Thursday, June 2, 2011

SAGE test for Mild Cognitive Impairment and Early Dementia

SAGE is a brief self-administered cognitive screening instrument to identify Mild Cognitive Impairment (MCI) and early dementia. It was developed by the Ohio State University Medical Center to provides the self-tested preliminary guidance for the early signs of dementia.

Average time to complete the test is 10 to 15 minutes. The total possible points are 22.

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The test is self-administered. There are four forms of the SAGE test. Only one test form should be given. It does not matter which form is taken, as they are all interchangeable.

All forms are in Adobe Portable Document (PDF) Format and require Adobe Reader. SAGE should be filled out in ink without the assistance of others. Inform the examinee that there are four pages to complete. Calendars and clocks should not be available during the testing. Do not answer specific questions. Just say, "Do the best that you can."

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Average time to complete the test is 15 minutes. The maximum score is 22. A score of 17 and above is considered normal. 


Please note that SAGE screening is not a diagnostic test of any condition. Research has shown that SAGE can often, but not always, indicate whether individuals fall into the normal range, have mild memory or thinking impairments, or have a more severe memory or thinking condition.  Please see the table below. 

17 to 22 - Individuals with these scores are very likely to be normal.
15 and 16 - Individuals with these scores are likely to have mild memory or thinking impairments. Further evaluation by a physician is recommended.
14 and below - Individuals with these scores are likely to have a more severe memory or thinking condition. Further evaluation by a physician is recommended.

About SAGE Test

Dr. Douglas Scharre, a neurologist at the Ohio State University Medical Center, developed the Self-Administered Gerocognitive Examination (SAGE) to help identify individuals with mild thinking and memory impairments at an early stage. The research shows four out of five people (80 percent) with mild thinking and memory (cognitive) issues will be detected by this test, and 95% of people who are normal thinking will have normal SAGE scores.

Scharre, who specializes in treating Alzheimer’s disease, said treatments for Alzheimer’s and dementia are more effective when they are introduced in the earliest stage of the disease. Unfortunately, he said he often sees patients more than three to four years after the first symptoms of a cognitive impairment began to appear.

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“It’s a recurring problem,” said Scharre. “People don’t come in early enough for a diagnosis, or families generally resist making the appointment because they don’t want confirmation of their worst fears. Whatever the reason, it’s unfortunate because the drugs we’re using now work better the earlier they are started.”

Many of the assessment tools for cognitive disorders being used today, while accurate, have aspects that deter their use. “Seldom are physicians reimbursed for the time and effort it takes to give such tests, or they tie up personnel to physically administer the test,” said Scharre, who advocates the use of routine screening for cognitive disorders in the primary care setting. Other diagnostic tests require the patient to use a computer, which can add heightened anxiety to some older adults who may be infrequent users of technology.

It only takes a paper, pen and a few minutes to take the test and because it’s self-administered, it doesn’t necessarily take time away from the appointment. “They can take the test in the waiting room while waiting for the doctor,” said Scharre.

Missing six or more points on the 22-point SAGE test usually warrants additional follow-up by the physician. Abnormal results can also prompt an early search for reversible and treatable conditions that may be causing the patient’s thinking and memory impairment. Many conditions besides Alzheimer’s disease, such as strokes and some thyroid conditions, can also impact memory, according to Scharre.

Scharre said there are potential cost savings to using the tests in a primary care setting. He reasons that a person who fares poorly on the self-exam will likely be less compliant taking medications on time, taking them in the proper dosages or following other recommendations such as maintaining healthy diets.

“Abnormal test results can serve as an early warning to the patient’s family,” added Scharre. “The results can be a signal that caregivers may need to begin closer monitoring of the patient to ensure their safety and good health is not compromised and that they are protected from financial predators.” Results of the new test compare favorably with current standard cognitive assessments that are not self-administered.

To validate the exam’s findings and accuracy, Scharre and other researchers at Ohio State evaluated study participants using SAGE, and then evaluated the same subjects with a battery of other established and well-documented assessment tools.

The study involved 254 study participants, 59 years of age or older, who took the SAGE self-assessment. Sixty-three (63) individuals were randomly selected to have a one-day clinical evaluation utilizing a battery of physical, neurological and cognitive tests.

SAGE scores compared favorably with the mini-mental state examination (MMSE), a brief questionnaire test that is commonly used in medicine to screen for cognitive impairments and dementia.

Both tests were able to differentiate clinically defined normal and mild cognitive improvement from subjects with dementia. However, SAGE, but not MMSE, was also able to distinguish between clinically defined normal from the mild cognitive improvement group.

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