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Chip Somodevilla

<a href="https://www.washingtonpost.com/donald-trump/" target="_blank" class="contextual_link">Donald Trump</a> invited his extended family to Mar-a-Lago in the mid-1990s. As the clan gathered at the palatial Florida estate, though, his father was badly struggling, according to Mary L. Trump, Donald’s niece.

Fred Trump Sr., the pugnacious developer then in his late 80s, didn’t recognize two of his children at the party, recalled Mary L. Trump, who attended the gathering. And when he did recognize Donald, the family patriarch approached his son with a picture of a Cadillac that he wanted to buy — as if he needed his son’s permission.

The incident, Mary L. Trump said, left Donald Trump visibly upset at his father’s descent into dementia, which medical records show had been diagnosed several years earlier. Trump reflected his anguish in an interview around that time, with Playboy in 1997 reporting that seeing his father “addled with Alzheimer’s” had left him wondering “out loud about the senselessness of life.”

“Turning 50 does make you think about mortality, or immortality, or whatever,” Trump, who had recently reached that milestone, told the magazine. “It does hit you.”

Today, as the 77-year-old Trump seeks to return to the White House, he is still focused on the ravages of dementia — but this time he is using the condition as a political weapon, alleging without medical proof that <a href="https://www.washingtonpost.com/elections/candidates/joe-biden-2024/" target="_blank" class="contextual_link">President Biden</a>, 81, is “cognitively impaired.” Those attacks follow a long pattern for the former president, who for years has bashed enemies as mentally frail while boasting in public about “acing” <a href="https://mocacognition.com/" target=_blank>the Montreal Cognitive Assessment</a>, a basic test that flags signs of early dementia.

Trump regularly claims to have passed the test twice, but through a spokesman, his campaign declined to release his test results or to specify when he most recently took it. Rep. Ronny Jackson (R-Tex.), the former White House physician, said in an interview this month that he administered it to Trump once, in January 2018. Trump in November released a three-paragraph <a href="https://truthsocial.com/@realDonaldTrump/posts/111444920245122377" target=_blank>letter</a> in which Bruce Aronwald, a doctor of osteopathy, said that Trump’s health was excellent and that “cognitive exams were exceptional” but provided no details. Aronwald did not respond to a request for comment.

Ziad Nasreddine, the neurologist who created the test, said in an interview that if an individual in their 70s had not taken the Montreal test since 2018, the results would not be valid to cite today.

Trump’s long fixation on mental fitness followed years of watching his father’s worsening dementia — a formative period that some associates said has been a defining and little-mentioned factor in his life, and which left him with an abiding concern that he might someday inherit the condition. While much remains unknown about Alzheimer’s, experts say there is an increased risk of inheriting a gene associated with the disease from a parent.

“Donald is no doubt fearful of Alzheimer’s,” said a former senior executive at the Trump Organization, who worked for years with Trump and saw him interact with Fred Trump Sr., and who spoke on the condition of anonymity to describe a confidential relationship. “He’s not going to talk about and not going to admit to it. But it’s relevant because every day he is hitting Biden with whether or not he is capable mentally of doing the job.”

Trump’s father’s condition also drove a wedge into his family, which fell into years of lawsuits that alleged in part that Donald Trump sought to take advantage of his father’s dementia to wrest control of the family estate — litigation that introduced reams of medical records detailing Fred Trump Sr.’s condition.

The full story of Trump’s father’s illness, and the family turmoil it sparked, casts new light on his views of an issue that’s become central to the presidential campaign, with pollsters finding a majority of voters have concerns about the mental fitness of both Trump and Biden. Those concerns have sharpened as both candidates have had lapses on the trail, with Biden mixing up the names of the leaders of Mexico and Egypt and Trump confusing former South Carolina Gov. <a href="https://www.washingtonpost.com/elections/candidates/nikki-haley-2024/" target="_blank" class="contextual_link">Nikki Haley</a> with former speaker of the House Nancy Pelosi, and warning that the United States could face “World War II” under Biden.

Trump declined an interview request and did not respond to a list of questions about his experience with his father’s Alzheimer’s.

Instead, Jason Miller, the Trump campaign’s senior adviser, said that Trump would take another cognitive test if Biden does the same. “President Trump has aced this test twice and is willing to take a third test if Joe Biden sits in the same room and takes it at the same time,” he said in a statement. “In fact, President Trump believes all Presidents should take the test.”

The issue has also come to the fore after Robert K. Hur, the special counsel who investigated Biden’s handling of classified material, said the president is an “elderly man with a poor memory” — a claim strongly disputed by the White House. A White House spokeswoman, Karine Jean-Pierre, <a href="https://www.whitehouse.gov/briefing-room/press-briefings/2024/02/28/press-briefing-by-press-secretary-karine-jean-pierre-52/" target="_blank">said</a> at a press briefing on Feb. 28 that Biden’s doctors concluded <a href="https://www.whitehouse.gov/wp-content/uploads/2024/02/Health-Summary-2.28.pdf" target="_blank">during a physical</a> that Biden “doesn’t need a cognitive test.”

Trump idolized his father, a gruff taskmaster who had made a fortune in real estate and sought to instill in his son the idea that he could be a “king.” But Trump also struggled to live up to his father’s demands. As Donald, a lackluster student, was sent as a teenager to a military academy, his older brother, Fred Trump Jr., was widely expected to take over the family business.

Those succession plans were scrambled, though, after Fred Trump Jr. opted to pursue a career as a pilot and struggled with alcoholism, which contributed to his death at 42. (Donald Trump later <a href="https://www.washingtonpost.com/politics/trump-pressured-his-alcoholic-brother-about-his-career-now-he-has-regrets-/2019/08/07/58ec2d70-b216-11e9-8f6c-7828e68cb15f_story.html" target=_blank>told</a> The Washington Post his death convinced him to never drink alcohol out of concern he was also at risk because of “the genetic effect.”)

In the early 1970s, as Donald took a leading role in the firm, Fred Trump Sr. told the New York Times that “Donald is the smartest person I know.”

By 1990, though, the claims of Trump’s business genius were being questioned as he fell into desperate financial condition. He eventually filed six corporate bankruptcies, and he faced the prospect of personal bankruptcy as his first wife, Ivana, sought $1 billion in a divorce settlement. His high-profile casinos in Atlantic City were badly faltering.

That’s when Trump sought to change his father’s will.

Trump arranged for a lawyer to write an amendment called a codicil giving him control over the estate and to protect his inheritance from creditors. He then had two of his father’s most trusted associates deliver it to Fred Trump Sr. as if it were a formality. But Trump’s mother, Mary MacLeod Trump, forbade Trump’s father from signing it immediately. Trump’s sister, Maryanne Trump Barry, later said in a deposition that her father didn’t like how the effort to change the will was being done “behind his back.”

Trump later admitted in a deposition that he hoped the gambit would rescue him from financial problems by giving him significant control over the estate. “It was a very bad period of time and if for any reason I was not able to come out of this well, then this would be giving me a trust to protect” his inheritance, Trump said.

That effort failed — but Trump’s actions would expose his father’s deteriorating mental state.

In October 1991, around the time Fred Trump Sr. turned 86 years old, he visited his doctor, C. Ronald MacKenzie. In a report about that visit, the physician wrote that he had “significant memory impairment” with “early signs of dementia” and “obvious memory decline in recent years,” according to records disclosed in the court case.

Months later, a second doctor wrote in a neuropsychological evaluation that Fred Trump Sr. “did not know his birth date, was unsure of his age, and turned to his son [Robert] for help in responding to questions.” The exam by Rajendra Jutagir found that Fred Trump Sr.’s cognitive ability was below the 15th percentile for a person in his age group. He could only recall three of the previous nine U.S. presidents and could not draw the hands of a clock to show the time.

Those detailed medical reports, later entered into court filings, paint an early picture of what would be a long decline for Fred Trump Sr. — one that his son claimed not to notice for years.

“Do you recall your father suffering from any memory lapses in 1991?” an attorney asked Trump in a deposition conducted in 2000.

“Do you recall him being diagnosed as having senile dementia in 1991?” the attorney said.

“No, I don’t,” Trump said in the deposition. To the contrary, Trump said that his father was “very, very sharp.”

Mary L. Trump said those claims were contradicted by other family members. Robert Trump, Donald’s younger brother, said that their father was in “notable decline” by 1990, as recounted by Mary L. Trump in a lawsuit over the will. Trump’s sister, Maryanne Barry, later was secretly recorded by Mary L. Trump as saying that “it was basically taking the whole estate and giving it to Donald” at a time when “Dad was in dementia.” (Maryanne Barry, who died last year, did not respond to a request for comment when The Post first <a href="https://www.washingtonpost.com/politics/maryanne-trump-barry-secret-recordings/2020/08/22/30d457f4-e334-11ea-ade1-28daf1a5e919_story.html" target=_blank>revealed</a> the secret tapes in 2020; Robert died in 2020.)

Regardless, by the mid-’90s even Donald Trump was publicly acknowledging the truth: that his father’s dementia was rapidly advancing.

Adam Scull/Photolink/MediaPunch

A few years after his father’s diagnosis, Trump was driving down Fifth Avenue with his father when they passed by the Empire State Building, the iconic 102-story office tower, a landmark known well by both men. As Trump later recalled to the New York Times, his father said, “That’s a tall building, isn’t it? How many apartments are in that building?” Trump thought his father was “kidding” but eventually realized this was a sign of Alzheimer’s, he told the newspaper.

Around the same time, Trump held the family gathering at Mar-a-Lago, where Mary L. Trump says Fred Trump Sr. did not recognize her or two of his children, Robert and Maryanne. After the incident in which Fred Trump Sr. seemed to ask permission to get a new Cadillac, Robert said it would be taken care of, but “Donald just walked away, like, ‘Oh, God, get him away from me. He’s so annoying.’ He had no patience, none whatsoever,” recalled Mary L. Trump, who has more recently become an outspoken political opponent of her uncle, including writing a book that called him “the world’s most dangerous man.”

The former senior executive at the Trump Organization recalled Trump bringing his father to a party in the mid-1990s when it was clear the elder Trump was suffering from dementia. He said Donald Trump had an abiding fear of germs and diseases.

“I remember distinctly he brought his father to the party and Donald was either holding his hand or close to him physically, and he introduced me to him and you could see his father wasn’t comprehending much of anything,” the former executive said. “Donald was not the type to show affection. It was just Donald being matter-of-fact that his father had Alzheimer’s.”

Trump later said in an appearance with television personality Mehmet Oz that his father in his last few years had developed what was “probably” Alzheimer’s, “which was very hard for us because he was such a smart guy, such a wonderful guy and, you know, that’s a rough thing.”

Trump’s father died at 93 years old in June 1999, eight years after the first formal diagnosis of dementia.

Shortly afterward, Mary L. Trump and some other family members sued Donald Trump and two of his siblings, accusing them and others of seeking to take advantage of Fred Trump Sr.’s declining mental abilities in the attempt to rewrite the will. The allegation came as part of a broader argument that she was owed more health-care coverage.

“Fred Sr.’s will is the product of undue influence and coercion by defendants upon Fred Sr., who clearly lacked the requisite mental capacity to make a will,” the lawsuit said. Donald Trump denied the allegation and later said that Mary L. Trump was “a seldom seen niece who knows little about me, says untruthful things about my wonderful parents (who couldn’t stand her!) and me.”

The case was settled under a nondisclosure agreement.

Jabin Botsford

In the lead-up to the 2020 elections, Trump’s preoccupation with mental acuity took center stage again — this time, because of a test similar to the one his father had taken three decades earlier.

The Montreal test was created by Nasreddine in 1996 to look for early signs of impairment, using some similar markers, including a clock face test, to the ones that doctors used to diagnose Fred Trump Sr. a few years earlier.

In the summer of 2020, Trump appeared on Fox News to boast of his “amazing” performance on the test — including a recitation of words he said he was asked to memorize and said in succession: “Person. Woman. Man. Camera. TV.” (Those words would never have appeared in that order in the test, <a href="https://www.washingtonpost.com/politics/2024/01/19/trump-cognitive-test/" target=_blank>Nasreddine recently told The Post</a>, noting that related words such as “man” and “woman” aren’t used in a sequence.)

Jackson, who had announced in a January 2018 press briefing that he had administered the Montreal test to Trump as White House physician, said in the interview that he no longer has a copy of Trump’s test.

Today, Trump continues to regularly refer to the Montreal test as he seeks to return to the White House. After making mistakes such as confusing Pelosi with Haley, he sought to quell questions by raising the Montreal Cognitive Assessment. “I took two of them, and ACED them both (no mistakes!). All Presidents, or people wanting to become President, should mandatorily take this test!” Trump wrote on Truth Social on Feb. 29.

It’s not a new suggestion in a presidential race. When Ronald Reagan ran for president in 1980, the questions were so great about his assuming the presidency at 69 years old that he agreed to be tested regularly for dementia and <a href="https://timesmachine.nytimes.com/timesmachine/1980/06/11/111165468.pdf?pdf_redirect=true&amp;ip=0" target="_blank">said </a>he would “step down” if his capabilities were diminished. Reagan served two terms, from 1981 to 1989, and said in a 1994 <a href="https://www.reaganlibrary.gov/reagans/ronald-reagan/reagans-letter-announcing-his-alzheimers-diagnosis" target="_blank">letter </a>to the public that he had been diagnosed with Alzheimer’s.

If Trump has not taken the test since 2018, Nasreddine said, it would be past time to do it again, given how cognitive capability can decline exponentially as one gets older. Then, if a test showed decline, it might make sense to get further tests that could indicate whether there are signs of Alzheimer’s or other dementia.

“I don’t think we can state a test six years ago is valid today,” Nasreddine said, speaking generally.

Nasreddine said a person in their 70s could retake the test every 18 months to two years, depending on how their cognition changes. “There’s higher risk as you get older, and it could turn into getting worse,” he said.

Trump has also misstated a number of things about it, such as claiming that by naming things in order that he got extra credit. Nasreddine said the test does not give extra credit. Last month, Trump claimed it included this question: “Multiply 3,293 times four, divide by three.” The actual question is easier, typically asking that seven be subtracted from 100, followed by several more such subtractions.

“That’s not on the test,” said Jackson, adding that Trump shouldn’t be taken “literally.” “He was making a joke about how difficult it was.”

Trump said he got a perfect score of 30 out of 30. In January 2018, he was 71 years old, so that would have put him in the top 10 percent of test-takers, Nasreddine said. The average score for a person that age was 27, the neurologist said.

Nasreddine said he believes a candidate or president at the age of Trump or Biden should take regular cognitive tests in the same way they take physicals, and release the information publicly. Such a test makes sense for older pilots, he said, and even more so for a president possessing the power to launch nuclear weapons.

“Candidates for the presidency should have all their capacity, physical and mental, checked by professionals,” he said. If Trump hasn’t taken the cognitive test in six years, “that is a long time.”

Trump has long emphasized his belief in the importance of genetics. He has said he is a “super genius” because of his “great genes.”

Trump’s niece, Mary L. Trump, said such beliefs are noteworthy. “If intelligence is a genetically inherited state” as Trump believes, she said, “then something like dementia, Alzheimer’s, which do have very strong genetic components, is more of a concern to somebody who is directly related to Fred Trump Sr. as Donald is. I’m not saying he has dementia, but you can’t say the one thing and not also acknowledge the other.”

Experts said much remains unknown about how people get Alzheimer’s, but research has shown that genetics may play a role.

In a 2020 <a href="https://urldefense.com/v3/__https://www.icaa.cc/media/presidential_lifespan_and_healthspan-draft_for_release_1.pdf__;!!M9LbjjnYNg9jBDflsQ!ACGII-9kOGuIK7zTTaKp2xjHXB1eCzK5zxNGRnHSHyiEB7pRJNJXHpf8JXqdFjkSPHmmIBSz-JovBXtQ-hlPgIwYKJY$" target=_blank>article </a>about the health of Biden and Trump in the journal Active Aging, the authors wrote that “Trump does face an elevated familial risk of late onset Alzheimer’s disease (AD) as this was a major contributor to his father’s death.” S. Jay Olshansky, the article’s lead author and professor of public health at the University of Illinois at Chicago, said that “the genetic risk hasn’t changed” and that he is awaiting a new medical report from Trump to update the analysis.

Jackson said he had never discussed genetic Alzheimer’s risks with the former president but said he would have told him “it’s nothing he should be worried about.” (A White House spokesman, Andrew Bates, told The Post via email that neither of Biden’s parents had dementia.)

Forty to 65 percent of people who have the disease inherited a gene particularly associated with increased risk, according to Allison Reiss, who studies the gene and is a member of the Alzheimer’s Foundation of America’s Medical Scientific and Memory Screening Advisory Board. That risk can further increase depending on whether an individual has the gene from one parent or from both, she said. (There is no indication that Trump’s mother had dementia.)

Reiss, who stressed she was speaking in general and not about any individual, said that a blood test can determine the presence of the gene. Experts said it is important to note that having the gene or other potential markers does not mean that a person will get the disease; nor does the absence of them mean a person won’t get Alzheimer’s.

Trump has not said whether he has taken a number of specialized tests for Alzheimer’s, including genetic testing. Such exams can also include brain scans, cerebrospinal fluid tests and blood tests, <a href="https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests#:~:text=Genetics%20and%20Alzheimer's.-,Brain%20imaging,Alzheimer's%20but%20require%20different%20treatment." target=_blank>according</a> to the Alzheimer’s Association.

Trump has not released a full medical report during the campaign, so far providing only the brief assessment from his physician, Aronwald.

Alice Crites contributed to this report.

Society of Professional Journalists, Washington Correspondence, 2016, "Divided Nation"

Society of American Business Editors and Writers, 2016, "Divided Nation"

Dirksen prize for congressional reporting, 2013, "Broken City"

New York Times bestseller list, "Trump Revealed," 2016

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The Real Romney

Flight from Monticello: Thomas Jefferson at War

John F. Kerry: The Boston Globe Biography

The World's Fastest Man: The Extraordinary Life of Cyclist Major Taylor, America's First Black Sports Hero

Syracuse University, degrees in political science and journalism

Michael Kranish is a national political investigative reporter. He co-authored The Post’s biography "Trump Revealed," as well as biographies of John F. Kerry and Mitt Romney. His latest book is "The World's Fastest Man: The Extraordinary Life of Cyclist Major Taylor." 

He previously was the deputy chief of the Boston Globe's Washington bureau.

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Shadowing Trump’s attacks on mental fitness — his own father’s dementia

Trump avoids mention of his father’s Alzheimer’s disease as he lashes Biden for being ‘cognitively impaired’