Closing Argument For November Fifth And Beyond

We Need To Take Away His Keys Now!

Ⅰ

We can say the following about Donald Trump with the authority that emanates from empirically validated findings.

(Reader alert: If you don’t believe in the scientific method, you probably don’t want to waste your time with this article)

1. Donald Trump suffers from neurodegenerative brain disease. He has crossed the diagnostic threshold from normal aging, characterized by mild cognitive decline, to brain illness, characterized by more severe decline, and, most critically, the likelihood of rapid further deterioration.
2. Donald Trump has unwittingly already participated in a cognitive exam, and the results support his fateful diagnosis. This assertion is controversial because Trump has refused to release his medical records or undertake a comprehensive neuropsychological examination. However, there is sufficient data about his functioning to consider a diagnosis of Neurocognitive Disorder even without the benefit of a personal examination. We will present this evidence in the next section.
3. It is more likely than not that, during the next four years, his current disorder will progress to full-scale dementia with its accompanying loss of functioning in fundamental areas such as dressing, feeding, and toileting. The research on the course of individuals with his current level of cognitive decline underscores this prediction. Once you meet the diagnostic criteria for Mild Neurocognitive Disorder (which he appears to have done at least a year ago), the risk of deterioration to full-scale dementia is around 15% per year, thus rising to around 60% over a four-year span.
4. The grave threat to the country revolves around what might happen between the day he is elected and when his family or the cabinet (via the 25th amendment) remove him from office. The damage will not be confined to Blue America or even the whole country. Because of his lifelong traits of remorselessness, arrogance, imperviousness to punishment, and utter lack of restraint, he has always “carried disaster lightly in each hand.” Now, with his deteriorating neurological condition, those traits pose a devastating multiplier force.

Ⅱ

Donald Trump has, unwittingly, already participated in a cognitive exam, and the results confirm his fateful diagnosis. To back up this assertion, we need to ask and answer the following questions:

1. Is there a scientifically reliable and valid process to diagnose neurodegenerative illness and its accompanying cognitive decline even without the patient’s collaboration? The answer is “yes.”

The answer is found in The Diagnostic and Statistical Manual of Mental Disorders — Version 5 (DSM-5), the authoritative and up-to-date (latest revision in 2022) resource that provides a unified classification of mental health and brain-related conditions. DSM-5 offers a common framework and language to define primary psychopathological syndromes and then provides specific criteria to diagnose them.

A specific chapter — titled Neurocognitive Disorders — is devoted to diagnosing meaningful cognitive decline syndromes due to a medical disease rather than a psychiatric illness. The authors of the Neurocognitive Disorders chapter in DSM-5 included some of the globe’s leading experts in geriatric psychiatry, neurology, neuropsychology, and psychiatric research. This group of experts (The Neurocognitive Disorders Work Group) spent five years evaluating the latest advances in scientific knowledge to devise the diagnostic steps to arrive at a valid diagnosis of meaningful and (almost always) irreversible cognitive decline.

These experts determined that the diagnosis of a Neurocognitive Disorder is all about the decline in critical areas of human functioning, referred to as cognitive domains. The diagnostician is looking for a decline across six domains: attention, memory, language, executive functioning, perceptual-motor, and social cognition. If the patient displays a significant decline in even just one of these domains, you must consider a diagnosis of one of the two primary neurocognitive syndromes. If the decline is “substantial” and the struggle with independent living is significant, the diagnosis of Major NCD (full-blown dementia) is warranted. If the decline is “moderate” and the struggle with independent living is just beginning to emerge, a diagnosis of Mild NCD (early dementia) is required.

If you can measure meaningful decline in one of these basic areas of functioning, you can make a diagnosis of neurodegenerative disease.

2. Is there sufficient data to arrive at a diagnosis of neurodegenerative disease for Donald Trump? Again, the answer is “yes.”

Trump no doubt believes he has avoided scrutiny on his brain health by refusing to release his medical records or collaborate in a neuropsychological exam. (It should be noted that Trump boasts that he has successfully handled “cognitive tests.” He is misleading us. In 2018, he took and apparently passed a 5-minute screening exam for full-scale dementia, not early dementia, which requires more comprehensive and rigorous testing). While his lack of cooperation has complicated the process of collecting sufficient data to arrive at an informed opinion on his brain health, it has not undermined it. There is another source of relevant information: direct observation of his behavior in these domains.

Thanks to reams of videotape on Trump, we have access to many behavioral observations to evaluate for possible cognitive decline. Direct behavioral observation is particularly relevant for the language domain, primarily consisting of verbal expressive behavior. Fortunately, this domain does not require collaboration with Trump since you can execute a detailed, clinically meaningful appraisal directly from a copious amount of speech samples readily available on YouTube. Furthermore, you can zero in on possible decline in the language domain by comparing speech samples from the past to the present.

Thus, we have abundant data in the language domain to evaluate possible neurological dysfunction.

3. Does the data indicate Donald Trump meets the diagnostic criteria for a degenerative neurological syndrome? It does.

That conclusion comes from comparing Trump’s speech over three time periods. Specifically, we applied a list of verbal behaviors associated with early dementia to randomly selected speech samples from Trump as a middle-aged man, from his term as president (2016–2020), and from very recent public appearances. Examples of verbal markers of likely neurological disease include wandering speech (the “weave”), word-finding difficulty, phonemic and semantic paraphasia (expression of inappropriate and unintended sounds or words), and difficulties in creating well-formed sentences in one’s speech. At the same time, we applied a list of verbal markers of aging to the same speech samples. These are verbal expressive behaviors associated with normal aging, such as decreased speech volume and rate, hoarseness, tremors in voice, and others.

The data was precise: Trump showed a noticeable decline in virtually all markers associated with brain disease. Interestingly, he displayed only a few signs of verbal struggle reflective of normal aging (his voice remains strong and confident). Thus, Trump shows clinically significant signs of cognitive decline in the language domain beyond normal aging.

We can reinforce these findings with other studies that have examined Trump’s language behavior. In Trump Wasn’t Always So Linguistically Challenged-What Could Explain The Change? Begley noted “striking and unmistakable” shifts In his vocabulary level and ability to string sentences together. In Popular Press Claims Regarding Linguistic Change in President Donald J. Trump, a study that zeroed in on word-finding difficulties, investigators found Trump displayed a “systematic increase in the use of filler words.” The author of a recent study that applied a metric of analytic thinking to Trump’s contemporary speeches concluded, “I can’t tell you how staggering this is. He does not think in a complex way at all.” STAT, a media organization focused on health research, asked experts in memory, psychology, and linguistics to compare clips of Trump’s speech from 2017 to clips from 2024. They concluded that “Trump’s speech included more short sentences, a confused order of words, repetition and extended digressions.”

We now have accumulating evidence that Donald Trump displays a meaningful decline in language functioning, which points to a disorder associated with some type of underlying brain disease.

4. Do we know which brain illness might be the cause of his documented deterioration? Not for certain.

Remember, Trump has refused to release medical records or cooperate with a neurological exam. Therefore, we do not have access to brain scans, lab results, or other clinical findings that might enable us to pinpoint the underlying disease causing his cognitive decline. Even if we had such findings it is often the case that clinicians cannot identify the underlying illness until the patient has descended to full scale dementia.

However, it is reasonable to suggest Alzheimer’s disease as the likely affliction behind his deterioration. First, Alzheimer’s disease is the most common cause of dementia, accounting for approximately 60–70% of dementia cases. But second, and more relevant to the evaluation of Trump, is the fact his father, Fred, was diagnosed with Alzheimer’s. Individuals with a first-degree relative, such as a parent, who had Alzheimer’s, are more likely to develop the condition — their risk increases by about 30 percent. Furthermore, scientists have identified a gene variant called apolipoprotein4 (APOE4) that increases your risk three times beyond that. Testing for the gene is safe, straightforward, and inexpensive. Unsurprisingly, I could not find anywhere in his reported health records that Trump had submitted to that genetic test.

What do these findings mean for Trump himself and for the country?

Ⅲ

When I developed the checklist of verbal markers last April and applied them to Trump’s speech from different eras, that effort required going over several interviews and speeches to generate sufficient data points to reveal a clearcut pattern of cognitive decline. This documented decline warranted a strong consideration of a formal diagnosis of Mild Neurocognitive Disorder (early dementia).

Well, things have changed since April. In the last two months, you could go over any interview, any speech, or his debate with Harris and the diagnostic signs of early dementia jump out of his mouth. His decline is accelerating. At this point, we should simply note that he has passed the duck test (“If it looks like a duck, walks like a duck, and quacks like a duck, then it probably is a duck”). Here are a few of the many instances of the duck quacking, of the ex-president struggling to communicate coherently.

Of course, here I am required to pause and note that the GOP establishment and many influential media outlets refuse to acknowledge the orange emperor has no clothes. That right-wing establishment demanded Biden resign after his poor debate performance. But did they express any concern over Trump declaring immigrants are eating pets, swaying to music for forty minutes rather than answering questions at a town hall, canceling interviews right and left, confusion over who the current president is, or wandering associations about Arnold Palmer’s penis size? No, it has been crickets. To write off what we are seeing and hearing as ‘that’s just Trump being Trump” or ‘you elites are fools to take him literally” should be called out for what it is: gaslighting.

Still, awareness of Trump’s deteriorating mental capacities might be breaking through to the mainstream media and the public. A recent New York Times article, “Trump’s Speeches, Increasingly Angry and Rambling, Reignite the Question of Age,” highlighted the unsettling changes in his more recent public utterances. While Trump held a nearly 30-point edge on the question of mental fitness when Joe Biden was in the race, an NBC poll from September shows Harris with a “20-point lead on the same question.”

What does this recent, more rapid decline mean? First, we should be more declarative about his near-term functioning. It is not possible to predict precisely for any individual the future course of a dementing brain. Remember, the clock starts ticking on the empirically derived guideline of 15% increased risk per year of descending into full-scale dementia when you cross the threshold of the diagnosis of early dementia. Trump appears to have crossed that threshold at least a year ago. But this 15% risk, accumulating each year, probably underplays the peril of Mr. Trump’s brain health. He is in a poor prognosis group because of his family history of Alzheimer’s and the fact that these diagnostic signs have escalated in the past year. Sadly for him, his recent noticeable decline certainly raises the concern that he may struggle to maintain the capacity for independent living over the next couple of years. Second, his documented decline in language functioning strongly suggests deterioration in the other five primary areas of cognitive functioning: memory, attention, executive skills, social cognition, and perceptual-motor skills.

There are worrisome signs with his memory and perceptual-motor skills (how one can navigate the world physically). Everyone can mix up names, but Trump mixes up people — Nikki Haley for Nancy Pelosi and Mayor Willie Brown for a councilman are recent examples. Imagine entrusting the demands of the presidency to a failing memory. Trump’s bent, forward-listing posture, jerking right arm and leg, and arm weakness are also unnerving signs of neurological dysfunction and not just normal aging.

In the April assessment of Trump’s neurological health, I gave him a pass in the three essential cognitive domains of attention, executive skills, and social cognition. I reasoned this pass was necessary because of his documented, frequently observed abysmally low functioning in these areas. It is difficult to demonstrate a decline — the key diagnostic criteria — when the baseline of functioning is well below average.

These deficiencies should not be attributed to neurological disease, I reasoned. That is not to say the manifestations of these deficiencies in the White House were not serious. A few examples:

• Trump’s notoriously short attention span forced accommodations upon all those in his orbit. A head of state described a 60-minute meeting with Trump as “60 one-minute meetings.” John Bolton, Trump’s National Security Advisor, said that — except when it comes to being reelected — Trump has the “attention span of a fruit fly.”
• With regard to his executive functioning, it is no exaggeration to say Trump was never able to formulate, much less execute, a plan for any substantive or thorny issue during his term. In his book The Fifth Risk, Michael Lewis describes Trump’s determination to shirk the executive demands of the office. After he won the election, Trump actively undermined the transition process. He quickly disbanded the transition team headed by Chris Christie, telling him, “We can take an hour off from the (Inaugural) party to learn everything we need to know about running the government.”
• Trump’s social cognition is deeply flawed. His self-awareness, ability to empathize, and capacity to work collaboratively with others are compromised. He has an arrogant self-image that has undermined trust in the White House. As Politico’s Diamond reported, “Trump’s unpredictable demands and attention to public statements — and his susceptibility to flattery — have created an administration where top officials feel constantly at siege, worried that the next presidential tweet will decide their professional future, and panicked that they need to impress him regularly.”

We can no longer give Trump a pass on the impact of his neurological struggles with his attention, executive skills, and ability to empathize and work with others. Even if he has only ever functioned in the bottom 1 or 2% in these areas, a 50% further drop-off, given the office he is seeking, is consequential.

IV

What might it be like for the country to have a president in observable cognitive decline? Donald Trump is not going to wake up one morning next Spring with full-scale dementia. There is typically a gradual descent to that state. However, given what we have observed over the past few months, it would be surprising if there weren’t noticeable and meaningful shifts in the six primary areas of functioning. Here are some expected ramifications of such shifts:

· Attention — tasks take noticeably longer to complete than previously, and work must be double-checked for errors.

· Executive functioning — struggles to understand complex material or concepts., has trouble resuming an interrupted task, and has difficulty organizing, planning, or making decisions.

· Learning and memory — difficulty recalling recent events, relies on reminders and list-making.

· Perceptual-motor skills — may rely more heavily on maps or notes for directions.

· Social cognition — less ability to read social cues, such as facial expressions, and decreased empathy, and diminished inhibition.

• Language — more severe mind-wandering, more difficulty expressing oneself in a cogent manner, decreased capacity to understand others speech.

These are the expected shifts for anyone in the throes of neurodegenerative decline. However, Donald Trump is not just “anyone.”

We are thoroughly familiar with him. He has been a well-known celebrity for 40 years and has been omnipresent on our screens for the past eight years. He is arguably the most well-chronicled candidate in history. A partial list of informational sources would include 13 autobiographical efforts, his social media posts, 71 biographies, many richly sourced, and hundreds of interviews from print, radio, and television.

This wealth of behavioral observations and biographical information has enabled us to conduct a reliable, detailed, and valid assessment of clinical psychopathy, a relatively rare (less than 1% of the population) and severe personality disorder. You can find the results of that evaluation here and here. Donald Trump meets the rigorous diagnostic criteria for that disorder: he is a clinical psychopath.

The essence of clinical psychopathy, also referred to as malignant narcissism, is captured by its three governing traits, as follows:

(1) Impulsivity — characterized by the inability to inhibit impulses or grapple with any issue that doesn’t serve the psychopath’s immediate, egocentric needs.

(2) Remorselessness — characterized by an utter lack of conscience, linked to an inability to experience states of guilt, shame, and fear that might curb immoral behavior.

(3) Drive to dominate — characterized by a one-dimensional focus on “winning” in all relationships, fueled by arrogant, manipulative, and deceitful behavior.

All of the behavior and all of the choices of the psychopath flow from these three governing traits.

So, the more acute question is: What might it be like for the country to have a president in observable cognitive decline who also displays Psychopathic Personality Disorder?

A dementing brain doesn’t usually alter the traits of the patient. The more common result: dementia leads the person to be “more so” regarding their cardinal traits. For Trump, given his baseline of psychopathic traits, this would mean a shift from:

Disinhibited to incontinent

Disagreeable to antagonistic (“You’re a s*** vice-president”)

Domineering to “I am your vengeance”

Demanding fealty to locking up “enemies within”

Arrogance to grandiosity (“I am never wrong”)

Uncaring to neglectful

Sense of entitlement to no rules at all applies to him

Garrulous to can’t get off the stage

Impulsive to reckless

Feckless to oblivious

You may notice that remorselessness is not on the list of traits that are becoming more extreme. Remorselessness, for the clinical psychopath, reflects the absence of the ability ever to feel remorse for any harmful behavior. There is no room for a shift downward because no capacity for remorse exists. Psychopaths appear to be born with a brain abnormality that prevents them from experiencing the states of guilt or shame. Biographical accounts of Trump, which include numerous anecdotes from childhood, validate that he has always been thoroughly unrepentant, unashamed, and uncaring. That will continue.

Becoming “more so” as a result of his dementing brain leaves the country vulnerable to more extreme versions of Trump’s set of innate, destructive personality traits. This is not speculation. We are seeing these shifts in real-time.

Many have recently noted that Trump is becoming more unhinged. They are not wrong. His turn to more dangerous and reckless speech is not performance art to win votes. Nor is it the machinations of an evil genius. It is the irreversible consequence of the combined force of his dementing brain and psychopathic personality structure.

I have compared Trump to a puppet on the strings of his master traits of impulsivity, remorselessness, and drive to dominate. With his cognitive decline, those strings are fraying. We can expect more rage, simplified thinking, bullish behavior, and continued deterioration of speech and impulse control. He will be unashamed and, increasingly, oblivious to the harm he inflicts.

There is nothing we can do to stop Trump’s accelerating cognitive decline, but we can protect the country from it. America, we need to take away his keys now!

Please note: This article is not financed by or related to any political campaign and may not be considered political advertising or action on behalf of any political candidate. All statements and opinions are those of the author alone, including any political endorsements made. The information published in this article is for information only and is not intended to provide psychological therapy or diagnostic advice and/or recommendations to any persons aside from its subject, Donald J. Trump, public figure. The content of this article is intended to provide informational, scientific, and educational material based on psychological science. The content of this article solely reflects the views and perspectives of its author and does not necessarily reflect the views or positions of the American Psychological Association, medium.com, or any other person and/or entity not otherwise listed as an author.