Pressure is mounting on President Joe Biden among voters and his own party to stand down or prove he is mentally fit enough to beat Donald Trump.
The 81-year-old has repeatedly refused to take a gold-standard cognition test that looks for signs of dementia or Parkinson's, which many doctors suspect he has.
Biden has said he doesn't need to take the exam, claiming 'every day I have that test' - implying the job of president itself is a test of his mental acuity.
By contrast, Donald Trump has bragged about 'acing' the test twice, gloating that he scored a perfect 30 out of 30 on both occasions.
So, how would you do? We've included instructions on how to do the test yourself at home at the bottom of this article. DailyMail.com has also spoken to the creator of the so-called MoCA test on his thoughts about Biden, which you can read here.
The Montreal Cognitive Assessment (MoCA) is a 10-minute test was created in 1996 for medical professionals to identify mild cognitive dysfunction, a precursor of dementia.
It assesses concentration, attention, memory, language, calculations, orientation, executive functions and visual skills.
The test is not a 'medical capability assessment' but a medical tool for screening cognition and is intended to be only administered by healthcare professionals that have received the required training and certification.
A score above 26 is deemed 'normal,' while anything lower than that is cause for concern.
Those who do well on the test do not need further cognitive examination.
The average score is 27.4. People with mild cognitive impairment score an average of 22.1, while Alzheimer's patients tend to score around 16.
First used in Montreal, Canada, the test is now one of the most respected methods of assessing cognitive health worldwide, available in over 100 languages and dialects, and formats for testing illiterate patients and in other cultural settings (by changing certain references).
If a patient has failed the MoCA or is suspected to have more subtle impairments, a 30 minute or a 60 minute battery of neuropsychologic tests are recommended, or a referral for more extensive neuropsychologic testing may be necessary.
Can YOU pass the cognitive test that experts want Biden to take?
This is how a doctor performs the test, and how a patient is graded. To test yourself, you'll need a partner and a sheet of paper.
Physicians say you should only do the test with a doctor to make sure the results are accurate and well-interpreted. There is a physician-approved self-test version which you can take online.
1. ALTERNATING TRAIL MAKING
TEST: Write the fist five letters of the alphabet and numbers (1-5, A-E) on a piece of paper.
Now connect them with dotted lines in ascending order.
RESULT: You get a point for every successful pair: 1-A; 2-B; 3-C; 4-D; 5-E. No lines can be crossed. The patient earns 0 if they make a mistake that is not immediately corrected.
2. VISUOCONSTRUCTIONAL SKILLS (CUBE)
TEST: Draw your own version of the cube in the space next to it.
It must be exactly the same as the one printed on the page.
RESULT: One point if it is drawn correctly (i.e. three-dimensional, all lines are drawn, no line is added, lines are relatively parallel and their length is similar – no point if any of those criteria are missing).
3. VISUOCONSTRUCTIONAL SKILLS (CLOCK)
TEST: Draw a clock, putting in all the numbers and set the time to 10 minutes past 11 o'clock.
RESULT: One point is allocated for each of the following three criteria:
- Contour (ONE POINT): the clock face must be a circle with only minor distortion acceptable (i.e. slight imperfection on closing the circle).
- Numbers (ONE POINT): all clock numbers must be present with no additional numbers; numbers must be in the correct order and placed in the approximate quadrants on the clock face. Roman numerals are acceptable. Numbers can be placed outside the circle contour.
- Hands (ONE POINT): there must be two hands jointly indicating the correct time; the hour hand must be clearly shorter than the minute hand. Hands must be centered within the clock face with their junction close to the clock center.
A point is not assigned for a given element if any of the above-criteria are not met.
4. NAMING
TEST: Name each animal.
RESULT: One point for each:
Lion
Rhinoceros (or rhino)
Camel (or dromedary)
5. MEMORY
TEST: This will involve your partner. Ask your partner to read out the below list of words, and then say back as many of the words as you can remember.
FACE, VELVET, CHURCH, DAISY, RED
RESULT: No plus points for this test, but minus points for every word missed or that is incorrect.
6. ATTENTION
TEST (numbers): Ask your partner to read out the below list of numbers, then recite the numbers back to them in order.
2 1 8 5 4
Also ask your partner to read out the below list of numbers, and then recite them back to them in a backwards order.
7 4 2
RESULT: One point for getting each scenario right
TEST (letters): Ask your partner to read out the below list of letters at a rate of one per second, and tap every time you hear the letter A.
F B A C M N A A J K L B A F A K D E A A A J A M O F A A B
RESULT: One point if no mistakes. No points if two or more errors.
TEST (math): Begin at the number 100, and then count down by subtracting seven every time. Do this five times. Your answers should look like the below numbers.
- 93
- 86
- 79
- 72
- 65
RESULT: Three points if four or five answers are correct, two points if two or three are correct, one point if one is correct, no points if they are all wrong.
7. SENTENCE REPETITION
TEST: Ask your partner to read out the below sentences, and then say it back to them. The sentence must be exactly the same, with no substitutions or changes to words.
'I only know that John is the one to help today. The cat always hid under the couch when dogs were in the room.'
RESULT: One point for each correct sentence.
8. VERBAL FLUENCY
TEST: Set a timer for 60 seconds and try to think of as many words as possible that begin with the letter F. The aim is to get at least 11 words.
These words cannot be proper nouns, like Bob or Boston, and cannot be the same sounding but with different suffixes (e.g. love, lover, loving).
RESULT: One point for reaching 11 words or more within a minute.
9. ABSTRACTION
TEST: The similarity between a banana and an orange is that they are both fruit. Find the similarity between the following two pairs.
Train - bicycle, and watch - ruler
RESULT: One point for each similarity that is correct
Acceptable answers:
- Train and bicycle: means of transport, means of traveling, used to take trips
- Ruler and watch: means of measurement, measuring instruments
Unacceptable answers:
- Train and bicycle: they have wheels
- Ruler and watch: they have numbers
10. DELAYED RECALL
TEST: Try to recall all the words you heard earlier in the memory section, on question five.
RESULT: One point for each word that was recalled correctly.
The words were FACE, VELVET, CHURCH, DAISY and RED.
11. ORIENTATION
TEST: Say the exact date, and then the month, year and day. Also say the place where you are and the city that you are in.
RESULT: One point for each that is correct, up to a maximum of six points.
TOTAL SCORE:
Add up all the points accumulating, adding a point if the patient has fewer than 12 years of formal education.
- Around 16: cognitive health of an Alzheimer's patient
- Around 22: cognitive health of someone with Mild Cognitive Impairment (MCI)
- Above 26: Normal
- 30: Perfect score
