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As someone who just lost one grandparent to dementia and has another entering treatment (and in the process of being moved into a care facility) he definitely has dementia or a similar cognitive decline. If you watch him now when he's publicly speaking and compare it to his 2016 campaign he's just not the same person anymore. He's now seeming to not remember what he was to be speaking about, going on random unexpected tangents, needs to be led around by someone else when anywhere other than the White House (and may also need to be led around within the White House, but that's not as visible) occasionally walks completely a different direction from where he should be going, and he's lost his talent for remembering names, mixing people's names with associations when he speaks ("Tim Apple" of Apple CEO Tim Cook, or "Tim Minnesota" of Tim Walz) or occasionally naming someone who hasn't held the position in a very long time, looking directly at the solar eclipse while the eclipse glasses were in his hand (or pocket? I can't remember now) its all really clear dementia behavior. Also the tests he's described taking, he describes them exactly as coherently and in an extremely similar manner to my grandmother's descriptions of probably the same tests. She also knew she had an MRI (and named the wrong thing it was for) and kept saying it was tomorrow for a week, which is pretty comparable to how Trump has been talking about his MRIs.
Like, for a normal person in an assisted living facility, I'd say with his mix of ailments he might not even make it until the end of the year, but he has quite frankly the best access to healthcare of anyone in the entire world. We're going to watch this poor man regress until there's no sign of him left because his team refuses to publicly admit that their guy is dying. Honestly it feels like elder abuse, letting him act like a toddler on the world stage (which is what dementia does, its like the person regresses in age) instead of publicly announcing his decline and how his team will be reviewing his work and slowly taking over his duties as he becomes less capable, letting him decline not in the spotlight but in privacy. It'll be an interesting next few years for sure, because I'll be shocked if he survives to the end of his presidency
Hopefully Melania isn't the new Nancy Reagan, making policy calls behind the scenes.