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

The SAGE test is an early diagnostic tool for Alzheimer’s. Someone worried about developing dementia may want to take the SAGE. If you have a history of Alzheimer’s disease in your family then you are slightly more likely to develop the disease. Symptoms might start around age 60, but this is also when most people would be prone to be slightly more forgetful or absent-minded. Having difficulty remembering something could be normal, but if you’re afraid of Alzheimer’s, or similar dementia, then filling out a SAGE and taking it to the doctor is a good step toward either getting peace of mind or treating the disease as early as possible.

Early interventions for dementia are much more effective. Alzheimer’s and similar diseases are progressive, meaning there is no cure, but there are pharmaceutical, therapeutic, and alternative treatments that can manage symptoms. Memory loss, for example, can be slowed down. The earlier the disease is identified, the more effective these treatments will be. Living the best life you can with dementia begins by identifying it early. The following is everything you need to know about the SAGE, 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 for dementia is a written test for people at risk of dementia or suspect they may be developing symptoms of Alzheimer’s or related dementia. SAGE stands for Self-Administered Gerocognitive Exam, and it has also been called the OSU Memory Test because it was developed at the Ohio State University Wexner Medical Center.

An easy-to-use tool can help if you’re worried about possible early signs of dementia. The SAGE is a fast, simple test that will tell you whether further steps should be taken. It has been proven effective at identifying thinking problems that indicate Alzheimer’s disease or related dementia.

How Does it Work?

The SAGE test works by testing a patient’s brain health. That is done via a series of questions that test logical thinking, recall, language, and problem-solving. SAGE is fairly simple and usually takes a person between 10 and 15 minutes to finish. The questions include:

– Knowing the date

– Simple math

– Short-term memory

– Names of objects or animals

– Problem-solving ability

– The Clock Drawing Test

Some examples of questions that might be included in the SAGE Test are:

– How many nickels are in 60 cents?

– Write down the names of 12 different animals.

– How are a bicycle and a train similar?

The idea is to test multiple areas of cognition, or how well a person thinks because brain-cell death from dementia affects someone’s ability to understand or communicate in measurable ways. For example, the test includes drawing 3-D boxes because people with dementia have difficulty with spatial recognition.

It’s important to note that the SAGE is not for making a diagnosis at home. Rather, the results should be analyzed by a doctor, who can properly score the exam and decide if there’s a need for more tests. Alzheimer’s disease and other dementias are difficult to diagnose, but with the SAGE as well as other tests including a CT scan, it’s possible to get a good idea of whether a person has the illness or not. In other words, the results of the SAGE are one indicator that a doctor can use to help in a diagnosis. In fact, the test does not include an answer sheet because there are multiple correct answers and doctors best analyze results.

Pros and Cons

Pros:

– SAGE can be a tool for measuring someone’s thinking ability over several years. The first time the test is taken could be considered a “baseline,” or the standard to be compared to when it’s taken again later. If scores on the test are worse two years later, this might indicate something wrong. Dementia diseases are progressive, worsening over time, and SAGE can help chart the progression. This is why there are four versions; someone who takes the test every year will still see new questions each time.

– More information helps doctors make a better diagnosis. The questions on SAGE are diverse, asking someone to remember the date, do simple math problems, recall the names of objects or animals, and more. Because different types of dementias affect the brain differently, this is helpful for determining what’s wrong. Someone with Frontotemporal dementia, for instance, would have difficulty coming up with the right words, but fewer problems with memory.

– Catching cognition problems early equals better treatment. Dementia cannot be cured, but its symptoms can be managed. The sooner management begins, the easier a person’s life with Alzheimer’s disease or related illness will be. If you or a loved one shows signs of developing dementia, you can better prepare for the future, including understanding what might be required of caregivers.

– Peace of mind can be huge. If you are stressed or exhausted (perhaps from caregiving for your loved one), then focus and memory might suffer. A person with a healthy brain may become worried that they’re showing signs of dementia. Taking a SAGE might reassure you that rather than developing an incurable brain disease, you just need more sleep.

– An easy way to start taking action. Many people resist going to the doctor, even if there’s an obvious problem. SAGE is something that can be done in the comfort of a home in a short amount of time. It may be much easier to ask your loved one to answer some questions on a sheet of paper than going to the trouble of traveling to a doctor’s office and being examined there. And if your loved one answers every question correctly, you’ve saved the trip.

– It’s inexpensive and simple. The SAGE requires only that the test be printed and then filled out. No training is required to administer the SAGE. It’s much simpler than neurological exams, and even saves a trip to the doctor’s office.

Cons:

– With virtually no drawbacks to this simple at-home test minus that there is no answer sheet. That means you need to go to the doctor to have them interpret the test results. This is merely a diagnostic tool for early detection that can help improve your loved one’s quality of life.

Accuracy

Studies have found that SAGE is an accurate indicator of whether someone has dementia. When hundreds of people aged 60 and up were administered the SAGE test, it predicted whether or not they developed dementia with about 95-percent accuracy. It was shown as slightly more accurate than the Mini-Mental State Examination, which asks questions similar to the SAGE, but is administered by a doctor. Mini-Mental State Examination is about 90 percent accurate. Without actually going to the doctor’s office, the SAGE is the most accurate way to figure out if someone is showing early signs of developing dementia.

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 the same length, 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 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 with an eraser, the printed pages and nothing else. Some drawing is required on the test and an erasable pencil may limit frustration by the test taker.

Step 3 – Give the test taker as much time as they require to complete the test. It is not timed, nor is timing considered when evaluating the results. That said, the average amount of time needed is around 15 minutes. Don’t pressure the test taker or set a timer.

Step 4 – Do not provide any assistance or answer any questions. The test is self-explanatory and answering questions or providing assistance will bias the results. If a question is difficult to understand, the person taking the exam 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. Reviewing a loved one’s work, will give family members a view of the cognitive ability of the test taker they might not otherwise have. If the reviewer can tell that all 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 – In reviewing the test taker’s work, it is clear they have some cognitive challenges, one should make an appointment with a primary care physician. A specialist is not required at this stage. Instead take the completed test to a primary care doctor to score and interpret the results, and determine next steps, including whether an appointment needs to be made with a neurologist who specializes in treating the brain.

Interpreting the Results

The maximum score on the SAGE is 22, and any score under 17 is considered an indicator of thinking difficulties that should be checked by a specialist. A score of 15 or 16 indicates the person might have a mild cognitive impairment, or MCI. Fourteen or below indicates probable dementia. However, no answer sheet is provided and scoring is left to primary care physicians or specialists. That said, in reviewing the completed test, it should be obvious to the reviewer if the test taker has struggled to answer the questions or perform the tasks correctly.

Alternatives and Comparisons

Compared to the Clock Drawing Test

The Clock Drawing test that is part of SAGE is also a stand-alone way to determine if someone is showing signs of mental problems that indicate Alzheimer’s disease or a related dementia. If you suspect your loved one might have dementia, the Clock Drawing Test is a good first step toward getting answers, and much more basic than taking the SAGE. Ideally, you would use SAGE to test someone who is showing very few signs of dementia. SAGE is designed to be slightly more difficult so it can help identify people who have very mild cases.