The President is Losing his Marbles

It's time for the 25th Amendment—even if it puts JD Vance in office.

Trump gazes at the middle distance after a guest to the White House faints.

On the night of December 1, over the course of about four hours, the president of the United States posted more than 160 times on Truth Social—a rate of once per minute; he sometimes posted the same thing twice. Almost all of these posts involved strange fantasies, lunatic conspiracy theories, violent imprecations against immigrants, calls for the prosecution of his opponents, and memories of the past—particularly, memories of having been flattered. A sample:

Several days ago, in response to the news that a beloved American cultural figure and his wife had been brutally murdered, the president of the United States had this to say:¹

If Trump were any other 79-year-old man, his family would be escorting him to a medical clinic, where his presentation would trigger a flurry of follow-up tests. This behavior is not normal, and it is not even normal for Trump.

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The president has always been notable for his disinhibition. He has always exhibited the symptoms of an extremely severe personality disorder.² But what we’re seeing now is something else. Never a man known for his excellent impulse control, his inappropriate outbursts have become so common that journalists only bother reporting the most bizarre. (“Quiet, piggy!”) His inappropriate comments and behaviors are increasing in frequency and weirdness.

Most significantly, they’re no longer calibrated to appeal to his base. He has lost his sense of his audience. Even his devoted fans on Truth Social are noticing that his insults are no longer transgressive and hilarious, but weird and creepy:

His affect is inappropriate. He oscillates from apathy to disinhibition to explosive rage to listlessness. He looks unwell. He is bloated, unkempt, and often confused.

He wanders in circles. On some days, half his face droops. On others, his right leg drags. He falls asleep in public daily. He uses profanity in public. He tells interminable anecdotes—one about French fries wanders through water pressure, hair-washing, McDonald’s drive-throughs, dishwasher restrictions, unmentionable bathroom fixtures, and the metaphysics of electoral destiny without ever returning to its point, if ever it had one. Even friendly journalists struggle to summarize Trump’s remarks.

On November 4, Karoline Leavitt told reporters that “as you all know because you are all witness to it every single day, the president is in optimal physical health.”

The New York Times approached this elliptically a few weeks ago in an article titled, “Shorter days, signs of fatigue: Trump faces realities of aging in office.” Noting that the president now has fewer events on his schedule—and growingly confines his public appearances to the hours between noon and 5 pm—they suggested that the president’s “battery,” as they decided to call his mind, “shows signs of wear.”

… During an Oval Office event that began around noon on November 6, Mr. Trump sat behind his desk for about 20 minutes as executives standing around him talked about weight-loss drugs. At one point, Mr. Trump’s eyelids drooped until his eyes were almost closed, and he appeared to doze on and off for several seconds. At another point, he opened his eyes and looked toward a line of journalists watching him. He stood up only after a guest who was standing near him fainted and collapsed.

At news conferences, foreign correspondents are exchanging glances of a kind once reserved for Kremlin-watchers in the late Brezhnev era. Intelligence services around the world are filing urgent cables: NORTH AMERICAN PRINCIPAL—IRREGULAR LINGUISTIC DETERIORATION.

Only Americans are expected to gaze upon a man who now speaks in sprawling, fugue-like anecdotes about “great wrists” and “water coming down from heaven” and nod along, as though this were a perfectly normal way for a statesman to communicate.

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We have now watched two elderly presidents, one after the other, go gaga before our eyes. In both instances, the president’s entourage has insisted strenuously that our eyes are lying. In both instances, the media has meekly accepted that mentioning this in any but the most oblique way would be gauche.

The taboo against precisely describing the president’s speech and behavior and then accurately telling the public what this suggests is policed most strictly by the prestige media, where the fear of appearing unseemly or unserious has curdled into a refusal to apply the analytical tools journalists routinely deploy everywhere else. It has been left to those on the fringes of the Internet—Substack, podcasters, social media, comment sections—to say the obvious.

This pattern of failure in the media isn’t an accident. At elite outlets, “seriousness” has come to mean a particular tone; this is understood as an injunction against saying the thing that would sound unspeakable if said plainly. The New York Times’ editors instinctively sense that writing precisely about the president’s cognition would be tabloid journalism, no matter how carefully and soberly it’s done. This is a category error. They’re confusing clinical description with sensationalism, because the topic itself feels lurid. The result is euphemism—“meandering,” “freewheeling,” “discursive”—without analysis. They will say that the president rambled; they will not describe how or why the rambling matters. Gravity, they’ve decided, consists in understatement, even when understatement amounts to lying, and lying about a matter of utmost urgency, at that.

The press corps is haunted by two ghosts: the Goldwater debacle, which they have half-remembered and over-learned, and the fear that discussion of Trump’s mental state will be used as a weapon against them. We will not be seen as armchair psychiatrists. We will not be accused of delegitimizing an elected president. They’re drawing the line in the wrong place. Rather than avoiding diagnosis while preserving description, they avoid both. This has produced a vacuum that is filled, inevitably, by those with fewer scruples and worse methods. One senses, too, a deeper, almost anthropological taboo: We can talk about the president’s corruption, cruelty, ideology, and even his madness, in a metaphorical sense—but no one can mention his neurological decline. The prestige media enforces a kind of secular blasphemy law: Thou shalt not describe the emperor’s mind.

The task of saying that the president is losing his marbles has thus been taken up by low-rent conspiracy theorists. No surprise. When legitimate institutions refuse to apply accurate language to an obvious phenomenon, illegitimate ones rush in. The result is the worsening of an already severe epistemic crisis. The truth becomes associated with unserious people, and seriousness becomes associated with evasion.

This situation is all the more extraordinary because our press corps has spent the past year flagellating itself for overlooking Biden’s deterioration:

Perhaps you’ll remember this:

TAPPER: Beginning in fall of 2023, our reporting shows, based on the interviews of over 200 people, that there were two Bidens: There was a functioning Biden and non-functioning Biden. And that goes back to 2019. But he was almost always functioning Biden. But beginning in 2023, the ratio of that functioning and non-functioning starts to change dramatically and also non-functioning Biden is getting worse. …

DETROW: When you say “non-functioning,” what’s the best way to define that?

TAPPER: I would describe it as unable to come up with the names of top advisers or close friends. I would say, “Look, we’re all human. We all forget names. We all lose our train of thought.” We all witness that in people who are aging. We’re talking about to the point of you not being able to have a conversation. You are not able to come up with data, information, knowledge, names that you should have at the ready.

Jake Tapper describes the threshold for concern quite precisely here. So let’s use his criteria. Is Trump able to come up with data, information, knowledge, names that he should have at the ready?

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Consider the video below. As you do, pay attention to the effort Trump is making to conceal his inability to remember the names of world leaders. He recently received the Syrian president, Ahmed al-Sharaa, in the White House, but he can’t remember his name. He can’t remember the name of the Australian prime minister, Anthony Albanese, either. He may well have spoken to Albanese to offer his condolences earlier in the day.

He has to read from his notes to remember the names of his grandchildren. He says “three” US servicemen, not two, were killed in Syria. He was almost certainly briefed on that attack earlier in the day. When terrorists kill US servicemen, the president is informed. He doesn’t remember the name of the Australian man, Ahmet al-Ahmed, who tackled the terrorist on Bondi Beach. He would have been briefed on that earlier in the day, too. He says that the man tackled the shooter “frontally.” If you’ve seen the video, you know that he tackled him from behind.

Some viewers might think he looks okay because they’re implicitly comparing him to Biden. In the last years of his presidency, Biden’s speech was quiet or inaudible, with slow retrieval, a heavy reliance on filler words, and stuttering. Physically, Biden appeared frail and hesitant. Trump’s symptoms are quite different. His speech is fluent but disinhibited, emotionally amplified, and verbose; it’s characterized by emptiness and semantic erosion. If Biden looked weak, Trump looks strong—he retains a large and imposing physical presence.

Trump’s lunatic energy masks the underlying pathology, but the pathology is obvious if you examine the structure of his speech, as opposed to its volume. A neurologist who examined this patient would ask:

• Can he hold an idea in mind long enough to develop it, or does it fragment into digressions?

• Do his sentences follow logically, or are there abrupt, unmotivated shifts?

• Are his sentences grammatically intact, or do we see agrammatism (missing verbs, broken constructions)?

• Does he use specific nouns and verbs, or vague placeholders (“thing,” “great,” “that”) and other fillers?

• Does he recognize when he’s gone off track or become incomprehensible?

• Does he appreciate what the listener needs to know and what’s extraneous?

A transcript will help you to see the problem clearly:³

… Rich, Vince is unbelievable on policy. And we have a policy thing that’s gonna be unbelievable happening. Should I announce it or should I keep it quiet? I put Vince in charge of the triumphal arch [he pronounces this “ark”]. We’re building an arc like the Arc de Triomphe. And we’re building it, uh, by the Arlington Bridge, the Arlington Cemetery, uh, opposite the Lincoln Memorial. You could say Jefferson, Washington, everything because they’re all right there.

And it’s something that is so special. Uh, it will be like the one in, in Paris, but to be honest with you, it blows it away. Blows it away in every way. And Vince came in one day and his eyes were teaming [sic]. I mean, he couldn’t believe how beautiful. It was ki— he saw it and he wanted to do that. That’s your primary thing.

There is nothing that can compete with that. It’s the only city in the world that’s of great importance that doesn’t have a triumphal arch [“ark”]. You know what that is. And, uh, this one is gonna blow them all away. The one that people know mostly is the Arc de Triomphe in Paris, France. And, uh, we’re gonna top it by, I think, a lot.

The only thing they have is history. You know, 1860s, something, I always say the one thing you can’t compete with, but eventually we’ll have that history too. But we’re gonna have something that, uh, li—the likes of which has, has never been done before. And it’s been waiting for 200 years, literally.

Uh, I think the Civil War got in the way of it. You know, the, uh, opening, they actually have the four, they have four columns, four small columns with the eagles on top. And they have the circle, you know, before on the other side from the Lincoln. And it’s, uh, it’s so unbelievable. It’s so unbelievable.

It’s been waiting for hundreds of years, and they were going to build on it a couple of times. It never happened. But it’s a circle that’s been waiting to have the arc built on it. And I think we’re very far along. I think you might wanna show it to the National Trust, if you’d like. You might wanna show it to a couple of people, take a look at it, because I’ve always gotten really along well with the National Trust.

So take a look and show it to them, and start, and maybe they give you some good ideas too, okay? But I’m proud of you, and I’m really especially proud of the job you’ve done. From day one, he and his partner, Ross, have been, uh, writing really great speeches. And I just wish I stuck with them a little bit more often.

But we, uh, we go on and off those speeches, right? And I think ultimately that’s the best combination, right? So one of the greatest in the world, the two of those guys, the greatest. Then we have a man who, to me, this is the most interesting story. Boy, do you look like Ivanka? Has anyone ever told you that?

I’m looking, I’m saying, “Is that Ivan—” Could you just turn around for the camera? Does she look, does she look like Ivanka? It’s the most unbelievable thing. Uh, so I wouldn’t, I didn’t wanna take a chance. I say, “Is that Ivanka?” You look just like Ivanka, which is a great compliment, actually.

So we have a doctor in the White House named Dr. James Jones. Can I tell the story?

Jones: Please, sir.

Trump: And he’s a great doctor, highly respected by so many people. He’s helped so many people. I’ve had people come to the White House and they were so sick. I’ve had people come to the White House along with your partner. You gotta, well, you have a lot of partners. You have Walter Reed Medical Center, which I think is the best in the world. They’ve seen things that nobody wants to see, right?

Jones: Yes, sir.

Trump: They have, uh, doctors have told me, “If you can get out of here, you’ve seen it all.” And that’s why they produce some of the best doctors in the world. Well, Dr. James Jones is a great doctor. He was the White House doctor during the Obama administration and during the Trump administration. Uh, and I guess during a little bit of, uh, maybe, no, those two? ‘Cause we had, we had somebody else named Doc Ronnie who actually got a glimpse of Obama in there too.

Is that Doc Ronnie back there? No. Doc Ronnie, uh, did all three. And he said Trump is in the best health of all. He had, he had Bush, he had Obama, he had Trump. He, he didn’t have Biden. He didn’t have Biden. But Dr. James went on a trip to Peru with the two Obama girls. They wanted to go hiking in, in, uh, Peru.

Uh, was it Peru? In, uh, Peru. And it’s known for being a rather rough place in terms of physical creatures crawling around. 28,000 people die a year from a snake bite, a certain snake. It’s a viper, right? It’s said to be the most poisonous snake in the world. And he made a comment and somebody else told him that’s very dangerous in that area to go hiking.

And the guide said, “Oh, don’t worry, we never see that snake. It’s over-exaggerated.” Even though 27, 28,000 people a year die. That’s not over-exaggerated. Because when they lift the rice and the this and the that out of the water, they get hit. And if you get hit, it’s automatic death. …

Note that no narrative thread is ever completed. He begins the story of the triumphal arch, restarts it multiple times, contradicts it, and ornaments it, but he never reaches an obvious endpoint. Often he thinks he’s finished—the cadence suggests closure even when none has occurred. That’s significant.

Don’t dismiss this as the typical digressive speech of an elderly windbag. It’s not. He’s displaying a systematic failure to close cognitive loops. He’s unable to sustain the internal scaffolding required to finish a single one of his thoughts. Similarly, he never elaborates on a point, he just moves in tight semantic circles. When he talks about the triumphal arch, “It’s unbelievable.” “It blows it away.” “It’s so special.” “Nothing can compete with that.” “It’s the only city … ” “It’s been waiting 200 years.” “It’s so unbelievable.” After the first few sentences, he adds no new information. This is emotional amplification without conceptual enrichment—verbosity without complexity. His speech is informationally impoverished. This is true, now, whenever he goes off the teleprompter.

Notice his over-reliance on deictic placeholders—words and expressions whose meaning is wholly dependent on the context. For example, “That’s your primary thing,” “You know what that is,” “It’s the circle, you know,” “They lift the rice and the this and the that,” “It was ki— he saw it and he wanted to do that.” In spoken language, deixis is normal. Here, it’s doing all the work. The listener is repeatedly asked to supply meaning that the speaker doesn’t provide (because he can’t). This offers the illusion of shared understanding, but it outsources the task of making the speech coherent to the audience.

Pay attention, too, to the role of paratactic constructions in his speech—clauses placed side by side, with no logical relationship or hierarchy. “You could say Jefferson, Washington, everything because they’re all right there.” That sentence is syntactically intact, but semantically unstructured. There’s no organizing principle—no explanation of relevance, scale, or category. Proper nouns are piled rather than ordered. The result is associative chaining, not an argument.

The sudden pivot to the woman who “looks like Ivanka” is especially notable. That isn’t a planned aside. It interrupts the speech, overrides the ostensible topic, and demands the audience’s participation (“turn around for the camera”). The interruption is driven by salience to the speaker alone, not communicative relevance. This kind of intrusion reflects impaired inhibitory control. He’s unable to suppress his response to an internally salient stimulus, even when it’s socially inappropriate.

There are multiple moments of chronological instability, too. The Arc de Triomphe is vaguely placed in “the 1860s, something.” “Eventually we’ll have that history too.” The Civil War “got in the way” of an imagined architectural plan that is otherwise undefined. These aren’t factual errors, per se, but a kind of temporal blurring, where time functions as a mood, not a dimension.

Note, too, that he frequently begins phrases, realizes he’s on the wrong track, interrupts himself, then fails to repair the phrase. “It was ki— he saw it …” “We had, we had somebody else named Doc Ronnie …” “During a little bit of, uh, maybe, no … ” In healthy speech, self-interruption is followed by repair—a clarification. Here, it leads to semantic abandonment.

Perhaps most importantly, his speech shows no evidence of a stable mental model of the listener. He assumes the audience knows what “that” is, and that listeners will find the same things salient, track jumps without signposting, and tolerate radical topic shifts. This is a breakdown in pragmatic alignment: The speaker is no longer reliably calibrating what the listener needs in order to follow.

Natural human speech, when transcribed, always looks chaotic. But Trump’s speech is chaotic in a particular way. Neurologists see speech like this in consultation rooms all the time. When these patterns present in the spontaneous speech of a 79-year-old, they’re clinically meaningful.⁴

And no, he did not always sound like this. Not at all. Watch the video below of the 33-year-old Trump. This is his baseline. Then, as now, he was a liar, a manipulator, and a determined enemy of beloved historic buildings. But his speech below does not suggest neurological degeneration. His topic maintenance is fine. His responses to questions are coherent and relevant. His syntax is normal. He’s not using filler words. He doesn’t go off track, so he doesn’t need to correct himself. Nothing he says is obviously extraneous:

I’m not making a diagnosis, I should stress. Of course I’m not. I don’t know what’s wrong with him. But I do know that disordered speech of this kind is significant, and even more significant when it deviates so greatly from the baseline. It’s even more significant in a man of his age. And it is all the more significant given his family history—his father developed dementia in his eighties; the risk is hereditary—and his overall health, which doesn’t look great.⁵

On some days, Trump seems fine. That’s not evidence that he’s fine. Cognitive decline doesn’t present as a steady, linear deterioration, nor does it manifest identically from day to day. Fluctuation is typical. He may appear lucid, energetic, and even persuasive at certain moments, particularly in familiar settings or when operating on well-rehearsed material. But a single coherent appearance doesn’t negate a broader pattern of decline. Clinicians don’t look for isolated good days. They look for trends—increasing disorganization, reduced narrative control, affective instability, and the erosion of executive function. It’s the trajectory that matters, not the snapshot. And Trump’s trajectory is bad.

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The president’s syntax would be disturbing enough in isolation. But we also have a peculiar pattern of medical disclosure. Last April, the president had a full physical exam at Walter Reed. In a memo published on the White House website, his physician, Sean Barbabella, declared him “fully fit,” and in “excellent health.” Trump’s cardiac age, he wrote, was younger than his chronological age.

Trump was given a basic cognitive screen at that exam:

Neurological: A comprehensive neurological examination revealed no abnormalities in his mental status, cranial nerves, motor and sensory function, reflexes, gait, and balance. Cognitive function, assessed using the Montreal Cognitive Assessment (MoCA), was normal with a score of 30 out of 30

In October, the president returned to Walter Reed for what he called a “semiannual” physical and his press secretary called a “routine yearly checkup,” his second in six months. Barbabella noted, in his written report, that this exam included “advanced imaging,” but he didn’t specify what this entailed.

Trump then told reporters he’d undergone an MRI, calling it “very standard,” and boasting that a doctor said it was “the best result he has ever seen.” When asked what part of his body had been scanned, he replied that he had “no idea.” The White House confirmed that “advanced imaging” was involved, but repeatedly declined to say what was imaged or why, insisting only that all consulted agreed that the president was in “exceptional health.”

But MRIs are not part of “very standard” physicals. They’re ordered when there’s a specific concern: new neurological symptoms, a suspected stroke, spinal pathology, cardiac issues. (A number of news outlets did cite physicians who pointed this out: “MRIs aren’t typically included in routine physicals,” noted Reuters.)

On Thanksgiving Day, Trump called Governor Tim Walz a “retard.” Walz took to national television to say, correctly, that this wasn’t normal behavior. He called on Trump to release the results of his MRI. Barbabella, in response, issued another memo. The MRI, he wrote, had been performed because “men in his age group benefit from a thorough evaluation of cardiovascular and abdominal health.”

“This level of detailed assessment is standard for an executive physical at President Trump’s age,” Barbabella wrote.

But it isn’t. Scientific American cited a host of specialists who “expressed doubt” about the suggestion that MRI screening is “typical preventive care.”

“No, it is certainly not standard medical practice to perform screening MRIs of the heart and abdomen,” says radiologist and MRI expert Thomas Kwee … Such imaging is typically only performed in the case of underlying disease, he says, or if there is suspicion of an underlying disease based on the patient’s medical history and physical examination. …

… Medpage Today’s editor in chief, physician Jeremy Faust, [told] CNN on Monday that “there’s really no such thing as routine prevention using an MRI.” Faust on Tuesday told Scientific American that the White House memo reference to “advanced imaging” left open questions as to exactly what tests Trump underwent. It could even possibly refer to a CT scan, for example, which is different than MRI. “If we knew exactly what imaging he received, it would give us a better idea of what conditions they are worried about,” Faust says.

In 2018, Trump declared that he’d “aced” the MoCA, a 10-minute screen used to detect mild cognitive impairment. In 2020, he went on Fox News to recount, with evident pride, his ability to remember the sequence “person, woman, man, camera, TV.” (The test was either administered incorrectly or he flunked it, for what it’s worth. The MoCA asks subjects to recall five unrelated words. “Woman” and “man” would not both be on the test.)

Last October, he declared he’d taken a very hard “aptitude test” at Walter Reed. This was almost certainly another MoCA. He challenged younger members of Congress to take it, too:

[We] have a great group of people, which they don’t. They have Jasmine Crocket, a low-IQ person. [Alexandria Ocasio-Cortez] is low IQ. … Have her pass, like, the exams that I decided to take when I was at Walter Reed. Those are really hard, they’re really aptitude tests, I guess, in a certain way. I don’t think Jasmine—the first couple of questions are easy, a tiger, an elephant, a giraffe, you know. When you get up to about five or six, and then when you get up to ten and twenty and twenty-five, they couldn’t come close to answering any of those questions.

Trump’s conflation of a cognitive screen with an aptitude test is itself evidence of impaired cognition. You, presumably, glanced at it and saw instantly that it was not an aptitude test, but a test of very basic cognitive function. The president didn’t. He described the test as “very hard.” If he truly found it tough to figure out what a banana and an orange have in common, do you think he’s able to handle the cognitive demands of the presidency?

It’s also relevant—though not decisive—that a close family member has been sounding the alarm. Trump’s niece, Mary Trump, has said that her uncle looks and sounds “exactly” like her grandfather, Fred Trump, did when his mind began to go. In a clinical setting, testimony like this would be treated with caution, especially given her public estrangement from Trump. But it wouldn’t be dismissed. Family members are often the first to notice changes in personality, affect, impulse control, and narrative coherence, precisely because they can compare current behavior not only to abstract norms, but to a lifetime of prior functioning. What a relative says, even an estranged relative, doesn’t establish a diagnosis, but it ordinarily forms part of the evidentiary picture.

We don’t know what the MRI at Walter Reed showed, or whether neurologists have already raised concerns and been overruled. We don’t know whether we’re seeing a neurodegenerative process, a vascular burden, a psychiatric overlay, or a highly idiosyncratic blend of age and personality mimicking a neurodegenerative disease. We do know that a political system that refuses to discuss this honestly is not a healthy one.

On the basis of what we do know, it is reasonable to suspect that once again, a coverup is in progress, and once again, the extent of a president’s incapacity is being concealed from the public.

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To raise these points is to invite the objection that I’m not a doctor and I haven’t examined him personally. True. But so what? I’m not offering him medical care. The relevant medical literature isn’t sacred scripture interpretable only by sages who have passed through a secret initiation and emerged bearing the stethoscope of true revelation. It’s a body of publicly available knowledge, written in ordinary language. Medicine isn’t necromancy, and neurology isn’t a mystery cult. The literature exists precisely so that observable phenomena can be compared with known patterns by anyone willing to look.

When journalists refuse to consult this literature—or at the very least, to call a few neurologists to ask if they’ve noticed Trump’s symptoms, then relay their answers with a bright “experts say!”—it’s not because they’re epistemically modest. It’s because they’re ruthlessly determined not to see what’s right in front of their eyes.

No one needs to personally examine Trump to see that something is wrong. It is a mainstream idea in neurology and neuropsychology that discourse structure—how someone tells a story—is a highly sensitive window into cognitive change. In diseases like Alzheimers, for example, subtle deterioration in speech can be detected years before diagnosis, as famously shown in this study comparing the press conferences of Ronald Reagan and George H.W. Bush:

… President Reagan showed a significant reduction in the number of unique words over time and a significant increase in conversational fillers and non-specific nouns over time. There was no significant trend in these features for President Bush.

You don’t need a medical degree to recognize speech patterns characteristic of various dementias. Listen for a growing reliance on fillers—words like “well,” “so,” “basically,” “actually,” “literally,” “um,” “ah.” (Biden relied so heavily on these in the later years of his presidency that listening to him was unendurable.) Listen for non-specific nouns—roughly, any pronoun or noun that contains “thing,” like something or anything. Listen for a narrowing vocabulary, lexical repetition, and diminished word specificity.

“Imageability” refers to the ease with which a word gives rise to a mental image. Patients with dementia rely heavily upon low-imageability verbs, like get, give, go, and have. Listen for those. In Alzheimer’s, the first detectable linguistic impairment is typically anomia—forgetting the names of everyday objects. In the early stages, patients have difficulty with speech comprehension as well as production. The next signs are circumlocution, lack of content, and paraphasias, where words are jumbled or meaningless.

Paraphasias are significant. Trump’s speech is now full of them. In semantic paraphasias, words are confused—a patient might say “foot” when he means “shoe.” In phonemic paraphasias, words are replaced by nonwords that preserve elements of the original—“Venezuero” for Venezuela, say.⁶ John Gartner, a psychologist and former professor at the Johns Hopkins University Medical School, has pointed out Trump’s phonemic and semantic paraphasias in many outlets, and on his own podcast. Here’s a sample of them:

Sometimes, the president can’t form words at all, and retreats to making sounds: “Buh … bluh-ub-bll … ” Often, his speech is nonsensical:

Nobody explain to me how allowing millions of people from places unknown, from countries unknown, who don’t speak languages—we have languages coming into our country, we have nobody that even speaks those languages. They are truly foreign languages. Nobody speaks them

Journalists are prone to calling these paraphasias “gaffes.” Or they laugh, as if the garbled sounds signified Trump’s vulgarity or his ignorance, not illness. This is an abdication of responsibility. By treating this lightly, they’re giving Trump’s Cabinet permission to deny what they’re seeing. (And they’re seeing it, trust me.)

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No one in a position to do something about this wants to see it. For Congress, the responsible course of action is to insist upon appropriate medical testing and full transparency about the results. If the president has had an MRI, the public should be told which organ was imaged, and why, in a way that makes sense. “Advanced imaging” is not a sufficient description. If cognitive screening has been conducted, it should be described accurately as such, not as an IQ test—and the results should be evaluated by independent experts.

Given his behavior, it is entirely reasonable for Congress to demand—it’s irresponsible to fail to demand—that the president undertake the following exams and share the results in full with Congress, if not the public: a neuropsychological battery; neuroimaging (MRI, PET) with radiology reports; speech and language evaluations performed by specialists; a MoCA administered by an independent clinician; and gait analysis. Congress should request a list of his medications, his neurological exam notes, his sleep apnea data, and the results of a thorough psychiatric assessment that includes screening for depression and agitation.

Ideally, an independent panel of neurologists and geriatric psychiatrists would examine the president. They would have the authority to tell the public, at least in broad terms, whether his cognitive performance lies within normal age-adjusted bounds. The standard of care for an ordinary patient with Trump’s symptoms would be, at minimum, a referral, scans, and a difficult conversation with family. The standard for a president shouldn’t be lower than it is for a pensioner in Milwaukee.

What’s more, journalists should describe his speech patterns as they are, without ellipses and enforced coyness, and they should say what this suggests without euphemisms. The current level of opacity is unacceptable.

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If the results of a serious, independent evaluation indicate what his speech suggests, there’s only one remedy. Trump will never resign voluntarily. He’s internalized Nixon’s final hours as the primal scene of masculine defeat. He’ll cling to that chair until he physically cannot. So the only remaining path is the 25th.

This would be unspeakably ugly—not just constitutionally traumatic, but politically explosive. It would require his Cabinet—a group of men and women whose careers depend on proximity to Trump, and who have so thoroughly corrupted themselves that to stay out of jail, they need Trump to be in office—to declare him unfit to exercise the powers of the presidency. Doing so would trigger immediate legal challenges, partisan hysteria, and accusations of a coup. It would fracture the Republican Party, inflame the base, and dominate the political life of the country for months, if not years. It would almost certainly be accompanied by violence, or at least by credible threats of it.

It would also have an immediate and inescapable consequence: It would make JD Vance the president. This alone explains the discipline with which the system avoids saying the obvious. No one wants this—not the public, not Democrats, not Republicans, not the national security establishment, not our allies. The only person in the universe who likes the idea is JD Vance.

For Democrats, the prospect is a nightmare. They’re on track to win back Congress and the presidency precisely because Trump is out of his mind. By 2028, they’re thinking, Trump will have done so much damage that Vance will be as unpopular as the president he serves and no threat to a Democratic challenger. Vance has no charismatic power. They’ll steamroll him.

But give him the power of incumbency and the ability to reverse Trump’s most damaging economic policies? All bets are off. Not only could Democrats lose, but they could lose to a figure who has years to live, and who represents a coherent and unapologetic illiberalism—one far more disciplined and programmatic than Trump’s. (Or at least, this is true of his latest incarnation; who knows what he really believes.)

Republicans are just as dismayed by the thought. They know the base sees Vance as a stalking horse for Silicon Valley and a charmless scold. They would not be riding back into power on his coattails. Vance lacks entirely the power to hold the GOP coalition together. If Trump is removed, the MAGA civil war that’s already underway could easily cease to be a metaphor. (Tucker Carlson was not wrong to tell Trump that appointing Vance would be his insurance policy against coups and assassinations.)

These realities exert a powerful, if unspoken, gravitational pull. Every incentive in the system points toward avoidance: delay, euphemism, denial, and the hope that the problem will somehow resolve itself. Members of Congress who might otherwise press for medical transparency understand that doing so would set in motion a chain of events they can’t control and whose endpoint they dread. Cabinet officials know that invoking the 25th Amendment wouldn’t restore normalcy; it would just introduce a different—and perhaps more dangerous—form of instability. Journalists, too, are dimly aware that to name the problem is to help usher in a successor many of them regard as worse, not better So the taboo is reinforced from all sides. Trump’s decline is tolerated not because it’s benign, but because confronting it would force the system to act.

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No such scruple inhibits intelligence services around the world from drawing the obvious conclusions, however. I guarantee you that they are taking a very keen interest in this situation.

In 1968, the CIA’s internal journal Studies in Intelligence published a now-declassified essay titled “VIP Health Watch.” It described a program to monitor “the psychological and physical health of foreign leaders,” noting that doing so was an integral intelligence function. The justification for such a program is obvious: The physical and mental state of a head of state directly affects war, peace, and succession.

Later analyses in the same journal, and subsequent scholarship, describe the CIA’s Medical and Psychological Analysis Center:

… MPAC strives to make timely medical assessments that are accurate, objective, and relevant for policy makers. While a third-year medical student can make a reliable medical diagnosis based on observation alone, a simple diagnosis on a world leader will not suffice for national-security decision makers. Indeed, arriving at a diagnosis and prognosis are only part of the analytical problem. What if a world leader suffers from chronic hypertension? Remote medical analysis should not only contain a judgment on the current condition but, most important, an estimate of the impact of health, personality, and medical treatment on decision making, negotiating style, and capacity to govern. MPAC also considers cultural factors that may play particularly important roles in a leader’s medical course. For instance, Sukarno refused to have surgery for a large kidney stone because a soothsayer had told him that he would “die by steel.” MPAC’s analyses must also address other key issues, such as the possibility of denial and deception and the political dynamics involved in VIP medical care.

The CIA’s health files on Mao, Brezhnev, and other aging leaders of nuclear powers were held to be core to American national security. Our allies’ and our adversaries’ intelligence services keep exactly the same kind of file on our leaders. (And they don’t insist that they can’t say anything meaningful about Trump because they haven’t personally examined him.)

Woodrow Wilson suffered a massive stroke in 1919 that left him severely disabled. His aides concealed his incapacity from the public, and his wife and a small circle around him effectively governed in his name. Historians still debate how much this shaped the failure of the League of Nations. FDR entered his final term with serious, progressive cardiovascular disease. Scholars describe him at Yalta as a man “older than his years,” physically spent. His decline probably affected US bargaining at a formative moment in the postwar settlement. Brezhnev, Andropov, and Chernenko alike presided over the late-Soviet gerontocracy in states of visible deterioration. Retrospective medical analyses suggest multi-infarct dementia and other vascular pathologies. Western Kremlinologists obsessively parsed their slurred speeches and missed parades.

We already accept that the cognitive state of leaders matters—and it matters a great deal. As the study of Reagan’s speech patterns indicates, we also accept that a president’s dysfunction can be detected in his speech. We just prefer to admit this 20 years after the fact.

Foreign intelligence services are, right now, updating their files on the American president. They’ve seen the speeches. They’ve read the MRI stories. They saw that wackadoo post about Rob Reiner. Their analysts are answering questions like this: “If this man is faced with a crisis at 3:00 am, how reliable is his executive function?”

If they’re asking this, shouldn’t we?

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Let’s look at another example. (This may be overkill. The editor in me says “leave this out,” but the pedagogue in me thinks it might be helpful. If you’ve already got the idea, just skip to the next section.)

I won’t make you read the transcript, but were you to present it to a neurologist as the speech of an anonymous 79-year-old, recorded in conversation with family, he would note, among other things, the tangentiality and topic derailment: fry-making → wrist admiration → counting how many franchises (“fifty-nine”) → rich father and son → size of the crowd (“25,000 people”) → drive-thru window reactions → electoral destiny, with water restrictions and dishwashers wedged in the middle. These transitions aren’t logical developments of a theme. They’re associative jumps. The fry cook’s wrist has no relevance to the story. The “fifty-nine” franchises appear and disappear without context. Water-pressure policy arrives in the middle of an anecdote about French fries and never quite leaves. The patient strays from the point, over and over, and fails to return. This points to frontal lobe dysfunction, which results in difficulty inhibiting irrelevant associations.

Water pressure is a long-standing Trump fixation, but the way he demonstrates it here is notable. He complains there’s “no water,” only “drip,” repeats this, then babbles on about restrictors in taps, showers, dishwashers, washing machines, and the mysterious “third item in the bathroom,”which he refuses to name. This is perseveration: the involuntary, inappropriate repetition of a theme beyond what the context demands. This too is a classic sign of frontal-executive impairment.

Even in cleaned-up transcripts, we see constructions like these: “I lather up and I turn that and I—there’s no water. The water’s drip. They call it, they put a restrictor on.” This isn’t normal disfluency. It combines aborted sentences (“I turn that and I—”); missing function words; non-standard forms (“the water’s drip”); and failed repair attempts. Agrammatism—grammar and syntax errors in spontaneous speech—is one of the core diagnostic criteria for non-fluent/agrammatic PPA.

A speaker with intact social cognition distinguishes between relevant and irrelevant detail. The fry-cook’s “great wrist” is irrelevant. So is the exact number of franchises, unless it will matter later (it doesn’t). So are repeated assurances that people were “bored” in drive-thru lines before recognizing him, and that “every one of them” reacted with “love.” Studies of bvFTD speech find “verbose but empty discourse, overinclusive of irrelevant details, with poor sensitivity to listener needs.” That is an exact description of Trump’s unscripted speech.

A neurologist would also notice this patient’s magical thinking and the confabulation in his reasoning. The logical leap from working a McDonald’s to concluding the 2024 election was in the bag “because the response was love” is not just narcissism (although it is that). It’s what the frontal-lobe literature describes as “affective confabulation,” when an emotionally salient impression is retrofitted as causal explanation.

Taken together—tangentiality, perseveration, agrammatism, pragmatic breakdown, confabulation—this pattern, in an anonymous patient, would trigger a workup focused on frontal-temporal pathology. An attending neurologist, dictating after the exam, would write this:

“Patient demonstrates circumstantial, tangential, and disorganized spontaneous speech with impaired topic maintenance, reduced semantic density, and loose associations. Differential includes bvFTD, PPA spectrum disorder, or other frontal-executive neurodegenerative disease.”

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If all of this is so obvious, why aren’t physicians saying so? They are. Bradford Dickerson, a neurologist at Harvard/Mass General and a frontotemporal dementia specialist, has said that Trump’s degraded speech should ring alarm bells: “If you see a change relative to a person’s base line in that type of speaking ability over the course of just a few years, I think it raises some real red flags.” Several recent stories have cited an unnamed neurologist who points out that Trump’s wide-based gait and right-leg circumduction are “diagnostic” or “pathognomonic” for frontotemporal dementia. (Bravo to this profile in courage who insisted on anonymity.)

“There’s reasonable evidence suggestive of forms of dementia,” clinical psychologist Ben Michaelis said after reviewing recent Trump speeches. “The reduction in complexity of sentences and vocabulary does lead you to a certain picture of cognitive diminishment.” Andrew Budson, a neurology professor at Boston University, added that it was probably related to the frontal lobe. “There are absolutely changes that are occurring, without any doubt,” he said, noting that Trump used to be capable of describe events coherently and without digression. “Now, it’s much more about evoking different things, using general terms and saying the same thing again and again, then jumping to something else, then jumping back to it.”

Among psychiatrists, there’s a small ecosystem who regularly discuss Trump’s cognitive state. It’s heavily concentrated among a few activists. John Gartner has been the loudest bell-ringer.⁷ The Daily Beast podcast recently had him on. He talked about the decline in Trump’s language, his wide-based gait and leg swing, the facial droop. He called the evidence of cognitive impairment “overwhelming.” It’s frontotemporal dementia, he reckons. His colleague Harry Segal, a clinical psychologist and senior lecturer at Cornell Medical School, agrees that Trump is displaying “dead-ringer, telltale signs” of frontotemporal dementia. “If Trump were your relative, you’d be thinking about assisted care right now,” adds Gartner.

The psychologist Suzanne Lachmann remarks that Trump “seemingly forget[s] how the sentence began and invent[s] something in the middle,” resulting in “an incomprehensible word salad,” a pattern frequently observed “in patients who have dementia.” Elisabeth Zoffmann, a forensic psychiatrist and professor of psychiatry at the University of British Columbia, suspects behavioral-variant frontotemporal dementia: “People presenting with such a cluster of observations should undergo expert assessment.” Lance Dodes, a distinguished fellow of the American Academy of Psychiatry and retired Harvard Medical School professor, describes the evidence of dementia as “overwhelming.”

“If a patient presented to me with the verbal incoherence, tangential thinking, and repetitive speech that Trump now regularly demonstrates, I would almost certainly refer them for a rigorous neuropsychiatric evaluation to rule out a cognitive illness,” writes Richard A. Friedman, a professor of clinical psychiatry at Cornell. Ben Michaelis, a clinical psychologist who has carried out cognitive assessments for the New York Supreme Court, notes the same symptoms and agrees: Trump is “really not in a strong cognitive place.” Allen Frances, the chair emeritus of psychiatry at the Duke School of Medicine, concedes that Trump “has deteriorated a great deal” since he was in office. “He seems pretty incoherent,” he says.

Outside of Trump’s circle, it does not seem that any physician has been willing to say, on the record, that he or she sees in these symptoms no cause for alarm.

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What of the MAGA-aligned journalists who gleefully documented Biden’s every stumble and stutter? Remember that they claimed the American people had been victims of an elaborate complot in which mainstream journalists, fully aware of Biden’s decline, worked hand-in-glove with the Democrats to hide his infirmity from the public?

MARIA BARTIROMO: Mollie, kick us off here. Give us your analysis of Ron Klein’s testimony and the use of the autopen. Is any of that legitimate now that we know that we’re not sure if Joe Biden actually knew what he was doing?

MOLLIE HEMINGWAY: Of course it’s legitimate to look into what the mental condition of President Biden was and what the people closest to him were doing about it. And we have in this testimony of Ron Klein, admitting people knew there were problems with Joe Biden late into his term. But I think it’s worth remembering that yes, everybody saw that that was happening. What happened also was this conspiracy of Democrats to hide that information, or hide it from being a big deal. But it would not have worked without a fully compliant media. That is what links the Biden decline story to also the Russia collusion hoax. When you have the Russia collusion hoax and people conspiring to spread a false narrative, it wouldn’t have worked if everybody in the media, with a few small exceptions, hadn’t gone along with it and run with these false claims …

PETER SCHWEIZER: Yeah. No, I agree with Molly. And also, look, the notion that these White House staffers are somehow insisting that “No, he seemed fine to us” is ridiculous … they all knew what was going on. And Molly’s exactly right. You expect that from White House officials. But the media was completely negligent on this.

MARIA BARTIROMO: I mean, it’s just so extraordinary the efforts that they went to, to stop President Trump. …

MARIA BARTIROMO: Real quick before you guys go. Molly, do you think we will see accountability here? You just heard what the director of the CIA told us. And what about the pardons that weren’t even signed by Joe Biden? It was by an auto pen. Are those legitimate? And what about January 6? Is there more to discover there?

MOLLIE HEMINGWAY: There won’t—it will not be good if there is not accountability. Some of the crimes that were committed here are quite serious. And so I think the DOJ needs to be thinking very hard about how to make it happen. But we also need to understand that Obama and Brennan and Comey, they’re all out of office. But the media who did this? They’re still in office. They’re still perpetrating hoaxes against the American people. They’re still meddling in every election, by just receiving propaganda and regurgitating it instead of doing actual journalism. So the accountability has to include the media as well.

MARIA BARTIROMO: I want to thank you both for your incredible work, your courage, and your journalism. …

Surely Mollie and Peter are saying the obvious about Trump’s increasingly alarming decline, right? I mean, given Mollie’s commitment to actual journalism, she’s got to be all over this?

No?

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This section is for members of Congress or Trump’s Cabinet, in the off chance they’re reading this. Perhaps, by this point, you’re uneasily persuaded I might be right, but you’re telling yourself that given the risks of acting on this, the safest course of action is to ignore it, cross your fingers, and pray that whoever’s really in charge does a good job. Perhaps, you’re thinking, it’s not so bad right now—he’s still loud, after all. He might decline slowly. (There’s a grim little joke in neurology: denial is the last function to go.)

I understand why you think this. But let me spell out the downside to this strategy.

The president is visibly impaired. The world, including our adversaries, has noticed. This, I guarantee. Imagine the convergence of the following pressure points:

1. Foreign adversaries start testing boundaries. Russia with airspace incursions, China with naval provocation patterns. They’ve started already. I can’t prove that this is related to Trump’s mental state, but it’s highly plausible.

2. Senior military officials begin privately doubting the president’s stability.
   They can’t say so publicly, but they act on their perception.

3. Cabinet members begin to fear complicity. They fantasize about the 25th Amendment in the shower, even as they would never touch it in daylight.

4. Congress becomes aware that the White House is not functioning normally. Members notice unusual behavior in private meetings. Staffers leak.

5. Diplomats start talking out of school. Foggy Bottom is incapable of keeping anything to itself.

6. Markets begin responding. Markets are exquisitely sensitive to cognitive decline in heads of state.

This is the trajectory we’re on, and there’s no universe in which it’s compatible with three more years in office. Unless something uncanny happens, JD Vance is going to be the president.

The question isn’t whether that happens. The question is when, and under what conditions of crisis. If it happens after a foreign-policy fiasco triggered by cognitive chaos, we get a President Vance inheriting a geopolitical inferno. If it happens before, we get a President Vance whose first act is to reassure America that he’s “a steady hand on the tiller.” Either way, he becomes president, and probably sooner than anyone expects.

Vance is emotionally untested at scale, deeply influenced by Orbánist illiberalism, ambitious but ideologically unstable, loyal to Trump out of expediency but not conviction, surrounded by people even more radical than he is, and opportunistic. He lacks charisma—completely. He may not be a dictator in waiting, but he’s the ideal vessel for those who are. The danger lies in the institutional vacuum a cognitively impaired president creates, a vacuum Vance will fill with people whose agendas are darker and more sophisticated than his own.

Here’s the scenario that should keep you up at night: Trump’s decline accelerates. Increasingly, his inner circle shields him. Foreign adversaries test him more aggressively. A crisis occurs—in the Taiwan Strait, the Persian Gulf, the Baltics. Trump misinterprets the situation or issues incoherent orders. The Cabinet panics. The 25th Amendment is invoked under conditions of acute geopolitical instability. President Vance takes office in a moment of national trauma. His administration is staffed by people from the radical post-liberal right, because the moderates have already left or been purged. The public, exhausted and frightened, accepts an increasingly illiberal program in exchange for the illusion of stability. This isn’t fanciful. History is full of regimes that slipped into despotism this way.

If you act now, you’ll be able to shape his Cabinet and, perhaps, prevent that fiasco from happening in the first place. If you wait—who knows.

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If this still seems like a gamble worth taking, let me sketch out another scenario. Leonid Brezhnev spent his final years in a state of cognitive deterioration that was fully visible on Soviet television: long pauses, slurred words, inability to follow the thread of a sentence. US intelligence feared that Soviet crisis management was now in the hands of a man who could not process fast-moving information. Soviet generals feared it too. A slow mind in a fast crisis is a danger to the world. This is the historical analogue to our current moment.

Now imagine:

3:00 a.m. A thermal signature over the Pacific. Ambiguous data. A possible missile. (Have you watched A House of Dynamite, by the way? If you haven’t, now would be a good time. Then read Nuclear War: A Scenario.)

Please deeply internalize this: A situations like this is not wildly improbable. We’ve come damned close, many times—and never has the planet been more unstable.

The national security advisor wakes the president. He has seven minutes to decide.

A healthy mind snaps from sleep to analysis. A diseased frontal lobe doesn’t. The president is confused, irritable, fixated on stray thoughts from the day before. He interrupts. He derails the briefing. He demands certainty where none exists. He lashes out. He can’t sustain syntax long enough to authenticate codes. He confuses the second alert with the first. He misinterprets nuance.

“Mr. President, we have an alert.”

“I just did this.”

“No, sir. This is new.”

He interrupts before the first sentence ends. “So it’s real.”

“We don’t know yet.”

“Then why are you calling me?”

They explain. “I don’t like probabilities,” he says. “I like certainty.”

They tell him the systems disagree. He seizes on that. “So now it’s different.”

“It’s updated.”

“Which means you were wrong.” They move to procedure. Codes. Authentication. He waves them off. “I know how this works.” He starts reading. Stops. Starts again. The words slip. He substitutes one. Then another.

“That’s not correct.”

“It’s what it says.”

“We need the exact—”

“Why did you change it, you idiots?”

Another update comes in. “So now it’s not coming,” he says.

“We don’t know that.”

“You just said—you people don’t know anything.”

They ask for his decision. “That’s your job.”

“No, sir.”

“Do the first thing.”

“Sir—”

“The thing you do when this happens.”

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Our system offers no safeguard, no protocol for “the president seems impaired.” If he issues a correct order, they must obey. He retains absolute authority.

The system presumes a mind capable of integrating information under extreme stress. This can’t be presumed here. Nuclear decision-making is deliberately designed to be legally exacting, precisely because certainty is rarely available when time is shortest. A president who experiences ambiguity as a provocation, who can’t understand probabilistic language, and who can’t sustain attention through a brief but rigid sequence isn’t just ill-suited to such a moment; he’s incapable of performing as required. No amount of confidence, volume, or force of personality can compensate for that.

The 25th Amendment requires time, coordination, Cabinet signatures, written declarations, and political legitimacy. A missile alert offers none of these. The military may refuse an illegal order, but a retaliatory strike under perceived attack is not illegal. It’s precisely the scenario the system was built for.

There is no mechanism to pause the chain of command for confusion, tangentiality, emotional dysregulation, or linguistic collapse. The nuclear briefcase contains codes and scripts. There’s no emergency brake for dementia.

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When I wrote about Biden’s growing impairment (yes, before the infamous debate), some readers found it objectionable: Why, they asked, was I reinforcing MAGA’s talking points?⁸ A different set of readers will find what I’m now writing about Trump objectionable. If that’s you, ask yourself: Did the people who refused to see Biden’s impairment do themselves any favors?

As we saw with Biden, once the signs are that obvious, the decline tends to be precipitous. Trump has three years left in his term. This situation will not get better. Yes, “President Vance” is a dismal prospect—trust me, I know.⁹ But if Trump is unable to carry out the duties of the presidency, Vance is what we’ve got. The Constitution doesn’t promise us a successor we find reassuring, competent, or agreeable. It just promises a lawful one.

Because the media refuses to describe the president’s behavior in clinical terms, Congress can pretend there’s nothing concrete to which they must respond, and the Cabinet never has to confront the choice the Constitution places before it. The public is left with the impression from officialdom that nothing is wrong. Each abdication is justified as prudence, decorum, or restraint. No one pulls the fire alarm because that would cause panic, even though the building is filling with smoke. The result is institutional paralysis, and a system that defaults to the worst possible option—pretending that a visibly failing president is fine, until the failure can no longer be contained by language.

It’s time for Congress to raise the alarm. If the GOP won’t, Democrats must. Donald Trump has the unilateral power to launch 3,700 nuclear weapons. We are entitled to demand a plausible and benign explanation for the symptoms we can plainly see. Any society that fails to insist upon this has a death wish.

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Correction: In the section citing physicians’ appraisals of Trump’s health, I attributed to Harry Segal remarks made by John Gartner. I’ve fixed this. I made a few more changes to this section, too, for clarity, and added remarks from other specialists that I’d meant to include. I’ve also corrected typos and minor errors of diction throughout.

1. You can’t visit Truth Social, by the way, without seeing ads for all the products he’s hawking and all the scams he’s running. His mind may be going, but his determination to fleece his acolytes remains that of a man in his twenties:

2. I’ve written about this at length:

3. I’ve edited the official transcript to show the way he pronounced the words.

4. Lest anyone say that the speech in question was unusually incoherent, remember that we summoned every flag officer in the military back to Quantico to hear this:

… I think we should maybe start thinking about battleships, by the way. You know, we have a Secretary of the Navy. He came to me. Because I look at the Iowa out in California, and I look at different ships in the old pictures. I used to watch Victory at Sea. I love Victory at Sea. Look at these admirals. It’s got to be your all-time favorite. Black and white. When I look at those ships, they came with the destroyers alongside of them, and, man, nothing was going to stop them. There were 20 deep, and they were in a straight line, and there was nothing going to stop them. And we actually talk about, you know, those ships. Some people would say, no, that’s old technology. I don’t know. I don’t think it’s old technology, when you look at those guns. But it’s something we’re actually considering, the concept of battleship. Nice six-inch side, solid steel. Not aluminum. Aluminum that melts if it looks at a missile coming at it. It starts melting as the missile is about two miles away. Now, those ships, they don’t make them that way anymore. But you look at it, and your Secretary likes it, and I’m sort of open to it. And bullets are a lot less expensive than missiles. A lot of reasons. I should take a vote, but I’m afraid to take that vote because I may get voted out on that one. But I tell you, it’s something we’re seriously considering. There were powers. There were big powers. They were just about as mean and scary as you could be. And so we’re looking at that. One of the biggest cases that we won was the decision of the United States Supreme Court to allow us to proceed on the word merit. Merit. So those two words are right up there. So this is, I would say, the opposite of you ask for a definition. The opposite of political correctness. We went through political correct where you had to have people that were totally unfit to be doing what you’re doing, for many reasons. I won’t get into them. But for many reasons, they were unfit. Now it’s all based on merit. That was such an unbelievable decision. I didn’t expect we were going to win that one. We went in. Whether or not the media’s talking about it, the whole world saw it. We said we need it. We went in for colleges, you know, where kids with a C average are getting into the best colleges and the kids with A averages won’t get in. And kids with the highest boards and the highest marks are the best marks couldn’t get into the best schools. And people that had not good boards and not very good marks. I mean, okay, but nothing special. They were getting into our best colleges. I said, this is just crazy. We can’t run. You can’t run a country like this. And it was lingering for years. And it got to the Supreme Court and we won that decision. Merit. Everything is based on merit. You’re all based on merit.

… Biden let people come in from prisons, mental institutions, drug dealers, murderers. You know, we had 11,488 murders allowed into our country by this guy who had no clue. He had no clue. He shouldn’t have been there in the first place, but he had no clue. The people that ran the office, the White House, were people that surrounded him. Radical left lunatics that are brilliant people but dumb as hell when it came to policy and common sense. And they allowed people from all over the world, from the Congo. They opened up prisons in the Congo. They came into our country totally unmatched, unvetted, unchecked. And from all over South America, not just South America. You know, you think South America. No, but from all over. A lot came in from Venezuela. Venezuela emptied its prison population into our country. That’s why they have Trinidad and Tobago, one of the worst gangs ever. But we took care of them. We took good, strong care of them.

… And I sent in the troops and they were gone as soon as I sent them in. Oh, when we send in the troops, if you have a real leader that says you got to do what you have to do. I put that out the other day, you got to do what you got to do because we don’t want our people hurt as they stand by. I was watching during Biden, troops standing up like this, brave, standing up in attention the way I should stand all the time. And I’m like this and people are standing and their mouth is this far away from their mouth and they’re spitting at him and they’re screaming at him. And that soldier standing there, he wants to knock the hell out of the person, but he’s not allowed to do anything. So they just stand there and they get abused.

… And it’s going to be much more than that as we go along because we basically don’t build ships anymore. We do build submarines, but we don’t build ships. Do you know in the Second World War, they were freighters and different types, but we were doing a ship a day and now we don’t do ships. And I’m not a fan of some of the ships you do. I’m a very esthetic person. I don’t like some of the ships you’re doing esthetically. They say, oh, it’s stealth. I say that’s not stealth. An ugly ship is not necessary in order to say you’re stealth. By the way, the B-2 Bombers were incredible. That is stealth. They went into that, I was with General Caine and every, and Pete were in the, we call it the war room, but we’re watching them go in and they were totally untouched. They were not seen. They were literally not seen. They dropped their bombs. They hit, every single one of them hit its target. It was total obliteration. CNN, when we came back, fake news CNN. Oh, their camera just went off. You know, their camera, every time I mention them, they turn the camera off because it’s never good. They say this is a problem, but I don’t blame them. You’re better off keeping it off. But they have some scammer, reporter who started saying, without any knowledge, that he may not have hit the targets as well as they thought. It may not have been obliteration. He did hit the targets … you’ve got to give us a little credit, right? It was obliteration it turned out. The Atomic Energy Commission said it was obliterated. They had, not only did they hit the target, they had these chutes, and think of this here, way up in the sky, there was no moon. It was dead dark; you couldn’t see a thing, you couldn’t see them. But they had, I guess, a beam going right into these chutes.

… What a difference a presidential election can make. That’s all it is. It’s just a presidential election. Yesterday at the White House, we put forward a plan for peace in Gaza. We announced it and we’re going to create something that was my idea. But unfortunately, I got drafted. It’s going to be called the Board of Peace and it’s going to reign over that territory. And we’re going to get that done and they asked if I’d be the chairman of the Board of Peace, I wasn’t counting on that. I had the idea for the Board of Peace, but I said yes. And I guess because of that, every leader, every everybody, wants to be on the Board of Peace.

… And, you know, they’re testing all these planes that all the companies are testing. And this one tested, like, through the roof. And they said, we’d like to name it the F-47. I said, Let me think about it. Then, after thinking for about two seconds, I said, Okay. You know what that means, 47. I’m 47. So I’m 45, 46, and 47. You know, if you think about it. I just don’t want the credit for 46. I don’t want to have their open borders and people coming in from all over the world, including jails and mental incidents. I don’t want that on my record. But I like having it. We’re investing tens of billions of dollars in modernizing our nuclear deterrence capabilities like never before. And we’ve begun construction on what we call the Golden Dome Missile Defense Shield. It’ll be the most sophisticated in the world. You watched it do well until they had some problems at the end with a little bit of a lack of ammunition, defensive ammunition. But they’ve got that taken care of. But I tell you, it’s what we’re doing is so good. And we deserve it. You know, we help other countries with it. We don’t have it ourselves. And Canada called me a couple of weeks ago. They want to be part of it, to which I said, Well, why don’t you just join our country? You become 51, become the 51st state, and you get it for free. So I don’t know if that made a big impact, but it does make a lot of sense. …

5. The relationship between obesity and dementia is unclear. Some studies indicate a significant correlation, and others a correlation with obesity in midlife, but not later. (Weight loss, perhaps, is a very early symptom). Living on junk food is probably a risk factor, and physical inactivity is clearly a risk. What’s more, obesity is associated with brain atrophy in the elderly, and seems to accelerate the progression of Alzheimer’s.

6. In later stages, speech becomes unintelligible, marked by lack of coherence, dysarthria (unclear articulation), echolalia (the repetition of words just spoken by another person), and palilalia (the involuntary repetition of words). The final stage is characterized by mutism and severe deficits of comprehension. A terrifying disease.

The literature on frontotemporal dementia and primary progressive aphasia describes the features of Trump’s speech very precisely. See, for example, “Speech and language impairments in behavioral variant frontotemporal dementia: A systematic review.” Behavioral-variant FTD—a degeneration of frontal and anterior temporal lobes—is characterized by disinhibition, impaired social judgment, and “empty” but verbose speech. Language symptoms “extend to multiple domains and go beyond executive dysfunction,” often appearing early.

Or see, “Classification of primary progressive aphasia and its variants,” which describes non-fluent/agrammatic primary progressive aphasia, defined by effortful, halting production (not Trump’s problem, I’d say) and so-called production errors in grammar and syntax: sentence fragments, misconjugated verbs, and broken constructions (very much Trump’s problem).

Several more patterns in Trump’s speech are especially salient. First, there’s the loss of hierarchical structure. A healthy person will build arguments and stories in nested layers: Themes are introduced, developed, and resolved. In Trump’s speech, themes are opened then abandoned; interpolated material never closes. He is obviously aware of this, which is why he calls his rambling speech “the weave.” (Because he also suffers from a severe personality disorder, he interprets his growing dysfunction in the only way he can: as a form of genius. It’s not.)

Note his failure to bind his pronouns. He uses words like “they,” “them,” “it,” “that” without clear antecedents. This is a symptom of degraded discourse organization, a sign of PPA or frontal involvement. Listen for the semantic drift. Concepts slide: a concrete anecdote about making fries becomes a commentary on campaign crowds, then a meditation on love and victory. The underlying associations are emotional, not logical. Listen for improvised repairs: the “I turn that and I—there’s no water” pattern, for example, in which a structure begins, collapses, and is replaced mid-stream with something simpler. This is a textbook indicator of non-fluent/agrammatic PPA, where syntactic planning is impaired, causing speakers retreat to shorter, less complex strings.

7. I would advise him, when speaking to the media, to stop making jokes, stop laughing nervously, and dress formally—preferably in a white coat. His efforts to seem warm and approachable work at cross-purposes with the deadly seriousness of his message.

8. See:

9. And, if I may, GOP representatives, you should have thought of this before.