上周，一群精神病学医生和专家联名给总统的御医（Dr. Ronny Jackson）写了一封紧急公开信，要求他给总统进行一项认知测试。
这项测试叫Montreal Cognitive Assessment, （MoCA），是认知测试的权威问卷方法。是精神病学医生常用来检测”轻度认知技能障碍（mild cognitive dysfunction)的权威工具。
The 30-point test takes about 10 minutes and asks the patient to perform a simple batch of memory and mental tasks. The tasks include drawing a line between a number and a letter in ascending order.
To test visuoconstructional skills. The patient is asked to draw a clock and put numbers on it, and to draw a cube.
In this clock drawing task, the subject is asked to draw a clock with the hours and showing the time 2:30. Successive results show a deterioration of pattern processing ability in a subject as they progress from mild cognitive impairment (MCI) to severe Alzheimer's disease (AD).
January 11, 2018
Rear Admiral Ronny L. Jackson
Chief Physician to the President
The White House Medical Unit
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear Rear Admiral Jackson,
Thank you for your long service to the nation. As healthcare and mental health professionals, we respect the significant responsibility you have to monitor and ensure the health and well-being of the President of the United States of America – not just on his behalf, but on behalf of all Americans.
We are fully aware that you are scheduled to perform a physical examination on President Donald Trump on Friday, January 12th. The White House has stated that the President will not receive any “psychiatric” testing as part of the physical examination you will be conducting. We strongly advise and encourage you to follow standard medical procedures for a physical examination conducted on patients 66 years and older according to Medicare guidelines. As such, your examination should include an evaluation of the 71-year old President’s neurological health, including cognitive and mental health functions.
Without performing an evaluation of this kind, President Trump would be receiving care that is inadequate to the standard care regularly administered to millions of Americans covered by Medicare. Equally important, without this evaluation, the American people will not have a clear understanding about the health and well-being of the President, which is essential for Americans to know of any president.
This is especially true at a time of increasing concern over the President’s:
• Declining faculties for complex thought, rambling speech, difficulty completing a thought
• Episodes of slurred speech
• Failure to recognize old friends
• Frequent repetition of the same concepts
• Decreased fine motor coordination
• Difficulties reading, listening and comprehending
• Suspect judgment, planning, problem solving and impulse control
• Markedly declining vocabulary in recent years, with over reliance on superlatives
Your examination should also include a basic dementia screen such as the Montreal Cognitive Assessment, and as thorough a neurological examination as you can perform given your specialty as an internist. Your duty to this patient and the country that employs you as an officer of the United States Navy is to refer your patient to specialist care if any elements of your neurological and psychiatric examination yield pertinent results. Your threshold for such referral should be low given this patient’s position. Relevant specialties you should consider for referral if needed include but are not limited to: Neurology, psychiatry, physiatry and neuropsychology.
You should also be aware of an editorial authored by former President Jimmy Carter in 1994 in the Journal of the American Medical Association, in which he explained how the country is in “continuing danger” from the possibility that a president could become mentally disabled "particularly by a neurological illness.” President Carter proposed a presidential fitness committee that could regularly assess a president’s neurological status by routinely administering a battery of cognitive tests to assess judgment, recall, decision-making and attention. Many of us in the medical and mental health communities agree WHOleheartedly, and such a measure has been proposed by Congressman Jamie Raskin (H.R. 1987). But we do not currently have such a committee. We have only you.
The Office of the President of the United States is the most powerful office in the world and its history. As such, medical care, medical evaluations and the medical status of the President have significant implications for the American people, who the President serves.
As medical and mental health professionals, we are fully aware that a diagnosis can only be made by an evaluating physician. In our professional judgment, the growing concern over President Trump’s health is not only reasonable, but essential considering the office that he holds and the grave responsibilities and extensive powers of this public office.
Dr. Jackson, we do not envy you for overseeing a clinical examination this week under such scrutiny. However, this is also an opportunity in which you can stand for the best of the medical profession, simply by doing what you were trained to do.
We strongly encourage you to examine the patient before you as he is, without fear or favor, and make any reasonable recommendations for further testing or referrals that your thorough screening suggests are appropriate. The health of the President relies on it – as do American lives and the safety of our nation.