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What is the mental competency test Nikki Haley wants politicians over 75 to take?

The Republican 2024 presidential candidate wants Biden, Feinstein and others to take the Montreal Cognitive Assessment. A neurologist explains how that test works.

Nikki Haley.
Nikki Haley, former ambassador to the United Nations, speaks at the Susan B. Anthony Pro-Life America headquarters in Arlington, Va., on April 25. (Al Drago/Bloomberg via Getty Images)

Since announcing her candidacy for president in next year's contest, Nikki Haley has repeatedly called for making "mental competency tests" compulsory for politicians over the age of 75. On Monday, the 51-year-old Republican hopeful elaborated on her proposal in an op-ed for Fox News — naming one specific test she wants all older politicians to take.

"The test I’m proposing for Sen. Feinstein, President Biden and others is not complicated or difficult. The Montreal Cognitive Assessment Test is a widely used tool for detecting cognitive decline," Haley wrote.

"They should both take the test, along with every other politician over the age of 75 — Republican or Democrat, man or woman — and publish the results," she continued. "This is not a qualification for office. Failing a mental competency test would not result in removal. It is about transparency. Voters deserve to know whether those who are making major decisions about war and peace, taxation and budgets, schools and safety, can pass a very basic mental exam."

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When CNN asked first lady Jill Biden in March if her husband would take a competency test, she said, “We would never even discuss something like that.”

Meanwhile, former President Donald Trump spent a good part of his 2020 presidential campaign touting his results on the Montreal Cognitive Assessment as indicative of his mental prowess, with anti-Trump Republicans and news organizations alike snarkily commenting on the peculiarity of the then president “boasting about his dementia test.”

What does the Montreal Cognitive Assessment do?

A patient tells a doctor about his health complaints.
Getty Images

The Montreal Cognitive Assessment is a tool that can help screen for cognitive impairment or decline. But Dr. Sharon Sha, a clinical professor of neurology and chief of the Memory Disorders Division at Stanford University, told Yahoo News a diagnosis can’t be made solely on the test results.

“I would not say that the Montreal Cognitive Assessment test determines [whether] someone has cognitive impairment or not. It's a good screening tool to help give a quick assessment ... and help guide whether additional testing is required or not,” Sha said.

“I don't think that this test should be used in isolation ever to give a diagnosis, but in the right expert hands it can be a very key component in doing a screening assessment for someone who has a cognitive complaint.”

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Sha also noted that it’s possible to have cognitive impairment without a decline in functional abilities — meaning that even with an impairment, it may still be possible to do day-to-day activities like work, drive a car and handle shopping or personal finances.

What does the test look like?

A woman taking an Alzheimer's disease cognitive function test.
A woman taking an Alzheimer's disease cognitive function test. (Getty Images)

The test takes about 10 minutes to complete and is scored out of 30 points, with 30 being a perfect score.

It’s composed of sections that look at several components of cognitive function, including memory, orientation, attention, language, executive function and visuospatial function. The language portion, for example, may include several pictures of animals that the person being tested needs to name, while the visuospatial function section involves copying a drawing.

For testing memory, “there are five words that are listed, and then the person being examined needs to repeat them immediately,” Sha explained. “Then five minutes later, they're asked again what those words are. Similarly, there may be questions about orientation, the day, the date, etc.”

The subtleties of a test score

Health care concept with geriatric doctor consulting examining elderly senior aged adult in medical exam clinic or hospital. (Getty Images)
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When interpreting test scores, Sha said there’s a lot of nuance involved. Scoring 26 out of 30, for example, may seem like a “normal” score based on testing parameters, but if all points were missed in the memory portion of the test and the person has complained of memory loss, that might be cause for concern.

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Sha said that examiners using the Montreal Cognitive Assessment, as with all cognitive assessments, also need to be mindful of the test taker’s educational, cultural and language backgrounds — which may affect test scores without accurately reflecting the person’s cognitive abilities day to day. Someone with less formal education or whose first language isn’t English, for example, may struggle to perform well on a formal exam but have no cognitive difficulty in everyday life.

On the flip side of that, someone like a politician, who likely has advanced degrees in law or business, may experience cognitive problems but be able to easily ace the test — because, as Sha pointed out, “a lot of these questions are very easy.”

“For someone who is highly educated and has concerns about, say, remembering things, just remembering five words five minutes later and scoring perfectly on this test may not be enough to capture some subtleties and difficulty that they might be having on a day-to-day basis,” she said.

“It really needs to be in expert hands to take the context. And that's why just as a general screening measure, doing the Montreal Cognitive Assessment may not be very relevant for someone who is as highly educated — or we assume is highly educated — [as] a political candidate.”