What Trump’s Physical Exam Doesn’t Test
The Montreal Cognitive Assessment (MoCA) can't assess fitness-for-duty.
The report checks the boxes. It doesn’t answer the question.
The White House released a three-page memorandum on Friday evening detailing the results of President Trump’s annual physical at Walter Reed. His physician, Captain Sean Barbabella, declared Trump in “excellent health” and “fully fit to carry out all duties of the Commander-in-Chief.”
The report is thorough by the standards of presidential physicals. Cardiac imaging, blood work, a cognitive screen.
But the question the public is asking is not whether Trump’s labs are in range. It’s whether a 79-year-old president can discharge the powers and duties of the office. That’s a functional question — about judgment, processing speed, decision-making under pressure — and this report does not answer it. Nothing in the structure of presidential health disclosure requires that it does.
Here’s what the report shows, what it contradicts, and what it leaves out.
A perfect score on the wrong test.
Trump scored 30 out of 30 on the Montreal Cognitive Assessment (MoCA). He has now taken this test at least three times in official physicals — in 2018, in April 2025, and now in May 2026 — and by his own account also in 2020.
The MoCA is a 10-minute screening tool. It asks you to name animals from a drawing, copy a cube, draw a clock. A score of 26 or above is considered normal. It was designed to catch moderate cognitive impairment in a doctor’s office. It was not designed to assess fitness-for-duty.
Two problems. First, repeating the same screening test creates a practice effect. You perform better just because you’ve seen it before. The MoCA’s own guidelines say it should not be used repeatedly for longitudinal monitoring. Second, and more fundamental: the MoCA doesn’t test the cognitive abilities that matter most for the presidency. It doesn’t measure decision-making under pressure, processing speed, complex planning, impulse control, judgment under ambiguity, or the ability to adapt when conditions change.
A comprehensive neuropsychological evaluation does. It takes 4 to 6 hours. It’s administered by a licensed neuropsychologist. It’s the standard for fitness-for-duty determinations in airline pilots, nuclear plant operators, and military commanders.
No sitting president has undergone one publicly.
Weight up, blood pressure down. The numbers don’t add up.
Trump weighed 224 pounds at his April 2025 physical. He now weighs 238. That’s a 14-pound gain in 13 months, putting his BMI at 29.7, one decimal point from clinical obesity.
His blood pressure was 128/74 in April 2025 and is now reported as 105/71. On its face, that’s normal. But a 23-point drop in systolic pressure in a patient who gained 14 pounds is paradoxical. Weight gain typically raises blood pressure. The memo lists no blood pressure medication.
The stroke risk no one is talking about.
Trump has no documented cardiovascular disease. His coronary CT angiography was clear. His carotid ultrasound was normal. His cholesterol is well-controlled on two medications.
But he has multiple risk factors for stroke and neurocognitive decline that the report either doesn’t address or actively worsens.
Age and sex. At 79, ischemic stroke risk doubles every decade. Male sex adds further risk at every age.
High-dose aspirin. Trump takes 325 mg of aspirin daily, more than three times the 81 mg most guidelines recommend, and against his own physicians’ advice. He has said publicly that he prefers the higher dose. The memo itself recommends “low-dose aspirin” while the president takes four times that amount.
This matters. The ASPREE trial, which studied 19,114 adults over 70, found that aspirin produced a 38% increased risk of intracranial hemorrhage (bleeding) with no significant reduction in ischemic (blockage) stroke. That was at 100 mg. At 325 mg, the hemorrhagic risk is higher. At his age, high-dose aspirin is more likely to cause a stroke from bleeding than prevent one from blockage.
COVID history. Trump’s medical history includes COVID infection in October 2020, which required hospitalization and experimental treatment. SARS-CoV-2 causes cerebromicrovascular damage through ACE-2 depletion in cerebral blood vessels. In older adults who are overweight or obese, there’s an increased risk of persistent neurocognitive effects from COVID, including processing speed deficits and executive dysfunction.
Obesity and sedentary lifestyle. At BMI 29.7 and gaining, Trump is near the obesity threshold. The memo recommends “increased physical activity,” meaning current activity is insufficient. Sedentary behavior is independently associated with dementia through reduced cerebral blood flow and metabolic pathways.
Obstructive sleep apnea, likely unscreened. No sleep study appears in any of the four memos. Trump’s profile — male, overweight, and 79 — puts OSA prevalence above 50%. OSA is an independent stroke risk factor and causes hippocampal damage via chronic intermittent hypoxia, accelerating cognitive decline.
No brain imaging. No MRI or CT of the head is mentioned in any of the four reports since Trump returned to office. For a 79-year-old with the risk profile described above, this is a significant gap. Silent strokes, white matter disease, and cerebral microbleeds are common at this age and directly predict future stroke and cognitive decline.
A drug disappeared. A lab value jumped tenfold.
Trump was on finasteride, a prostate and hair-loss drug, from at least 2016 through 2020. It disappeared from his medication list in the April 2025 memo without explanation. It’s still absent in 2026. No reason was given.
This matters because finasteride suppresses PSA by approximately 50%. Trump’s PSA went from 0.10 in April 2025 to 1.0 in May 2026 — a 10x increase. A PSA of 1.0 is normal for a 79-year-old. But the jump is not interpretable without knowing the drug timeline. If he stopped finasteride, the rise could be drug rebound. If he didn’t stop it, the rise warrants investigation.
This is the pattern throughout the report: individually defensible data points presented without the context that would allow longitudinal clinical assessment.
One physician, no independence, total presidential control.
There is no legal requirement for the president to release information about their health. Every finding comes from one military physician who serves at the president’s pleasure, with no independent review.
Presidential physicians have a long track record of shading the truth. During Trump’s first term, his physician Dr. Sean Conley admitted he wasn’t upfront about how sick the president was during his COVID hospitalization because he wanted to project an “upbeat attitude.” FDR’s doctors concealed a fatal heart condition. Garfield’s physician lied about the severity of his wounds. Cleveland had secret cancer surgery on a yacht.
The physician’s role is advisory. The actual question of whether a president can do the job is a political judgment that falls to the vice president and the cabinet under the 25th Amendment.
What a real assessment would look like.
Five of nine components of a comprehensive fitness assessment were not done. Brain imaging, comprehensive neuropsychological testing, sleep screening, intracranial vascular imaging, and independent medical review are all absent.
The physical exam tells us about the patient’s body. It does not tell us whether the president can govern.