The foreign ministry said if Mr Trump was confrontational, it “must really be diagnosed as the relapse of the dotage of a dotard”.
The North first called Mr Trump a dotard, meaning old and weak, in 2017.
It is the first time in over a year that Pyongyang has been openly critical of Donald Trump, the BBC’s Korea correspondent Laura Bicker said.
The Oxford English Dictionary defines a dotard as “a person whose mental faculties are impaired, specifically, a person whose intellect or understanding is impaired in old age”.
