When he speaks "off the cuff" like this, he has a real problem focusing his thoughts. He's enchanted by the sound of his own voice and just seems to say whatever comes into his head. As a result, he often delivers a rambling, repetitive, semi-coherent word salad, and everyone in the room is left scratching their heads.
He has a similar problem when he reads from a teleprompter - not because he can't read but because his vision is bad, so sometimes he just improvises based on what he can actually see on the prompter. Reporters who have follow him have said that the text on the teleprompter is now larger, but it doesn't always help. I call these his "what did he just say??" moments.
This is what has caused some of his recent gaffes such as saying that we have to eliminate laws allowing children to be born from their mother's womb in the 9th month (the word on the prompter was "torn"), or when he talked about mass shootings in Toldeo, Ohio (it was in Dayton - the words on the prompter were "Texas and Ohio"). Or when he talked about the Continental Army taking over the airports (on the prompter it said "ramparts"). He needs glasses, and is often too vain to use them in public, and sometimes that makes him say stupid things.
http://www.businessinsider.com/trump-dislikes-tweeting-publicly-reading-glasses-2019-11
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