Self-Administered Gerocognitive Exam (SAGE): Accuracy, Benefits, Scoring and How to Administer

Symptoms of dementia can start around age 60, but this is also when most people are prone to be slightly more forgetful or absent-minded due to the natural aging process. Recognizing the difference between early stage dementia and normal aging can be challenging, but the Self-Administered Gerocognitive Exam (SAGE) can help. The SAGE test can not diagnose dementia by itself, but it can indicate when it’s time to see a doctor. It can also be one of the tools, along with brain scans, blood work, genetic tests and more, that professionals use to diagnose dementia.

The SAGE test’s ability to detect early signs of dementia is important because early interventions are the most effective tool for treating the disease. Alzheimer’s and other forms of dementia are progressive diseases that worsen with time. There is no cure for dementia, but there are pharmaceutical, therapeutic and alternative treatments that can help alleviate and manage symptoms. The earlier these treatments are used the more effective they are.

This article details everything you need to know about the SAGE test, including where to get it, how it works and how to administer the test to a loved one.

What is the SAGE Test?

The SAGE test is a written exam that is used to assess individuals who are at risk of dementia or suspect they have symptoms of the disease. It’s a fast, simple and non-invasive test that will dictate if further steps should be taken. It has been proven effective at identifying cognitive problems that are indicative of Alzheimer’s disease or other forms of dementia. SAGE is an acronym that stands for Self-Administered Gerocognitive Exam, but it also been called the OSU Memory Test because it was developed at the Ohio State University Wexner Medical Center.

How Does it Work?

The SAGE exam assesses brain health by asking a series of questions that test logical thinking, recall, language and problem solving. The SAGE test is fairly straightforward and usually takes between 10 and 15 minutes to finish. The questions include:

• Knowing the date
• Completing simple math calculations
• Short-term memory recall
• Naming objects or animals
• Problem-solving abilities
• The clock-drawing test

Some examples of SAGE questions include:

• How many nickels make 60 cents?
• List 12 different animals.
• How are a bicycle and a train similar?

Remember, the SAGE exam is not meant for making a home diagnosis. The questions are available to download online, but there is no answer sheet. That’s because there are multiple answers that might be correct, and those answer should be analyzed by a professional. So, SAGE test results should be taken to a doctor, who can properly score the exam and decide if more tests are needed.

Pros and Cons

Pros:

• Easy place to begin. The SAGE test is something that can be done at home and in a short amount of time. For most, it’s easier to answer a few questions than it is go to the doctor’s office.
• Free and simple. There is no charge to download and print the SAGE test, and no training is required to administer it. Plus, the test itself is simpler than many neurological exams.
• Catches early signs. Many tests are not effective at detecting early signs of dementia. The disease is not curable, but the earlier it’s diagnosed, the sooner treatments can begin, which means they will have more impact on the patient and their quality of life.
• Measuring stick. Dementia is a progressive disease, and the SAGE test can help chart the progression if it’s taken multiple times. The first results will serve as a baseline used to evaluate future results and determine the stage of dementia. Because the SAGE test is meant to be taken repeatedly, there are four versions of the exam to ensure patients have new questions each time they take it.
• Data increase. There are a wide variety of  questions on the SAGE test, ranging from math problems to language recall to spatial awareness. Since different dementias affect the brain in different ways, the variety of information offered by the SAGE test can help can help professionals determine what type of dementia the patient is experiencing. For example, someone with Frontotemporal dementia will have a hard time finding the right words for something but not as hard of a time with their short-term memory.
• Peace of mind. For those who are worried about a loved one showing signs of dementia, or if they’re worried about showing signs themselves, the SAGE exam can provide some answers. Even if the results recommend seeing a doctor, at least the next steps will be known.

Cons:

• Doctor required. The only drawback to the SAGE test is that it does not have an answer sheet, and the results should be interpreted by a medical professional.

Accuracy

During a study at Ohio State, researchers evaluated participants using SAGE and then tested the subjects using other tools. The SAGE test had a 79% sensitivity rate, which means it correctly identified dementia in test subjects 79% of the time. And it had a false positive rate of 5%, which means that 95% of the time it correctly identified test subjects who did not have dementia. This makes SAGE one of the best tests for evaluating people who are at risk of dementia or are showing symptoms. The Mini-Mental State Exam (MMSE) is another one of the most common tests, and it was found to have a 71% sensitivity rate and a 10% false positive rate during this study.

How to Administer

Step 1 – Download and print the test. There are four different versions of the SAGE test, but you only need one. They are interchangeable and all have 12 questions. The test is also available in several languages, including Spanish. You can find online versions of the SAGE Test, but the test taker’s computer skills may bias their results. Therefore, it is recommended to use a printed version. Download the English version here and the Spanish version here.

Step 2 – Provide the test taker with a pencil, eraser and the printed-out exam. Some drawing is required on the test and an erasable pencil may limit frustration by your loved one.

Step 3 – Give the test taker as much time as they require to complete the test. It is not timed and timing is not considered when evaluating the results. On average, most people take about 15 minutes to complete the exam. Do not pressure the test taker or set a timer.

Step 4 – Do not provide any assistance or help answering any questions. The test is self-explanatory and assisting will bias the results. If a question is difficult to understand, the test taker needs to do their best.

Step 5 – Review the results. While the SAGE test is meant to be evaluated by a medical professional, any adult can look at the answers and get a sense of the test taker’s performance. If the reviewer can tell that all of the answers are correct, then one probably does not need to consult with a doctor. It might be a good idea to take the test again in a year to see if the results have changed.

Step 6 – After reviewing the completed exam, it may be obvious if your loved one is having cognitive difficulties. If they are, consult with your loved one’s primary care physician. A specialist is not required at this point. During the appointment, the doctor can interpret the results and make a plan of action if further steps are needed for a diagnosis, such as additional testing or seeing a specialist.

Interpreting the Results

No answer sheet is provided with the SAGE test and scoring is done by medical professionals. That said, when reviewing your loved ones’ completed test, it may be obvious if the test taker has struggled to answer the questions or perform the tasks correctly. The SAGE results can have a maximum score of 22. Any score under 17 is considered an indicator of cognitive deficiencies that should be evaluated by a specialist. A score of 15 or 16 indicates the person might have mild cognitive impairment. Scores of 14 and below indicate probable dementia.

Alternatives and Comparisons

Compared to the Clock-Drawing Test

The Clock-Drawing Test is part of the SAGE test, but is can also be used by itself to determine if someone is showing signs of Alzheimer’s disease or another dementia because it’s so simple. The test taker is asked to draw an analog clock (with minute and hour hands) at a specific time. If they clock is wrong in any way, it’s a sign that they may have some cognitive impairments and could use further evaluations, which could include the SAGE test. Not only is the SAGE test a more accurate indicator of dementia than the Clock-Drawing Test, it provides a wider range of information, which can include the type or stage of dementia.