Health
Amid concerns about Biden’s mental acuity, experts reveal how cognitive tests work and what they reveal
After President Biden’s lackluster debate performance sparked renewed concerns about his mental acuity, both sides of the political spectrum have been clamoring for him to take a cognitive test.
Biden has not seen a neurologist, but did undergo his annual physical exam in February, Dr. Kevin O’Connor, physician for the president, said in a July 8 statement from the White House.
The doctor reiterated that Biden’s physical exam did not reveal concerns about a neurological disorder.
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In a recent interview with George Stephanopoulos, Biden remained noncommittal about formal cognitive testing, noting, “I have a cognitive test every single day” — meaning by performing his duties as president of the United States.
Many Americans, however, have wanted greater transparency.
In a recent interview, Biden remained noncommittal about formal cognitive testing, noting, “I have a cognitive test every single day” — meaning by performing his duties as president of the United States. (ANDREW CABALLERO-REYNOLDS/AFP via Getty Images)
“I am writing today to request that you urge President Biden, in the strongest possible terms, to take a cognitive and neurological exam and to share the results with the American people,” Sen. Lindsey Graham (R-S.C.) wrote to Dr. O’Connor on July 12.
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The United States Preventative Services Task Force (USPSTF) states on its website that there is insufficient evidence to recommend screening tests for cognitive impairment in older adults.
The free Medicare annual wellness visit, however, does cover detection of cognitive impairment, according to the Centers for Medicare & Medicaid Services website.
What exactly is a cognitive test?
Fox News Digital spoke with leading neurologists to determine how cognitive tests work, as well as what they can and can’t identify.
None of the doctors who offered comments have assessed or treated President Biden.
There are three main types of cognitive testing available, experts said. Those include the MMSE (Mini-Mental State Examination), the MoCA (Montreal Cognitive Assessment), and neuropsychological testing. (iStock)
“Cognitive tests are designed to measure a range of mental functions and abilities, targeting specific areas such as memory, attention and concentration, language and processing speed,” Dr. Fred Cohen, assistant professor of medicine and neurology at the Icahn School of Medicine at Mount Sinai in New York, told Fox News Digital.
These tests are divided into three types: screening tests, mental status examinations and neuropsychological testing.
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“The Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE) and neuropsychological testing are all important tools doctors and neuropsychologists can employ to assess a person’s behavior and thinking ability,” Dr. Michael S. Okun, medical adviser for the Parkinson’s Foundation and director of the Fixel Institute for Neurological Diseases at University of Florida Health, told Fox News Digital.
The first step is often a screening test, but that does not diagnose any specific disease – it can only suggest the possibility of cognitive impairment, experts say.
Further testing is needed to identify the underlying cause.
What is dementia?
Dementia describes a group of conditions in which people have an impaired ability to remember, think or make decisions, which disrupts their daily activities, according to the U.S. Centers for Disease Control and Prevention (CDC)’s website.
There are many types of dementia, but Alzheimer’s disease is the most common.
“Cognitive tests are designed to measure a range of mental functions and abilities, targeting specific areas such as memory, attention and concentration, language and processing speed,” an expert said. (iStock)
“There is rock-solid data that 5% to 8% of folks over the age of 60 will later develop dementia,” Okun said.
This data was partly why Congress passed a law prohibiting commercial pilots from flying after the age of 65, he noted.
Dementia risk increases with age. By the time people are in their 80s or 90s, the chances are between 10% and 30%, according to Okun.
What is the MMSE?
The MMSE (Mini-Mental State Examination) is a 30-point questionnaire that assesses various cognitive functions, including memory and orientation.
It can be used to monitor changes over time, Cohen said.
The 11-question test, introduced in 1975, is a quick dementia screen that typically takes about five to 10 minutes to administer, according to experts.
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Some of the questions ask the person to perform specific tasks, like providing the current date and year, subtracting 7 from 100 repeatedly, recalling three unrelated objects after three minutes, and following a three-step command, such as “take a paper in your right hand, fold it in half and put it on the floor,” Cohen said.
What is the MoCA?
Like the MMSE, the MoCA (Montreal Cognitive Assessment) is scored out of 30 points, but takes slightly longer to administer, Cohen said.
It includes tasks such as drawing a clock, naming animals, recalling lists of words or numbers, and making “abstractions” — such as stating “fruit” when given an apple and orange.
Most cognitive tests don’t consider the mood of the individual – so if someone is depressed, that person may score lower, experts warn.
“Former President Trump has mentioned that he took a cognitive test that included identifying animals, indicating that he was likely given the MoCA,” Cohen said.
People receive points for correct answers on both tests — lower scores indicate greater concern for cognitive deficiency.
“The MoCA takes about 10 minutes to administer, and it is a little better than the MMSE, especially if your goal is to screen for mild cognitive impairment,” Okun added.
The first step is often a screening test, but that does not diagnose any specific disease – it can only suggest the possibility of cognitive impairment, experts say. (iStock)
These tests can only reveal what is going on at that moment in time; they cannot determine how someone is functioning in their everyday life, according to experts.
The screening tools may identify potential cognitive issues, but more comprehensive testing is required if a deficiency is suspected, Cohen cautioned.
“The MoCA and MMSE are considered by experts to be broad and shallow tests, and therefore should only be applied for screening and triage,” Okun added.
People can achieve a perfect or near-perfect score on a MoCA or MMSE but still have significant cognitive impairment, he noted.
The tests also don’t consider the mood of the individual – so if someone is depressed, that person may score lower, according to previous research.
Language barriers, physical handicaps or lower levels of education can also affect the results, experts say.
What is neuropsychological testing?
This type of testing, which takes several hours, is a true comprehensive assessment that can be applied for diagnosis of cognitive disorders, according to Okun.
A neuropsychologist tailors the test to the individual’s presenting symptoms.
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“Neuropsychologists spend a great deal of time gathering a detailed history that goes well beyond what a general doctor, neurologist or psychiatrist may have time to collect during their usually brief consultation(s),” he added.
The specialist may ask if the person has difficulty searching for words in conversation or uttering the wrong words or sounds within a word.
After President Biden’s lackluster debate performance sparked renewed concerns about his mental acuity, both sides of the political spectrum have clamored for him to take a cognitive test. (Getty Images; iStock)
Specialists may also ask if someone forgets notable events or repeats the same comment, misplaces items, bumps into things or gets lost in thought.
“Folks should be aware that the MoCA and the MMSE are not a replacement for neuropsychological testing, even if a person achieves perfect or near-perfect scores,” Okun advised.
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He recommends considering this testing when family and friends notice any changes, no matter how small, in their loved one’s behavior or job performance.
Added Okun, “The comprehensive testing will form the basis for a treatment plan and provide a critical baseline performance, which can be used to track disease progression.”
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An accidental lab discovery has opened the door to entirely new ways of preventing the flu.
While investigating how influenza replicates, researchers discovered that different flu strains use completely different strategies to infiltrate human cells, SWNS reported.
By targeting the specific molecules the viruses rely on, scientists found that they could block them from entering new cells and halt their replication altogether.
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Researchers say these “fundamental insights” into seasonal influenza highlight a clear path toward developing better preventive medications.
“The hope is that fundamental, curiosity-based research like this helps to pave the way for novel strategies to treat and prevent influenza infections,” principal investigator Dr. Emily Bruce, from the University of Vermont’s Larner College of Medicine, said in the SWNS report.
While investigating how influenza replicates, researchers discovered that different flu strains use completely different strategies to infiltrate human cells. (iStock)
While several flu strains cause illness, H1N1 and H3N2 influenza A viruses are the most common. However, current flu tests cannot differentiate between them, and clinical treatments are identical for both.
Although vaccines and antivirals are available, Bruce noted a “dire” need for better medications to stop the virus from spreading cell to xxcell.
“You don’t get sick when a virus is in one cell,” he noted. “You get sick because a virus replicates itself and goes into many more cells.”
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The study, which was published in The Journal of Virology, originally aimed to map how viral RNA segments are transported within cells to create new viral particles.
The team used H1N1 and H3N2 viruses isolated from the nasal passages of positive patients in 2022.
Clinical treatments remain identical for both primary strains of the flu virus. (iStock)
During the investigation, the team unexpectedly stumbled upon a cellular pathway that blocked the virus from entering lung cells, SWNS reported.
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The data revealed that when a specific human protein called Rab11B was depleted, H3N2 viruses failed to enter human lung cells. H1N1 viruses were completely unaffected.
Using reverse genetics, the team mapped this defect and uncovered a brand-new, H3N2-specific role for Rab11B during viral entry.
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This discovery challenged the scientific assumption that all flu viruses enter cells the same way.
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“Viruses are like pirates from different countries hijacking someone’s ship,” Bruce said. “Different viruses, like different types of pirates, use different methods to get onboard.”
This discovery challenged the scientific assumption that all flu viruses enter cells the same way. (iStock)
“We had previously thought that all flu viruses used the same way to get into a cell, but we discovered that this is not true,” she went on. “H1N1 and H3N2 need different proteins to get in, and if you get rid of the right protein, a specific virus can’t get in.”
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While these findings identify a critical cellular pathway for viral entry, the study was conducted using isolated cells, the researchers acknowledged.
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Further research is needed to determine whether blocking the protein is safe and effective within a live, complex human respiratory system.
Bruce and the team hope to conduct further research to determine whether this Rab11B-dependency is a fundamental property of H3N2, or if it’s a trait unique to currently circulating flu strains.
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Eating processed meat like ham, sausage and bacon may be linked to a higher risk of certain types of cancer, according to new research.
While health organizations have already confirmed that processed meat can contribute to colon cancer, this study looked closer at cancers in the upper digestive tract, where the link has historically been less clear.
To understand these connections, researchers from the European Prospective Investigation into Cancer and Nutrition (EPIC), one of the world’s largest long-term nutrition and cancer cohorts, tracked the health and diets of 450,112 people across Europe for an average of 14 years.
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The study group included 131,426 men and 318,686 women, according to the study’s press release.
During the follow-up period, 876 people developed stomach cancer and 215 people developed esophageal adenocarcinoma, which is cancer of the tube connecting the mouth to the stomach.
For female participants, eating both processed meat and white meat was linked to an increased risk of developing the disease. (iStock)
Researchers tracked where the stomach cancers grew, separating them into the upper part of the stomach near the throat and the lower part of the stomach.
The researchers also sorted the tumors into two categories based on how the cancer cells appeared under a microscope: intestinal, which forms more organized structures, and diffuse, in which the cells are more scattered throughout the tissue.
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After adjusting for other lifestyle factors, the researchers found that for every extra 30 grams of processed meat a person ate per day, their overall risk of stomach cancer went up by 9%. Eating that same extra 30 grams a day was also linked to a 13% higher risk of esophageal adenocarcinoma.
A standard single slice of regular deli-sliced ham or lunch meat averages around 28 grams, according to USDA data and nutritional tracking databases.
An extra 20 grams of white meat, such as chicken and turkey, was linked to a 12% higher risk of cancer in the main body of the stomach. (iStock)
An extra 20 grams of white meat, such as chicken or turkey, was linked to a 12% higher risk of cancer in the main body of the stomach, the researchers noted.
The study also revealed differences between men and women. For male participants, only processed meat showed a clear, statistically significant link to a higher risk of stomach cancer. For female participants, however, eating both processed meat and white meat was linked to an increased risk.
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These findings align with global health benchmarks, particularly those established by the World Health Organization’s International Agency for Research on Cancer.
The agency has long classified processed meat as a known human carcinogen, primarily due to its strong, well-documented links to colorectal cancer.
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However, health organizations have also consistently pointed to a potential, yet less definitive, relationship between these meats and cancers of the stomach.
Eating 30 grams of processed meat a day, or the equivalent to one slice of ham, was linked to a 13% higher risk of esophageal adenocarcinoma. (iStock)
Further scientific investigation is needed to confirm the findings and to account for other underlying risk factors, such as certain stomach infections, which could interact with dietary habits.
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A key limitation of the study is its reliance on self-reported diets, which can sometimes lead to inaccuracies in how participants recall their meat consumption over time, the researchers noted.
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The findings were published in the International Journal of Cancer.
Fox News Digital reached out to the researchers requesting comment.
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