Trump has inspired widespread speculation about his cognitive decline at least 4 times

Donald Trump has spent more than 20 percent of his presidency at his golf resorts, and this past weekend was no exception. After three days of hitting balls around at his club in Bedminster, New Jersey, the president finally decided to return to Washington, D.C. on Monday. Footage of Trump’s arrival shows him exiting Air Force One, then descending the stairs to the tarmac, where a limousine festooned with American flag awaits. But instead of climbing inside, Trump wanders off in a different direction, taking several steps off course before a Secret Service agent can corral him. It’s an odd moment, in which Trump briefly appears befuddled and out of sorts.

The president’s confusion has fueled further speculation about his possible cognitive decline. Holly Figueroa O’Reilly, one of the organizers of the March for Truth, wondered in a tweet that went viral whether or not Trump is “sundowning.”

Sundowning, according to the Mayo Clinic, “refers to a state of confusion occurring in the late afternoon and spanning into the night...that may affect people with dementia, such as Alzheimer's disease.” Though numerouscommentators have suggested Trump’s behaviors correlate with well-known dementia symptoms, he has not been publicly diagnosed with dementia or any other mental health conditions by a medical expert. Growing concerns about Trump’s mental state are speculative, and based on a pattern of potentially worrisome behavior illustrated by the following incidents.

1. He wandered off in the middle of a foreign press event.

Trump met with Prime Minister Benjamin Netanyahu at a joint press conference in May. In the middle of the event, as Netanyahu stood for photos, Trump got up from his chair and wandered away from the Israeli leader. A few seconds later, staffers ushered him back toward where he should have been standing.

2. He forgot to sign an executive order at an executive order signing press event.

Back in April, Trump invited media to watch as he signed two orders focused on trade. He gave brief remarks at the event, then left the podium before signing the documents. Then he absentmindedly opened a door and headed for another room. Mike Pence had to tap the president on his way out to remind him about the unsigned orders. After a brief discussion, Trump continued walking, and Pence followed him out the door with the paperwork.

3. He didn't realize Rudy Giuliani was sitting directly in front of him.

At a press event highlighting Trump's executive orders on cyber security, the president was seated directly across from former New York City Mayor Rudy Giuliani. After a brief speech, Trump introduced Giuliani—who again, was sitting right in front of him—and began searching confusedly around the room. “Where’s Rudy?” you can hear Trump asking in the footage, as Homeland Security Secretary John Kelly directs his attention in the right direction.

4. He couldn't correctly name the country he’d just bombed.

Trump discussed the moments leading up to the U.S. bombing of Syria in an interview with Fox Business’ Maria Bartiromo. Describing a dinner with Xi Jinping, Trump informed Bartiromo that he told the Chinese president, "We’ve just launched 59 missiles heading to Iraq.” When Bartiromo corrected Trump on the country, he paused for a beat, then seemed to recognize his error.