Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology clinic at Weill Cornell Medical College. He found Donald Trump’s behavior during Tuesday night’s debate so alarming that he wrote in The Atlantic about the need for Trump to undergo a serious “neuropsychiatric evaluation."

Friedman said that the previous mental-status exams Trump brags about having passed are quite easy and are “designed to detect fairly serious cognitive dysfunction.” A 90-minute debate is much more demanding and more revealing. “Specifically, the debate serves as an evaluation of the candidates’ mental flexibility under pressure—their capacity to deal with uncertainty and the unforeseen,” Friedman wrote.

He was not diagnosing Trump, Friedman stressed, but strongly recommending further testing. The doctor emphasized that Trump displays the signs to warrant that. As an example, Friedman cited Trump’s rambling answer as to whether he regretted anything he’d done during the January 6th insurrection. Trump’s response was “both tangential, in that it is completely irrelevant to the question, and circumstantial, in that it is rambling and never gets to a point,” Friedman wrote. “Circumstantial and tangential speech can indicate a fundamental problem with an underlying cognitive process, such as logical and goal-oriented thinking.”

Trump has shown the same alarming pattern in other public appearances, Friedman noted.

More from Friedman:

If a patient presented to me with the verbal incoherence, tangential thinking, and repetitive speech that Trump now regularly demonstrates, I would almost certainly refer them for a rigorous neuropsychiatric evaluation to rule out a cognitive illness. A condition such as vascular dementia or Alzheimer’s disease would not be out of the ordinary for a 78-year-old. Only careful medical examination can establish whether someone indeed has a diagnosable illness—simply observing Trump, or anyone else, from afar is not enough. For those who do have such diseases or conditions, several treatments and services exist to help them and their loved ones cope with their decline. But that does not mean any of them would be qualified to serve as commander in chief.

You don’t really need to be a doctor to notice that Trump does not seem to be playing with a full deck. We’ve noticed, too.

It’s long past time for the mainstream media to start catching up and asking the same questions it ceaselessly asked about President Joe Biden.