I

t was the kind of utterance that makes professional transcribers question their career choice:

“ … there is no collusion between certainly myself and my campaign, but I can always speak for myself — and the Russians, zero.”

When President Trump offered that response to a question at a press conference last week, it was the latest example of his tortured syntax, mid-thought changes of subject, and apparent trouble formulating complete sentences, let alone a coherent paragraph, in unscripted speech.

advertisement

President Trump denied his campaign colluded with Russia while speaking at a press conference in May 2017. Via YouTube

He was not always so linguistically challenged.

STAT reviewed decades of Trump’s on-air interviews and compared them to Q&A sessions since his inauguration. The differences are striking and unmistakable.

Research has shown that changes in speaking style can result from cognitive decline. STAT therefore asked experts in neurolinguistics and cognitive assessment, as well as psychologists and psychiatrists, to compare Trump’s speech from decades ago to that in 2017; they all agreed there had been a deterioration, and some said it could reflect changes in the health of Trump’s brain.

Newsletters

Sign up to our Daily Recap newsletter

Please enter a valid email address.

In interviews Trump gave in the 1980s and 1990s (with Tom Brokaw, David Letterman, Oprah Winfrey, Charlie Rose, and others), he spoke articulately, used sophisticated vocabulary, inserted dependent clauses into his sentences without losing his train of thought, and strung together sentences into a polished paragraph, which — and this is no mean feat — would have scanned just fine in print. This was so even when reporters asked tough questions about, for instance, his divorce, his brush with bankruptcy, and why he doesn’t build housing for working-class Americans.

In an interview from 1987, Donald Trump talks about poverty and homelessness in the US. Via YouTube

Trump fluently peppered his answers with words and phrases such as “subsided,” “inclination,” “discredited,” “sparring session,” and “a certain innate intelligence.” He tossed off well-turned sentences such as, “It could have been a contentious route,” and, “These are the only casinos in the United States that are so rated.” He even offered thoughtful, articulate aphorisms: “If you get into what’s missing, you don’t appreciate what you have,” and, “Adversity is a very funny thing.”

Now, Trump’s vocabulary is simpler. He repeats himself over and over, and lurches from one subject to an unrelated one, as in this answer during an interview with the Associated Press last month:

“People want the border wall. My base definitely wants the border wall, my base really wants it — you’ve been to many of the rallies. OK, the thing they want more than anything is the wall. My base, which is a big base; I think my base is 45 percent. You know, it’s funny. The Democrats, they have a big advantage in the Electoral College. Big, big, big advantage. … The Electoral College is very difficult for a Republican to win, and I will tell you, the people want to see it. They want to see the wall.”

For decades, studies have found that deterioration in the fluency, complexity, and vocabulary level of spontaneous speech can indicate slipping brain function due to normal aging or neurodegenerative disease. STAT and the experts therefore considered only unscripted utterances, not planned speeches and statements, since only the former tap the neural networks that offer a window into brain function.

The experts noted clear changes from Trump’s unscripted answers 30 years ago to those in 2017, in some cases stark enough to raise questions about his brain health. They noted, however, that the same sort of linguistic decline can also reflect stress, frustration, anger, or just plain fatigue.

Ben Michaelis, a psychologist in New York City, performed cognitive assessments at the behest of the New York Supreme Court and criminal courts and taught the technique at a hospital and university. “There are clearly some changes in Trump as a speaker” since the 1980s, said Michaelis, who does not support Trump, including a “clear reduction in linguistic sophistication over time,” with “simpler word choices and sentence structure. … In fairness to Trump, he’s 70, so some decline in his cognitive functioning over time would be expected.”

Some sentences, or partial sentences, would, if written, make a second-grade teacher despair. “We’ll do some questions, unless you have enough questions,” Trump told a February press conference. And last week, he told NBC’s Lester Holt, “When I did this now I said, I probably, maybe will confuse people, maybe I’ll expand that, you know, lengthen the time because it should be over with, in my opinion, should have been over with a long time ago.”

In an interview conducted earlier this month, President Trump explains the timing of James Comey's firing. Via YouTube

Other sentences are missing words. Again, from the AP: “If they don’t treat fairly, I am terminating NAFTA,” and, “I don’t support or unsupport” — leaving out a “me” in the first and an “it” (or more specific noun) in the second. Other sentences simply don’t track: “From the time I took office til now, you know, it’s a very exact thing. It’s not like generalities.”

There are numerous contrasting examples from decades ago, including this — with sophisticated grammar and syntax, and a coherent paragraph-length chain of thought — from a 1992 Charlie Rose interview: “Ross Perot, he made some monumental mistakes. Had he not dropped out of the election, had he not made the gaffes about the watch dogs and the guard dogs, if he didn’t have three or four bad days — and they were real bad days — he could have conceivably won this crazy election.”

The change in linguistic facility could be strategic; maybe Trump thinks his supporters like to hear him speak simply and with more passion than proper syntax. “He may be using it as a strategy to appeal to certain types of people,” said Michaelis. But linguistic decline is also obvious in two interviews with David Letterman, in 1988 and 2013, presumably with much the same kind of audience. In the first, Trump threw around words such as “aesthetically” and “precarious,” and used long, complex sentences. In the second, he used simpler speech patterns, few polysyllabic words, and noticeably more fillers such as “uh” and “I mean.”

Donald Trump shares his take on Ross Perot's 1992 presidential campaign. Via YouTube

The reason linguistic and cognitive decline often go hand in hand, studies show, is that fluency reflects the performance of the brain’s prefrontal cortex, the seat of higher-order cognitive functions such as working memory, judgment, understanding, and planning, as well as the temporal lobe, which searches for and retrieves the right words from memory. Neurologists therefore use tests of verbal fluency, and especially how it has changed over time, to assess cognitive status.

Those tests ask, for instance, how many words beginning with W a patient can list, and how many breeds of dogs he can name, rather than have patients speak spontaneously. The latter “is too hard to score,” said neuropsychologist Sterling Johnson, of the University of Wisconsin, who studies brain function in Alzheimer’s disease. “But everyday speech is definitely a way of measuring cognitive decline. If people are noticing [a change in Trump’s language agility], that’s meaningful.”

Although neither Johnson nor other experts STAT consulted said the apparent loss of linguistic fluency was unambiguous evidence of mental decline, most thought something was going on.

John Montgomery, a psychologist in New York City and adjunct professor at New York University, said “it’s hard to say definitively without rigorous testing” of Trump’s speaking patterns, “but I think it’s pretty safe to say that Trump has had significant cognitive decline over the years.”

No one observing Trump from afar, though, can tell whether that’s “an indication of dementia, of normal cognitive decline that many people experience as they age, or whether it’s due to other factors” such as stress and emotional upheaval, said Montgomery, who is not a Trump supporter.

Even a Trump supporter saw and heard striking differences between interviews from the 1980s and 1990s and those of 2017, however. “I can see what people are responding to,” said Dr. Robert Pyles, a psychiatrist in suburban Boston. He heard “a difference in tone and pace. … What I did not detect was any gaps in mentation or meaning. I don’t see any clear evidence of neurological or cognitive dysfunction.”

Johnson cautioned that language can deteriorate for other reasons. “His language difficulties could be due to the immense pressure he’s under, or to annoyance that things aren’t going right and that there are all these scandals,” he said. “It could also be due to a neurodegenerative disease or the normal cognitive decline that comes with aging.” Trump will be 71 next month.

Newsletters

Sign up to our Daily Recap newsletter

Please enter a valid email address.

Northwestern University psychology professor Dan McAdams, a critic of Trump who has inferred his psychological makeup from his public behavior, said any cognitive decline in the president might reflect normal aging and not dementia. “Research shows that virtually nobody is as sharp at age 70 as they were at age 40,” he said. “A wide range of cognitive functions, including verbal fluency, begin to decline long before we hit retirement age. So, no surprise here.”

Researchers have used neurolinguistics analysis of past presidents to detect, retrospectively, early Alzheimer’s disease. In a famous 2015 study, scientists at Arizona State University evaluated how Presidents Ronald Reagan and George H.W. Bush spoke at their news conferences. Reagan’s speech was riddled with indefinite nouns (something, anything), “low imageability” verbs (have, go, get), incomplete sentences, limited vocabulary, simple grammar, and fillers (well, basically, um, ah, so) — all characteristic of cognitive problems. That suggested Reagan’s brain was slipping just a few years into his 1981-1989 tenure; that decline continued. He was diagnosed with Alzheimer’s disease in 1994. Bush showed no linguistic deterioration; he remained mentally sharp throughout his 1989-1993 tenure and beyond.

Sharon Begley answered reader questions about this article on Facebook. Read the conversation here.

Leave a Comment

Please enter your name.
Please enter a comment.

  • See this all before. Pill induced drug anxiety. He’ll need some time at the Betty ford clinic getting cleaned up. Our president is a pharma monster.

    • LMAO! Could be true. Would be lotsa fun to know what meds he’s on, and for what, who prescribed them, and for how long.
      Benzodiozapines may be the most commonly prescribed class of drugs in America, for anxiety, depression, long term use can cause permanent brain damage, brain atrophy, loss of brain mass, the brain shrinks. Can also cause confusion, incoherence, short and long term memory loss, short term use relieves anxiety but long term use can aggravate anxiety. Very addictive, very hard to kick, but legal if prescribed by an MD.

  • I think the biggest problem is he’s still pandering to the sorts of idiots that couldn’t handle listening to a rational sentence. Do you know anyone of sound mind that still vehemently defends the guy? Do you know anyone of above normal intelligence that inexplicably supports him? He talks in nonsense because that appeals to idiots that only want to latch onto buzzwords. They don’t have the ability to listen to a thoughtful speech, and don’t have the patience or intellect to listen to reason. He throws out a few hateful bullet points that appeal to common morons, and they eat it up. It’s why, for God’s sake, they have a Trump store in the nearest town. What a joke that is. I bet Hitler would have had t-shirts and bumper stickers for sale had he thought of it. Only the deeply stupid would still support someone who has consistently and unashamedly lied to the country he supposedly serves. Only someone with a massive personality disorder would have a President store.

    • While I agree that much of what he says can only appeal to the under thoughtful, I think that we need to consider that his appeal really reflects a more general problem with humanity. It is a human trait to want answers delivered to us. We want to believe that the world makes sense and that there are those that know what that is. This is the attraction of pundits and preachers. Rather or not we want to believe it, we are drawn to those that seem to know. I have seen narcissists fool even very intelligent people because they deliver with certainty and this can work around their critical thinking. While yes, he presents solutions that can only appeal to those who don’t use any critical thinking, it is possible to engage in a campaign to fool at some of the people most of the time. I would suggest that while Drumpt is an example of an extreme, that it is the certainty of his presentation, not the actual solutions that mean a great deal to his supporters. This is just the nature of politics and why all of them should be accounted for by what they actually do, not what they promise.

    • Trump has mastered the art of crowd hypnosis, mass hypnosis. Whether this is learned, or comes naturally – psychopaths seem to have a natural instinct for it – or half and half, is an open question, but he uses a very basic and reliable mass hypnosis technique in his public speeches and often in his interviews, he runs on saying so many vague ambiguous conflicting and meaningless things that the rational analytical conscious brain gives up and shuts down leaving the unconscious wide open for influence and suggestion, people who do not make a habit of thinking rationally and analytically much of the time are very vulnerable to this. They see him getting up there and saying forcefully whatever he says and assume it must be true, else why would he say it with such conviction? They’re not considering the possibilities that he may be consciously lying for personal gain, that he may be delusional, that he may be manipulating the hell out of them.

  • In a country already hypnotized by the Movie Industry, Electronic Arts, & Media Do we really have to measure IQ’s & conduct Psychoanalysis to define who is fit to run the USAA?
    The hunger games is the answer and it was highly predictive forecast in the works…………CONTROLLE THE MASSES
    Now the writers feeding next gen movies are capitalizing on it, ahead of time……….

  • How would Trump’s vocabulary and syntax compare to, say, Sarah Palin’s word salad? Both seem to jump randomly from topic to topic, rather like they are thinking out loud, ruminating, forgetful or unaware of their responsibilities or audience.

    Also, Sen. John McCain’s confusing questions to James Comey at the recent Senate Intelligence hearing. Some related that to his glioblastoma….

    • Senator McCain’s speech showed that he had a physical problem inside his brain. Senator McCain was examined by his medical team, where they found the blood clot associated with the glioblastoma. McCain had the blood clot removed. His doctors presented his treatment options, and they decided on a treatment plan. Senator McCain is already home in Arizona. McCain’s daughter stated that they hiked. He is anxious to return to Congress.

      I don’t understand your statement of: Some related that to his glioblastoma…. What else would you relate his confusing questions to? At least he doesn’t suffer from the confusion that permeats the White House.

  • To be fair, I would think that it might be difficult to express one’s thoughts in a consistently coherent manner when one is constantly lying through one’s teeth.

  • I think it is just normal age related decline and I dont see him as being above average in intelligence even back then. And that huge case of narcissistic personality disorder has gotten worse.

  • I’m an attorney, retired now, I have been conservator for several schizophrenic clients over the years, I have and have had other friends and relatives with various mental disabilities including ADHD and senile dementia.

    As I have been watching Trump, his unscripted speech patterns, his public behavior, I see two things:

    1. He is well above average intelligence.

    2. He is very manipulative, he uses mass hypnosis techniques in his scripted speeches and body language that are well known to good hypnotists and hypnotherapists.

    3. He also exhibits classic signs consistent with any or all of the following: Attention Deficit Hyperactivity Disorder, Antisocial Personality Disorder (Sociopathy), Narcissistic Personality Disorder, Paranoid Schizophrenia, early Senile Dementia.

    This is not a diagnosis, that would take a psych eval, just that what Trump does in public on a regular basis is consistent with those diagnoses as we see the criteria in the DSMIV and elsewhere.

    There is a book to be released in October – “THE DANGEROUS CASE OF DONALD TRUMP” – the teasers say it’s a collaborative work by 27 psychiatrists and psychologists, you can pre-order at Amazon.

    • As to Item 3 – I would add frontotemporal dementia – with an impact on executive function, impulse control, and language skills. This is an illness that can take awhile to diagnose, and in its early stages is often misdiagnosed as a psychiatric illness.

    • While I have no problem with numbers 2 and 3, although ADHD is likely weak, and paranoid schizophrenia is unlikely in favor of delusional disorder, I can’t agree with number 1, or to be more precise, you have to define how above average he is. If you are suggesting for example that he is in the 90th percentile or above, I would think you are grossly mistaken. I think there could be a good case to place him at say about the 70th to the 80th. As far as using hypnotic techniques. Of course he is. Almost any successful politician or salesman does. But theses techniques don’t reflect any genius, but rather the learning of a goal orientated person who has been selling people most of his life. His career has been mostly in the area of selling. He has been bankrupted 7 times. He even managed to bankrupt a Casino. This is all before the current consideration of dementia. He has always been a narcissistic and they always tend to be some sort of salesman and are often successful in that they are able to sell others, but no, no real intelligence and no really cleaver manipulation. I would suggest that this is just well practiced, and fairly common, salesmanship.

  • I do agree with Tamara that the DEGREE of decline – I would say collapse – in verbal fluency discussed here is NOT normal age-related decline. It’s much more pronounced than that. Whether it’s significant enough to be considered disabling is the real issue we should be discussing.

Sign up for our Morning Rounds newsletter

Your daily dose of news in health and medicine