John Fetterman released some results from a cognitive test. What are these tests, and how do they work?

Pennsylvania Democratic Senate nominee John Fetterman’s campaign said Thursday that cognitive tests show his brain is working normally for a person his age, after his May stroke.

The campaign shared the outcomes of the tests with The Inquirer after they were first reported by the New York Times. They did not provide any documentation of the results, or make available to the media the speech therapist who administered the tests.

They were released the same week Fetterman, the state’s 53-year-old lieutenant governor, committed to debate Republican opponent Mehmet Oz, a retired surgeon and TV show host, in a TV studio and with the assistance of closed captions.

» READ MORE: John Fetterman has lingering speech issues after his stroke. What’s the impact on his Senate run?

Fetterman has struggled with auditory processing in the four months since his stroke and has used closed captions to ensure he understands questions in interviews.

Oz, who has consistently challenged Fetterman’s mental and physical abilities, immediately questioned taking the campaign’s word on Fetterman’s mental acuity.

Here’s what experts told us about these tests, and how they are used with stroke survivors.

Tests that gauge mental function and how well your brain is working are called cognitive assessments. These tests are commonly performed after strokes, after a traumatic brain injury, concussion, or any time there is reason for concern about a potential cognitive deficit.

Cognitive assessments generally consist of a series of questions or activities that test different cognitive abilities, such as attention, memory, and language skills, said Leah Croll, an assistant professor of clinical neurology at Temple University’s Lewis Katz School of Medicine.

Two common cognitive tests were administered to Fetterman — the Saint Louis University Mental Status Examination, or SLUMS, and the Repeatable Battery for the Assessment of Neuropsychological Status, or RBANS.

On July 14, he took the SLUMS, according to his campaign.

This assessment takes about 10 minutes, said Thomas Watanabe, the clinical director of the Drucker Brain Injury Center at MossRehab, which is part of Jefferson Health in Philadelphia. The SLUMS test includes basic memory questions and asks patients to perform simple tasks like recognizing a shape and drawing an X in it.

The test is similar to the Montreal Cognitive Assessment test that former President Donald Trump took while he was in office.

Fetterman also took the RBANS test earlier this week, his campaign said. This assessment takes about 30 minutes to complete. It consists of a dozen smaller tests that check five types of function: immediate memory, delayed memory, attention, language, and visuospatial perception, Watanabe said.

Results were in line with Fetterman’s age and educational level on both tests, his campaign said. He scored a 28 out of 30 on the SLUMS test. Any score between 27 and 30 is considered within normal limit for a high school graduate.

Fetterman’s campaign has not released his RBANS score but said it was also within normal limits.

» READ MORE: What are auditory processing issues, and how are they treated?

Determining someone’s ability to return to work is more nuanced than just looking at test scores. Clinicians also consider how the stroke occurred, how the patient is recovering, and what responsibilities they have at work, said Temple’s Croll.

“Overall, there’s no one way to interpret the scores that patients get on these assessments,” she said.

Only the patient and their medical team have enough information to make these judgments, experts said.

Watanabe, from MossRehab, gives the example of a firefighter in recovery from a stroke. A 30-minute test in a quiet room might not reveal deficiencies that could be critical for the job, such as whether the emergency responder can maintain focus while racing up stairs at the sounding of a siren.

The campaign has said Fetterman is physically and mentally fit to be a senator, but it has been slow to release some details about his condition. The campaign waited two days to disclose Fetterman’s May 13 stroke. Fetterman underwent a procedure to get a pacemaker and defibrillator implanted in his chest on primary day.

Three weeks later, the campaign explained some of the underlying causes in a June 3 letter from Fetterman’s cardiologist in Pittsburgh. The doctor gave him a good prognosis but also revealed his heart issues dated back to 2017.

» READ MORE: Fetterman says he ‘almost died,’ but cardiologist says his prognosis, despite ignoring medical advice, is now good

None of the doctors who performed the surgery to implant a defibrillator and pacemaker or Fetterman’s current neurological team, have provided details about the procedure or their prognosis.

Oz, who trails in the polls, has consistently attacked both Fetterman’s health and his transparency about his condition.

And on Thursday his campaign questioned the legitimacy of the Fetterman team’s claims without documentation.

“How can anyone glean anything from a quote in the New York Times story provided by a campaign spokesman about what a doctor said to somebody else?” campaign strategist Barney Keller said in a statement.

“They didn’t provide the copies of the scores or medical records,” he added. “They won’t provide media access to Fetterman’s doctor.”

Fetterman’s campaign fired back, accusing Oz of making “a career out of lying to people.”

“For weeks, all Dr. Oz has talked about is the debate and John’s health. Now those are settled: John is healthy, and he’s agreed to debate. So let’s stop talking about process, and start talking about substance.”

Fetterman’s been back on the campaign trail since August, typically giving about 10-minute speeches without notes. He sometimes misses a word, drops a word, or mushes two together. It’s noticeable, but not a big distraction, and the crowds have received him well. At a rally in Blue Bell on Sunday he appeared to make fewer flubs than he has in previous speeches since his stroke.

He’s also conducted fund-raisers and some one-on-one media interviews, including a 40-minute interview with the Times this month.

Fetterman has been forthright about his speech challenges. Even before his stroke, he was never known to be a particularly eloquent orator.

His verbal stumbles after the stroke have been shared widely on social media, often by Republican operatives. Doctored videos to make his speaking seem more awkward circulated on social media this week and got thousands of views.