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[i]Baltimore psychologist John Gartner, a former professor at Johns Hopkins University and founder of “Duty to Warn,” a movement by medical professionals to draw attention to Trump’s cognitive health that dates back to Trump’s first year in office.

“If you walked into an emergency room in a psychotic state, the first question would be, ‘Who is the president of the United States?’ That’s literally on the psychiatric medical exam,” Gartner says, referring to Trump’s confusing Biden with Obama.

Gartner believes Trump – whose campaign did not respond to a request for comment – has “advanced dementia” and says the old “Goldwater Rule” does not apply here. That standard, which says medical professionals should not diagnose the mental health of someone they have not examined, was adopted by the American Psychiatric Association after a magazine explored whether 1964 GOP presidential nominee Barry Goldwater was mentally fit to be president.whether 1964 GOP presidential nominee Barry Goldwater was mentally fit to be president.

Donald Jurivich, chair of Geriatrics at the University of North Dakota School of Medicine & Health Sciences, cautions against diagnosing someone with dementia without a medical exam.

Jurivich says he noticed differences in how former President Ronald Reagan behaved late in his presidency, and suspected Reagan had Alzheimer’s disease. “That proved over time to be correct,” Jurivich says. But “dementia is based on a loss of executive function, [and] there’s no way you can see that in a TV sound bite or a speech.”

Behavior associated with dementia, Jurivich notes, could also be the result of everything from thyroid dysfunction to high stress – the latter an obvious possibility for a man balancing a presidential campaign with court appearances for criminal and civil cases. Or, for that matter, a man running the nation and running for reelection.

Then, in New Hampshire on January 19, Trump fuelled speculation about his mental powers by talking gibberish about Nikki Haley, his last-remaining rival for the Republican presidential nomination. He repeatedly blamed her for the chaos at the Capitol on January 6, 2021, when she was nowhere near the riot. “Nikki Haley was in charge of security,” Trump affirmed at a rally. “We offered her 10,000 people, soldiers, National Guard, whatever they want. They turned it down. They don’t want to talk about that.” He meant Nancy Pelosi, the former Democratic speaker of the House of Representatives, who was not in charge of security either, by the way.

Let’s stop the wishful thinking and face the stark reality: There is a clear path to dictatorship in the United States, and it is getting shorter every day. In 13 weeks, Donald Trump will have locked up the Republican nomination. In the RealClearPolitics poll average (for the period from Nov. 9 to 20), Trump leads his nearest competitor by 47 points and leads the rest of the field combined by 27 points. The idea that he is unelectable in the general election is nonsense — he is tied or ahead of President Biden in all the latest polls — stripping other Republican challengers of their own stated reasons for existence. The fact that many Americans might prefer other candidates, much ballyhooed by such political sages as Karl Rove, will soon become irrelevant when millions of Republican voters turn out to choose the person whom no one allegedly wants.

For many months now, we have been living in a world of self-delusion, rich with imagined possibilities. Maybe it will be Ron DeSantis, or maybe Nikki Haley. Maybe the myriad indictments of Trump will doom him with Republican suburbanites. Such hopeful speculation has allowed us to drift along passively, conducting business as usual, taking no dramatic action to change course, in the hope and expectation that something will happen. Like people on a riverboat, we have long known there is a waterfall ahead but assume we will somehow find our way to shore before we go over the edge. But now the actions required to get us to shore are looking harder and harder, if not downright impossible.

The magical-thinking phase is ending. Barring some miracle, Trump will soon be the presumptive Republican nominee for president. When that happens, there will be a swift and dramatic shift in the political power dynamic, in his favor. Until now, Republicans and conservatives have enjoyed relative freedom to express anti-Trump sentiments, to speak openly and positively about alternative candidates, to vent criticisms of Trump’s behavior past and present. Donors who find Trump distasteful have been free to spread their money around to help his competitors. Establishment Republicans have made no secret of their hope that Trump will be convicted and thus removed from the equation without their having to take a stand against him.