Being the President of the United States is one of the most difficult, high-pressure jobs in the world. Decision making, collaboration, critical thought, and strong communication are just some of the areas that the president must excel in to do the job right and mental faculties are the cornerstone of success. It is not uncommon for high-pressure jobs to require cognitive testing; the FAA, for example, requires a battery of neuropsychological testing for its pilots with the primary purpose being safety. By assessing cognition and emotional functioning, issues that may pose a risk to the safety of passengers and pilots can be mitigated. The military also requires cognitive testing and ultimately the president is the commander-in-chief.

Polling shows that the majority of Americans, Republicans and Democrats, favor cognitive testing for their presidential candidates. While putting age limits on candidates may initially appearing as a good solution, this would not fix the issue as there are older individuals with perfect cognition and others that are younger but deteriorated in terms of cognitive ability.

Historically, feeble attempts to test cognition have been made by inappropriately using the Montreal Cognitive Assessment (MoCA) which was created as a screening test for severe cognitive impairment. It includes 30 questions such as asking the patient to draw a clock, copy a picture of a cube and identify pictures of animals – the same activities given to kindergarteners. It is meant to screen for severe cognitive impairment and is wholly inappropriate to test the faculties the president would need. Not all cognitive tests are created equally. There are in fact 6 key cognitive function domains defined by the diagnostic and statistical manual of mental disorders (DSM-5): complex attention, executive function, learning and memory, language, perceptual-motor control, and social cognition. These are the 6 areas that Americans would expect their president to be optimal in and what we do not currently test for in our presidential candidates. These are to be tested with a comprehensive battery of neuropsychological testing which is already administered to those in high pressure jobs such as the military or airline pilots.

The American people deserve leaders who are sharp, engaged, and cognitively on point. No one, whether they are registered Republicans, Democrats, or those not even registered to vote want cognitive impairment on the ballot.