The Self-Administered Gerocognitive Exam, known as SAGE, is a brief, pen-and-paper cognitive assessment tool designed to detect the early signs of cognitive, memory, or thinking impairments. The test evaluates your thinking abilities which can help doctors understand how well the brain is functioning.
Douglas Scharre, MD, director of the division of cognitive neurology at The Ohio State University Wexner Medical Center in Columbus, developed the test over a five-year period based on clinical experience and review of literature.“Questions were designed to evaluate every part of a patient’s brain,” Dr. Scharre explains.
The scoring for SAGE was designed to give equal weight to questions that assess brain function for the front, the back, the left, and the right side of the brain, so that no area was overrepresented.
SAGE does not diagnose any specific condition, so it will not tell your doctor if you have Alzheimer’s disease or any other condition that can impact your thinking.
But it is a helpful screening tool for mild cognitive impairment (MCI) from any cause, as well as early dementia.
What Is Mild Cognitive Impairment?
MCI is a condition characterised by a minor decline in mental abilities, according to the National Institute on Aging. Often these changes are noticeable to the person experiencing them, family members, or close friends, but they are not severe enough to interfere with normal daily life and activities.
According to the Alzheimer’s Association, approximately 12 to 18 percent of people age 60 or older have MCI.
People living with MCI are more likely to develop Alzheimer’s disease or other dementias. About 10 to 15 percent of individuals with MCI go on to develop dementia each year, notes the Alzheimer’s Association.
Symptoms of MCI are often vague but may include the following:
- Memory loss, such as forgetting certain words
- Forgetting important events, like appointments
- Losing your train of thought in conversation, or when reading a book or watching a movie
- Becoming disoriented in familiar surroundings
- Becoming more impulsive or showing poor judgement
MCI does not always lead to dementia. In some individuals MCI reverts to normal cognition, and in others the condition stabilszes and no further decline in cognition is experienced.
Currently there are no medications for MCI, but establishing an early diagnosis can be important in managing and treating symptoms as they progress.
How Does the SAGE Test Work?
SAGE evaluates your thinking abilities by asking you questions related to language, reasoning, problem-solving, and memory.
Scharre explains that the questions cover a wide range of cognitive domains, especially those abilities that are early predictors of mild cognitive impairment.
SAGE measures cognitive function by assessing the following areas:
- Orientation (month, date, year)
- Language (verbal fluency and picture naming)
- Reasoning and computation (abstraction and calculation)
- Visuospatial (three-dimensional construction and clock drawing)
- Executive (problem-solving)
- Memory
Examples of questions include:
- How many nickels are in 60 cents?
- Write down the names of 12 different animals
In addition to the scored items on the test, SAGE asks questions about your medical history, such as “Have you suffered a stroke?” The test asks if you’ve had a family history of cognitive impairment. You’re also asked about any current symptoms you may be having, such as problems with memory, balance, or if you’ve experienced any personality changes. These answers can help your clinician identify possible causes of cognitive decline.
Who Should Consider Taking the SAGE Test?
According to Scharre, anyone who is experiencing memory, language, problem-solving, or thinking problems should consider taking SAGE.
“This may be especially important if you are noticing very mild symptoms, since SAGE is designed to pick up early deficits and allow your healthcare providers to diagnose and manage any potential conditions at an early stage,” he explains.
Friends or family members may want to encourage a loved one to take the test if they notice issues related to memory or thinking.
You may also wish to take a SAGE test to establish a baseline cognitive assessment to use for comparison in the future if you have a family history of dementia or thinking problems.
“Typically, we would suggest repeating the test every six months unless significant cognitive changes are occurring,” advises Scharre.
Where Can I Find the Test?
You can download the test for free at the Wexner Medical Center website. There is also a digital version made for tablets produced by a company called BrainTest which consists of identical test questions. This version is scored by a panel and results are sent to you so can take them to your primary care physician for further discussion. You can download the electronic version at BrainTest.com as a free trial (but note that you must provide payment information to complete registration for the trial period).
How to Take the SAGE Test?
If you are taking the paper version of the test, you’ll find four slightly different variations of the test on the official website. It doesn’t matter which one you take. The test consists of four pages. Print it out and answer the questions in ink without the assistance of others. Don’t look at a clock or calendar while taking the test, and just do the best you can.
You can take the test in virtually any setting. It will usually take about 10 to 15 minutes but there’s no set time limit.
It’s important not to cheat in order to get a better assessment.
In some cases, you might choose to take the test at your doctor’s office where it can be evaluated right away.
What Are the Next Steps After Taking It?
After you complete the test, you should take it to your healthcare provider who can score the test and give you feedback.
According to Scharre, your doctor may be able to glean that a specific part of your brain is not working as well as other parts depending on how you answer specific questions. “That may help them in their diagnostic considerations,” he explains.
Depending on your test results, your primary care physician may schedule additional neurological tests or brain imaging – magnetic resonance imaging (MRI) or computerised tomography (CT) scans – to rule out other conditions that may be impairing your thinking or memory, such as stroke, Parkinson’s disease, brain tumour, or other illnesses like hypothyroidism.
How Accurate and Reliable Are the Results?
Like any test, SAGE is not perfect. Scharre points out that individuals have a wide variety of cognitive talents, and this needs to be taken into account. “There will be individuals who score well but have a decline from their previous abilities. Repeat testing over time will find those that are progressing,” he explains.
“Some individuals will not score as well, but that may represent their baseline talents, and their score would not suggest any specific brain condition,” he adds. This is why it’s important to have the test interpreted in light of one’s medical history by a healthcare provider.
It’s important to note that other factors could be affecting your memory and thinking on any given day.
“Perhaps you don’t have a memory impairment but are quite depressed, ill, or sleep-deprived.” explains Jessica Z. K. Caldwell, PhD, a director at the Cleveland Clinic’s Ruvo Center for Brain Health in Las Vegas, Nevada. If you have concerns about your memory but are also experiencing these symptoms, Dr. Caldwell suggests you see your doctor.
