide-based and he has developed a swing of his right leg. He appears glued to the floor when he “dances” for his audience. If caught on camera standing still, he appears unnaturally immobile."
In an attempt to better understand what we are witnessing with Donald Trump’s behavior, I recently spoke with Dr. Elisabeth Zoffmann, a forensic psychiatrist and an Associate Clinical Professor of Forensic and General Psychiatry at the University of British Columbia. Dr. Zoffmann shares her evidence-based preliminary conclusion that Donald Trump is displaying a range of behaviors that suggest cognitive challenges if not impairment. The former president appears to be suffering from Behavioral Variant Fronto-Temporal Dementia, Dr. Zoffmann concludes, and needs to be evaluated by neurologists who specialize in the condition.
This interview has been edited for length and clarity:
What do you see when you look at Donald Trump through a clinical lens?
My observations are garnered from viewing the phenomenon of Mr. Trump for the past decade. Also, observations from viewing old videotape interviews and coverage of Mr. Trump as a younger man form part of my impression that Mr. Trump might benefit from a thorough evaluation by a neuropsychiatrist with expertise in neurodegenerative disorders. My observations are as follows:
- Changes in speech patterns with many fewer and simpler words (decline in vocabulary) with fewer adjectives and adverbs.
- A decline in cognitive focus on speech subjects with incomplete sentences and an inability to focus on a topic long enough to complete a sentence when not reading from a teleprompter.
- Difficulty pronouncing words, word substitution and nonsense words – known as paraphasia
- Tangential thinking where the topic switches mid-sentence to some unrelated topic.
- Frequent repetition of words and phrases as if his mind is stuck in a loop.
- Disinhibition and an inability to control verbal outbursts.
- Socially inappropriate behavior – mocking a man with muscular dystrophy, disrespecting fallen soldiers as losers.
- Lack of self-awareness in that he apparently cannot see how inappropriate his behavior has become and use his judgment to stop himself.
- Changes in movement and gait. His walk appears wide-based and he has developed a swing of his right leg. He appears glued to the floor when he “dances” for his audience. If caught on camera standing still, he appears unnaturally immobile.
- The changes in judgment and impulse control have uncovered and perhaps worsened underlying personality traits that others have characterized as narcissistic and antisocial. The changes have led some experts to suggest a diagnosis of “malignant narcissism."
Mr. Trump has stated that he passed a cognitive that he described in terms that suggested either the Mini-Mental Status Exam (MMSE) or the Montreal Cognitive Assessment (MOCA) scale. These are both simple screening tests for suspicions of Alzheimer’s Disease.
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My clinical experience and these collected observations are congruent with the diagnostic criteria for Behavioral Variant Fronto-Temporal Dementia (FTD). People presenting with such a cluster of observations should undergo expert assessment. This diagnosis is often largely based on external observations and collateral reporting from others close to the person. Early in the disease, the individual may be aware of changes, but as frontal lobe deterioration progresses the capacity for self-awareness diminishes. Unlike Alzheimer’s Disease, people with FTD have intact short-term memory and can easily score full points on screening tests like the MMSE and MOCA.
Is a person with FTD inherently dangerous?
No.
When social awareness is deteriorating the sufferers may become irritable with caregivers. In Mr. Trump’s case, the overall picture is consistent with Behavioral Variable Fronto-Temporal Dementia (with the caveats mentioned about needing a thorough evaluation including an MRI brain scan.) The associated disinhibition exposes unfortunate aspects of his personality and worldview where he repeatedly dehumanizes anyone he sees as “the other." His repeated statements dehumanizing migrants and exaggerating their numbers and suggesting they are all killers is a good example. This meme has caught on with his supporters and in situations of mass-thinking they may pose a danger to migrants seeking refuge.
"My clinical experience and these collected observations are congruent with the diagnostic criteria for Behavioral Variant Fronto-Temporal Dementia (FTD)."
Mr. Trump’s memes seem to resonate with a stratum of American society that feels disaffected and maligned in a rapidly changing world. Being blinded to new information and new ways of experiencing scientific discovery poses a risk for those people – for example, anti-vaccine people frequently dying of COVID-19 when they could have vaccines.
People often conflate dementia and Alzheimer’s. Can you please clarify?
Dementia is a catch-all term for a number of recognized neurodegenerative disorders: Alzheimer’s Disease, Lewy Body Disease, Multi-infarct Dementia, Pick’s Disease, Parkinson’s Disease, Primary Progressive Aphasia variant Fronto-temporal Dementia and Behavioral Variant Fronto-temporal Dementia.
In reading and hearing the comments of other observers and experts I am reminded of the fable of Five Blind Men trying to describe an elephant. One has the tail, others have the trunk, tusk, legs, and ears and all give a version of what they have observed. One cannot get a complete picture of the elephant without combining all of the observations. In the various interviews and comments from other experts, I recognize all the criteria I set out from my observations of Mr. Trump. I think we get a clearer picture if we combine all these observations.
When you were first approached about making a public statement about Trump's apparent neurological challenges you were reluctant to speak “on the record.” What changed your mind?
I am an older, semi-retired, female psychiatrist though during my career, I was (and still am) a respected Forensic Psychiatrist and an Associate Clinical Professor of Forensic and General Psychiatry at the University of British Columbia. I have observed through my career that opinions expressed by female experts are not taken as seriously as those posed by male experts even though they are lying through their teeth. There are ample scientific studies with mock juries that support these observations.
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However, seeing that I am but one of many experts expressing similar opinions I am assured that my observations are not spurious and that I can contribute to a dispassionate process collating all our observations into a cohesive whole.
The American mainstream news media is fixated on the narrative of President Biden’s mental competence and suggest that he is as impaired as Trump. What are your observations?
I have not had the same opportunities to observe President Biden the way I have followed the fascinating American political events unwinding over the past 9 – 10 years. I have seen President Biden in videos describing his lifelong problems with stuttering. I have also seen video of him encouraging youngsters with the same affliction. President Biden is an example of a person who has worked very hard to conquer his stutter so he can speak in public.
The most cogent example of President Biden’s cognitive abilities is his recent State of the Union Address. He spoke for 63 minutes, without a teleprompter during many points. There were no tangential digressions, no word-finding problems, his sentences and paragraphs were articulate, he was coherent, and there were no insults or other disinhibited behavior. At times he spoke slowly and purposefully and at other times he was passionate (not shouting). Throughout his speech, there were instances where his stutter caused him to start and pause but he was able to correct himself and not lose his train of thought.
In other instances, I observe President Biden speaking more slowly and purposefully. That may be a sign of thoughtfulness, attempts to control stutter or needing to take more time to gather his thoughts. Whatever else is going on his responses are coherent and socially appropriate.
If Donald Trump is found to suffer from FTD will his condition stabilize or improve?
FTD is a progressive neurodegenerative disorder that leads to progressive deterioration and early death. Once again, I caution that my observations combined with those of other experts should lead to a thorough assessment by a neuropsychiatrist expert in the diagnosis and management of neurodegenerative disorders.
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