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

The SAGE test is an early diagnostic tool for Alzheimer’s. If you or your loved one are worried about developing dementia, the SAGE test can give you peace of mind. 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. One might be concerned about the difference between the signs of dementia and the normal aging process. The SAGE exam is a valuable tool that can help differentiate between the two. This is because taking the SAGE test and having your primary care physician review the results is a good step toward knowing everything is working properly or treating the disease as early as possible.

Early interventions for dementia are the most effective tool for treating the disease. Alzheimer’s and other forms of dementia are progressive diseases that worsen as patients go through their stages. There is no cure for dementia, but there are pharmaceutical, therapeutic, and alternative treatments that can help alleviate and manage symptoms. Memory loss, for example, can be slowed down. The earlier the disease is identified, the more effective treatments are. Identifying the disease and starting early treatment options are the best way to ensure the highest quality of life for your loved one. 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 for dementia is a written test that is used as a diagnostic tool to help those at risk of dementia or who suspect they have symptoms of the disease. SAGE is an acronym that stands for Self-Administered Gerocognitive Exam but has also been called the OSU Memory Test because it was developed at the Ohio State University Wexner Medical Center. The SAGE is a fast and simple 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 another form of 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

– Completing simple math calculations

– Short-term memory recall

– Naming objects or animals

– Problem-solving abilities

– The Clock Drawing Test

Some examples of questions on the SAGE Test are:

– How many nickels make 60 cents?

– List 12 different animals.

– How are a bicycle and a train similar?

This tests multiple areas of cognition meaning how well a person thinks and communicates. Additionally, the test includes drawing 3-D boxes because people with dementia have difficulty with spatial recognition.

It is important to note that the SAGE exam is not meant for making a home diagnosis. Rather, the results should be analyzed by a doctor, who can properly score the exam and decide if there are more tests needed. Alzheimer’s disease and other forms of dementia are difficult to diagnose. The SAGE exam in addition to other diagnostic tests like a CT scan, can provide definite answers. The test does not include an answer sheet because there are multiple correct answers that medical professionals can best analyze.

Pros and Cons

Pros:

– SAGE can be a tool for measuring someone’s thinking ability over a period of time. The first time the test is taken can be used as a “baseline,” or the standard to be compared to when it is later taken. If it is taken later and there are differences in the scores, this can indicate a problem. Dementia is a progressive disease meaning it worsens over time, and the SAGE exam can help chart the progression. Because it is meant to be taken repeatedly, four versions of the exam ensure your loved one will see new questions each time they take it.

– More information helps doctors make a faster diagnosis. The questions on SAGE are vast. They range from asking someone to remember the date, complete a simple math problem, recall the names of objects or animals, and more. Because different types of dementia affect the brain differently, this is a helpful tool for determining what is going on in your loved one’s brain. 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.

– Catching cognition problems early ensures better treatment. Dementia is not curable, but its symptoms are manageable. The sooner diagnosis and treatment begin, the higher the quality of life your loved one will have by managing their symptoms and preparing for the future with their care plans.

– 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 you need less stress and more sleep rather than developing an incurable brain disease.

– An easy place to begin. Many people resist going to the doctor, even if there is an obvious problem. SAGE is something that can be done at home and in a short amount of time. It may be much easier to ask your loved one to answer questions instead of going to their primary care physician for an examination.

– It is 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 is simpler than other neurological exams and can save a trip to the doctor’s office.

Cons:

– There are virtually no drawbacks to this simple at-home test. The largest drawback is that there is no answer sheet. That means you need to go to the doctor to have a medical professional interpret the test results.

Accuracy

Studies have found that the SAGE exam is an accurate indicator of whether someone has dementia. Studies have been conducted where hundreds of people 60 and over were administered the SAGE test and proved an approximate 95 percent accuracy rate in correctly diagnosing patients. It has proved to be slightly more accurate than the Mini-Mental State Examination, which asks questions similar to the SAGE but is administered by a doctor. The Mini-Mental State Examination has an approximate 90 percent accuracy rate. Without going to the doctor’s office, the SAGE test is the most accurate way to determine if someone is showing early signs of 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 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. 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 – After reviewing the completed exam, it is normally obvious if your loved one is having cognitive difficulties. At this point, 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 like additional testing or going to a specialist.

Interpreting the Results

The SAGE exam results can have a maximum score of 22. Any score under 17 is considered an indicator of thinking deficiencies that should be checked out by a specialist. A score of 15 or 16 indicates the person might have a mild cognitive impairment or MCI. Scores of fourteen and below indicate a probable dementia diagnosis. No answer sheet is provided with the test and scoring is done by medical professionals. That said, when reviewing your loved ones’ completed test, it should be obvious 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 which is part of SAGE is also a stand-alone diagnostic tool to determine if your loved one is showing signs of Alzheimer’s or another form of dementia. This means that the Clock Drawing Test can be a good first step toward getting answers, and is much more basic than taking the SAGE exam. Ideally, one would administer the SAGE test to someone who is showing early signs of dementia. SAGE is designed to have a greater degree of difficulty so it can help identify patients who have mild cases of dementia.