President Donald Trump's closing speech on the eve of the midterm elections was widely derided as an unfocused mess and, according to one psychologist, was also marked by signs of his ongoing decline — including an alarming instance in which he appeared to drift off while standing.

Trump delivered his closing message for the midterms on Monday afternoon in front of the Lincoln Memorial Reflecting Pool. Midterm elections, held at the midpoint of a president's term, decide every U.S. House seat and roughly a third of the Senate, making the eve-of-vote address one of a campaign's final chances to reach voters before they cast ballots. It quickly became apparent to many viewers that the president was not interested in staying on message, discussing his troubled renovation of the pool for at least the first 10 minutes and failing to mention the midterms at all within the first 20. Some observers also noted how exhausted and haggard he seemed after a month of traveling for rallies.

Dr. John Paul Garrison is a clinical and forensic psychologist with a specialty in body language, who produces a series of YouTube videos in which he applies his professional insights to the behavior of public figures. Many of his recent videos have focused on Trump, with Garrison suggesting that the president is suffering a severe decline, possibly accelerated by a stroke. His assessments, delivered through those videos, are interpretations drawn from reviewing footage of public appearances.

In his latest video, published Monday evening, Garrison examined the signs of Trump's continuing decline on display during the Reflecting Pool address, including a particularly "concerning" instance in which he seemed to be falling asleep while standing up as he listened to Interior Secretary Doug Burgum — whose department oversees the National Park Service and the U.S. Park Police — speak.

"Now you're seeing him start to drift, but you're going to see him what I believe is fully fall asleep in just a minute," Garrison explained, adding later, as Trump's eyes seemed to close fully: "I think that he is truly asleep."

"The fact that he's starting to nod off while he is standing is concerning," Garrison added. "In addition to that, the fact that he's able to wake up again so quickly suggests to me that there is some issue with his arousal system, that the pathways related to wakefulness are somehow disrupted, that there's something unusual about the way those are functioning right now."

At one point, Garrison highlighted Trump's attempt to clap after Burgum asked the audience to applaud for the U.S. Park Police, arguing that the president appeared "barely conscious." He added that Trump also seemed to drift in and out of sleep throughout Burgum's entire address, and exhibited involuntary spasms — an issue that has become increasingly prevalent during the president's public appearances.

Garrison's full analysis of the speech is available on his YouTube channel. With polls opening the following day, the video allows viewers to review both the address and Garrison's observations in full.