Produced by ElevenLabs and News Over Audio (NOA) with AI narration.
Tuesday’s presidential debate was, among other things, an excellent real-world test of the candidates’ cognitive abilities, and any fair-minded mental health professional would be extremely concerned by Donald Trump’s performance.
The former president has repeatedly bragged over the past few years about passing various mental health tests with flying colors. Most of these tests are designed to detect fairly severe cognitive impairment and are very easy to pass, asking simple questions like “What day is it?” and other tasks like teaching participants to spell. world In contrast, a 90-minute debate, filled with unknown questions and unexpected rebuttals, requires candidates to think on their feet. It’s a much more demanding and representative test of cognitive health than a simple mental status exam at a doctor’s office. Specifically, the debate serves to assess candidates’ mental flexibility under pressure — their ability to deal with uncertainty and the unexpected.
To be clear, although I am a psychiatrist, I do not make medical diagnoses of any particular public figure. I have not met or examined either candidate. However, I watched the debate paying particular attention to signs of a healthy brain, such as the candidates’ vocabulary, coherence of words and logic, and ability to adapt to new topics. While Kamala Harris certainly exhibited stiffness and repetition, her speech remained within the normal range for a politician known for repeating her favorite talking points. In contrast, Donald Trump’s display of such tendencies was alarming. He displayed a familiar pattern commonly seen in people with cognitive decline.
It was often difficult or impossible to follow Trump’s train of thought. Asked by host David Muir if he regretted anything he did during the January 6 riot, Trump replied: “Yes, I regret everything.”
I said “bloody carnage.” It was a different word, an energy-related word, because they destroyed our energy business. There was a bloody carnage there. And Charlottesville, as you say, that story was debunked. Laura Ingraham, Sean Hannity, Jesse, all of these people covered it. If they read one more sentence, you’ll see it was perfect. It was debunked in almost every newspaper. But they still bring it up. Just like they bring up 2025. They bring up all these things. I ask: You talk about the Capitol. Why are we allowing these millions of people to cross our southern border? Why doesn’t she do anything? And I’ll tell you what I would do. And I’m proud of it.
Dodging questions is a time-honored debate-winning tactic. But Trump’s response seems to go beyond evasion. It is digressive, meaning it is completely unrelated to the question, and situational, meaning it rambles and doesn’t get to the point. Situational and digressive statements can indicate fundamental problems with underlying cognitive processes, such as logical or goal-directed thinking. Did Trump realize that his answer was both irrelevant and illogical?
Eleven days before the debate, Trump spoke at a campaign event in Pennsylvania. Responded He responded to criticism of his incoherent speech by claiming it was part of a deliberate strategy to annoy his opponents. “I do a weave,” he told the audience. “You know what a weave is? I say nine different things and they all tie together in a beautiful way. And it’s just like, a friend of mine, who’s an English professor, says, ‘That’s the most amazing thing I’ve ever seen.'” Viewers can judge for themselves whether the incoherent statements they heard during the debate came together in the end.
The speech, which Trump excuses as “weaving,” is not strategic, but one of many quirks that are spiraling out of control. Last week, David A. Graham wrote: Atlantic Ocean The former president is known to have a tendency to describe things and events as “like nothing anyone has ever seen before.” As per usual, Trump repeatedly used superlatives during the debate. When talking about the economy under his presidency, he said, “No one has ever seen anything like this.” When talking about inflation under Biden, he said, “We’ve never seen it this bad.” When talking about the U.S. withdrawal from Afghanistan, he said, “It was one of the most incompetently handled situations that we’ve ever seen.” Meanwhile, Harris also showed signs of using catchphrases and resorted to well-worn phrases. For example, she asked viewers to “figure it out” more than 15 times. But Trump’s phrasing is so incoherent, aberrant, and frequent that it’s hard to pass it off as normal conversation.
Trump’s speeches in the debates were repetitive not only in form but also in content. Politicians often return to their favorite topics in debates, which is a good strategy. Harris mentioned the 2025 project twice, which was widely unpopular among voters. Recent Opinion Pollsand three times stressed that Americans want to “move forward” or “blaze a new trail.” Trump likewise took every opportunity to elaborate on immigration, a pet peeve of Harris’. But many of the former president’s repetitions seemed more compulsive than strategic. After praising Hungarian dictator Viktor Orbán, Trump spoke at length and inarticulately, unprompted, about a U.S.-Europe gas pipeline, an issue that is unlikely to resonate with many voters. A few minutes later, he brought it up again. The host cut him off for a commercial break. Even when Trump could have rationally defended himself, he failed to articulate evidence of basic innocence. When Harris brought up his infamous 2017 remark about white supremacist demonstrations in Charlottesville, Virginia, that “there are very fine people on both sides,” Trump could have pointed out that he had already made it clear then that “I’m not talking about neo-Nazis or white supremacists, because they should be totally condemned.” But he didn’t.
In psychiatry, the tendency to clearly and stubbornly repeat an idea beyond the point of relevance is called “persistence” and is known to correlate with a variety of clinical disorders, including those involving loss of cognitive reserve. Impairments in cognitive function, such as short-term memory, tend to make people persist over and over on familiar topics. Short-term memory is essentially the sketchpad of your mind: how many different thoughts you can juggle, record, and use in your head at the same time. Given the complexities of being president, short-term memory is an essential skill.
If a patient came to me with the kind of incoherent speech, rambling thoughts, and repetitive speech that Trump now regularly displays, I would almost certainly recommend a rigorous neuropsychiatric evaluation to rule out cognitive impairment. Conditions such as vascular dementia and Alzheimer’s disease are not uncommon in a 78-year-old. Only a careful medical examination can confirm whether someone has a diagnosable disease. It is not enough to simply observe Trump or anyone else from afar. For those who suffer from such diseases and conditions, there are several treatments and services available to help them and their families cope with the decline. But that does not mean that someone is qualified to serve as commander in chief.