"We've observed in Donald Trump what appears to be a diminished range of vocabulary, that the sort of number of words he uses has diminished over time," said Pakman. "We've seen these, what I call glitches, where when he gets a word wrong, there's a physical thing where a shoulder goes up, and he seems to almost reboot, for lack of a better term ... am I making something out of nothing, or are there clinically relevant observations that we can make here?"
Shea confirmed these are all, in fact, trouble signs.
"What's happening within the brain networks is that the brain is supposed to be regulating and suppressing unwanted motor movements," she said, noting that this isn't well developed in kids, and also deteriorates as people age. "The frontal lobe should be suppressing unwanted motor movements like those twitches."
Pakman then noted a study during the 2024 presidential campaign finding that former President Joe Biden's vocabulary only diminished slightly from years ago, and former Vice President Kamala Harris' didn't at all — but Trump's diminished significantly. "Is that clinically relevant in some way?"
"It's absolutely clinically relevant," said Shea. "That signifies that the brain deterioration in Trump is much more significant than in Biden ... his vocabulary is very repetitive. It's very monosyllabic, which sometimes is going to have to do with the fact that it's really hard for Trump to say multisyllabic words right now." His "perseveration" on topics like the 2020 election is worrisome as well, she said.
The topic then turned to the Montreal Cognitive Assessment, the dementia test Trump constantly brags about "acing" — which Shea clarified isn't really a good sign.
"If he actually got a perfect score, a 30 out of 30, it honestly tells me nothing ... even people who have dementia, who come into my office who already have a diagnosis, can still sometimes get 30 out of 30 on that test," said Shea. "So 30 out of 30 doesn't actually tell me much. The fact that he has taken it multiple times over the course of a year and a half tells me way more." What that means, she said, is "they're looking for something, whether it's decline or medication, how is he responding to medication?"
Pakman later noted that he has seen a deterioration of Trump's motor skills as well, including his inability to cap a Sharpie and fumbling with Tic Tacs at Lindsey Graham's funeral — something Shea isn't as thorough of an expert in, but which she agreed was troubling.
"The brain controls everything," said Shea. "So, fine motor control of your articulators is the same thing as fine motor control with your fingers." She noted that his handwriting has shown signs of deterioration as well. "It's not just the muscles themselves. It's the proprioception, where his body is in space and what his arms and legs and things are doing. It's visual perceptual processing. It involves more than we think. So when you have general brain decline ... everything becomes affected."
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