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Public interest in the (MoCA) earlier this year -- including people trying to see whether they, too, could score a perfect 30/30 like President Trump -- may have created a learning effect that could influence patients' test results, a group of Canadian physicians suggest.

In a 1-week period in January, 190 unique online news items discussed Trump and the cognitive test, with 54% of those articles embedding or linking to all or part of the MoCA questionnaire, reported Hourmazd Haghbayan, MD, of the University of Toronto, and colleagues in . About 17% of the articles directly invited readers to and 9% presented the answer key.

After January 16, when White House physician Ronny Jackson, MD, included Trump's top marks in a , online searches for the term "Montreal Cognitive Assessment" ballooned.

Previous studies have shown that MoCA may be susceptible to in patients who repeat the exam over time. In the Trump-related news items, only version 1 of MoCA was identified. Other versions were referenced through links to the .

The effect of disseminating the cognitive screen to the public isn't clear, but "it is possible that the MoCA's applicability may be compromised in individuals exposed to its contents via such mainstream media reporting," Haghbayan and co-authors said. Future research needs to validate test performance in people exposed to MoCA; in the meantime, clinicians should consider asking whether patients have seen the test and, if so, using MoCA versions 2 or 3.

Despite news outlets encouraging people to , MoCA is designed to be administered and interpreted by a trained professional. Test creator Ziad Nasreddine, MD, of the MoCA Clinic and Institute in Quebec, said in a there was "no significant learning effect when mild cognitively impaired subjects were exposed multiple times to the same test" in his experience. But if physicians are concerned, they "can use the already available alternate MoCA versions."