Forensic psychiatrist on physical signs of Trump's mental decline:
"Changes in movement and gait"
"His walk appears wide-based," Dr. Elisabeth Zoffmann notes of Trump. "He
has developed a swing of his right leg."
By Chauncey DeVega

Donald Trump�s obvious public challenges with speech, language, and
thinking are continuing to get worse. At a recent rally in Ohio, the
former president continued to act like a broken computer, going off on
odd tangents, rambling, muddling his speech, and saying, �Joe Biden won
against Barack Hussein Obama, has anyone ever heard of him? Every swing
state, Biden beat Obama but in every other state, he got killed.�

This is not an example of one so-called gaffe or misstatement but rather
part of a much larger pattern where Donald Trump confuses people and
time. Experts have empirically shown such behavior likely indicates some
type of brain disease. Dr. John Gartner, a prominent psychologist and
contributor to the bestselling book "The Dangerous Case of Donald Trump:
27 Psychiatrists and Mental Health Experts Assess a President," has
repeatedly warned in a series of conversations about Trump�s apparent
challenges in cognition and communication that something seems to be very
wrong with the ex-president:

Not enough people are sounding the alarm, that based on his behavior,
and in my opinion, Donald Trump is dangerously demented. In fact, we are
seeing the opposite among too many in the news media, the political
leaders and among the public. There is also this focus on Biden's gaffes
or other things that are well within the normal limits of aging. By
comparison, Trump appears to be showing gross signs of dementia. This is
a tale of two brains. Biden's brain is aging. Trump's brain is dementing.

Dr. Gartner�s attempts to sound the alarm about Trump�s behavior have
been joined by the hundreds of medical professionals who have signed his
Change.org petition, �We diagnose Trump with probable dementia: A
petition for licensed professionals only.�

To deny the obvious about Donald Trump�s evidently diseased mind is to
deny reality and to ignore the real possibility that a man who is already
morally and ethically corrupt and now appears to be experiencing problems
with his thinking could be back in the White House with the awesome
responsibility and power of the presidency � including the sole authority
to order the use of America�s nuclear weapons. Trump�s mind and overall
behavior and character are not just a national emergency but a global
crisis as well.

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Because of a commitment to horserace journalism, fake objectivity and
balance, self-interest and fear, the mainstream American news media �
especially the elite agenda-setting news media � has largely ignored
Donald Trump�s obvious struggles with communication and cognition. The
Washington Post�s Jennifer Rubin is a notable exception.

"His walk appears wide-based and he has developed a swing of his right
leg. He appears glued to the floor when he �dances� for his audience. If
caught on camera standing still, he appears unnaturally immobile."

In an attempt to better understand what we are witnessing with Donald
Trump�s behavior, I recently spoke with Dr. Elisabeth Zoffmann, a
forensic psychiatrist and an Associate Clinical Professor of Forensic and
General Psychiatry at the University of British Columbia. Dr. Zoffmann
shares her evidence-based preliminary conclusion that Donald Trump is
displaying a range of behaviors that suggest cognitive challenges if not
impairment. The former president appears to be suffering from Behavioral
Variant Fronto-Temporal Dementia, Dr. Zoffmann concludes, and needs to be
evaluated by neurologists who specialize in the condition.

This interview has been edited for length and clarity:

What do you see when you look at Donald Trump through a clinical lens?

My observations are garnered from viewing the phenomenon of Mr. Trump for
the past decade. Also, observations from viewing old videotape interviews
and coverage of Mr. Trump as a younger man form part of my impression
that Mr. Trump might benefit from a thorough evaluation by a
neuropsychiatrist with expertise in neurodegenerative disorders. My
observations are as follows:

Changes in speech patterns with many fewer and simpler words (decline
in vocabulary) with fewer adjectives and adverbs.
A decline in cognitive focus on speech subjects with incomplete
sentences and an inability to focus on a topic long enough to complete a
sentence when not reading from a teleprompter.
Difficulty pronouncing words, word substitution and nonsense words �
known as paraphasia
Tangential thinking where the topic switches mid-sentence to some
unrelated topic.
Frequent repetition of words and phrases as if his mind is stuck in a
loop.
Disinhibition and an inability to control verbal outbursts.
Socially inappropriate behavior � mocking a man with muscular
dystrophy, disrespecting fallen soldiers as losers.
Lack of self-awareness in that he apparently cannot see how
inappropriate his behavior has become and use his judgment to stop
himself.
Changes in movement and gait. His walk appears wide-based and he has
developed a swing of his right leg. He appears glued to the floor when he
�dances� for his audience. If caught on camera standing still, he appears
unnaturally immobile.
The changes in judgment and impulse control have uncovered and
perhaps worsened underlying personality traits that others have
characterized as narcissistic and antisocial. The changes have led some
experts to suggest a diagnosis of �malignant narcissism."

Mr. Trump has stated that he passed a cognitive that he described in
terms that suggested either the Mini-Mental Status Exam (MMSE) or the
Montreal Cognitive Assessment (MOCA) scale. These are both simple
screening tests for suspicions of Alzheimer�s Disease.

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My clinical experience and these collected observations are congruent
with the diagnostic criteria for Behavioral Variant Fronto-Temporal
Dementia (FTD). People presenting with such a cluster of observations
should undergo expert assessment. This diagnosis is often largely based
on external observations and collateral reporting from others close to
the person. Early in the disease, the individual may be aware of changes,
but as frontal lobe deterioration progresses the capacity for self-
awareness diminishes. Unlike Alzheimer�s Disease, people with FTD have
intact short-term memory and can easily score full points on screening
tests like the MMSE and MOCA.

Is a person with FTD inherently dangerous?

No.

When social awareness is deteriorating the sufferers may become irritable
with caregivers. In Mr. Trump�s case, the overall picture is consistent
with Behavioral Variable Fronto-Temporal Dementia (with the caveats
mentioned about needing a thorough evaluation including an MRI brain
scan.) The associated disinhibition exposes unfortunate aspects of his
personality and worldview where he repeatedly dehumanizes anyone he sees
as �the other." His repeated statements dehumanizing migrants and
exaggerating their numbers and suggesting they are all killers is a good
example. This meme has caught on with his supporters and in situations of
mass-thinking they may pose a danger to migrants seeking refuge.

"My clinical experience and these collected observations are congruent
with the diagnostic criteria for Behavioral Variant Fronto-Temporal
Dementia (FTD)."

Mr. Trump�s memes seem to resonate with a stratum of American society
that feels disaffected and maligned in a rapidly changing world. Being
blinded to new information and new ways of experiencing scientific
discovery poses a risk for those people � for example, anti-vaccine
people frequently dying of COVID-19 when they could have vaccines.

People often conflate dementia and Alzheimer�s. Can you please clarify?

Dementia is a catch-all term for a number of recognized neurodegenerative
disorders: Alzheimer�s Disease, Lewy Body Disease, Multi-infarct
Dementia, Pick�s Disease, Parkinson�s Disease, Primary Progressive
Aphasia variant Fronto-temporal Dementia and Behavioral Variant Fronto-
temporal Dementia.

In reading and hearing the comments of other observers and experts I am
reminded of the fable of Five Blind Men trying to describe an elephant.
One has the tail, others have the trunk, tusk, legs, and ears and all
give a version of what they have observed. One cannot get a complete
picture of the elephant without combining all of the observations. In the
various interviews and comments from other experts, I recognize all the
criteria I set out from my observations of Mr. Trump. I think we get a
clearer picture if we combine all these observations.

When you were first approached about making a public statement about
Trump's apparent neurological challenges you were reluctant to speak �on
the record.� What changed your mind?