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It hasn’t received much media attention perhaps because this article by a neurologist appeared in STAT, which is a health science publication.

It’s by Ford Vox, M.D., a medical journalist and commentator who practices brain injury medicine in Atlanta.

Finally an expert in neurology weighs in on Trump in a detailed assessment of symptoms related to a brain disorder.

Duty to Warn therapists like me have been concerned that under stress Trump could suffer a psychotic break because of his malignant narcissism and his psychological defenses shattering. As if this isn’t of serious enough concern, we now have the added chance that he could make irrational impulsive decisions due to an actual brain disorder.

What has to be teased out is how his malignant narcissism in some way may mask the symptoms of an actual physical disorder, one which may in fact be terminal – especially Lewy Body dementia which often has a steep and rapid decline to death.

I’m a brain specialist. I think Trump should be tested for a degenerative brain disease

It is somewhat technical but well worth reading if the medical jargon doesn’t bother you. If you want a more accessible laypersons explication, Slate published:

There Is a Very Useful Test We Could Use to Track Politicians’ Cognitive Decline

The test referred to is here:

Mini-Mental State Examination (MMSE)

Patient’s Name: Donald Trump    Date: As soon as possible

Instructions: Score one point for each correct response within each question or activity.

Maximum Score

Patient’s Score

Questions

5

“What is the year? Season? Date? Day? Month?”

5

“Where are we now? State? County? Town/city? Hospital? Floor?”

3

The examiner names three unrelated objects clearly and slowly, thenthe instructor asks the patient to name all three of them. The patient’sresponse is used for scoring. The examiner repeats them until patientlearns all of them, if possible.

5

“I would like you to count backward from 100 by sevens.” (93, 86, 79,72, 65, …)
Alternative: “Spell WORLD backwards.” (D-L-R-O-W)

3

“Earlier I told you the names of three things. Can you tell me whatthose were?”

2

Show the patient two simple objects, such as a wristwatch and a pencil,and ask the patient to name them.

1

“Repeat the phrase: ‘No ifs, ands, or buts.’”

3

“Take the paper in your right hand, fold it in half, and put it on the floor.”(The examiner gives the patient a piece of blank paper.)

1

“Please read this and do what it says.” (Written instruction is “Close your eyes.”)

1

“Make up and write a sentence about anything.” (This sentence must contain a noun and a verb.)

1

“Please copy this picture.” (The examiner gives the patient a blankpiece of paper and asks him/her to draw the symbol below. All 10 angles must be present and two must intersect.)

30

TOTAL

kos-121017b.jpg

We have a president who, in a just political world, would have had impeachment proceedings well underway in the House by now. In a just political world removal under the 25th Amendment because he’s medically unfit and dangerous would also be under serious consideration — but realistically Pence won’t initiate this until and unless Trump’s disorder is so obvious that there was a political and public outcry to save the country from him. 

As someone who belonged to  the duty to warn movement of therapists before the group, now numbering thousands, even had a name, I always thought his behavior would have to become manifestly dangerous to any reasonable observer before any action was taken.  Because of a combination of malignant narcissism and a descent into dementia this may happen soon.

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This is a Creative Commons article. The original version of this article appeared here.

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