A piece of paper, 15 minutes and 12 questions—those three things may be all it takes to determine whether an aging adult is showing signs of cognitive impairment, according to researchers from The Ohio State University Wexner Medical Center.
In an effort to diagnose dementia in its earliest stages, Douglas Scharre, director of the Division of Cognitive Neurology for Ohio State, and his colleagues developed the Self-Administered Gerocognitive Examination—nicknamed SAGE—an at-home mental functioning test that older adults can give themselves.
"Current treatments for dementia conditions like Alzheimer's disease work better the earlier you start them," says Scharre. "But people are waiting an average of three to four years after family members notice significant memory or thinking changes before they would see their primary care physician for the first time."
SAGE aims to eliminate the need for an elder to go to their doctor to receive a preliminary cognitive evaluation, and thus hopefully identify more individuals who are still in the early stages of Alzheimer's disease.
Diagnosing dementia is a multi-step endeavor
For a doctor to determine whether a senior is suffering from full-blown dementia they typically must conduct a series of diagnostic evaluations, including so-called "mental functioning tests," a full physical workup, a neurological exam and brain imaging scans.
SAGE falls into the mental functioning test category, which also includes the mini-cog test and the mini-mental state exam.
The mini-cog test involves completing two tasks: drawing a clock face with the hands pointing to a particular time and all 12 numbers in their proper places, and remembering the names of three objects and being able to recall them a few minutes later.
The mini-mental state exam is comprised of around a dozen questions and problems designed to test an individual's mental functioning. These questions range from "What is today's date?" to asking a person to spell the word "world" both normally and backwards.
How accurate is it?
SAGE is similar in design to its predecessors, with one major difference.
While both the mini-cog and the mini-mental state exam must be given by a specially-trained administrator, one of SAGE's primary selling points is that it can be taken by adults in their own homes, without anyone else present, and still offer accurate results.
"The test's self-administered features allows it to be taken virtually anywhere," says Scharre. This can be especially appealing for seniors whose cognitive health seems questionable, but who are reluctant to go to the doctor.
A recent scientific evaluation of SAGE's precision found that it was 95 percent accurate in determining when an individual was cognitively healthy and 80 percent accurate in determining when an individual was exhibiting signs of mental decline.
What do the results mean, and who should take it?
SAGE cannot diagnose dementia, it can only detect whether an older adult's brain isn't working as well as it should. A doctor follow-up is crucial for anyone who decides to take the exam, especially if they receive a low score by missing six out of a possible 22 points.
Test takers should keep in mind that results should always be taken with a grain of salt. Everyone's baseline brain functioning is different, so a low score on SAGE isn't automatically a cause for concern, according to Scharre. "Everyone has different cognitive levels and some have had previous brain issues such as mini-strokes or head trauma. If their score is a bit low, their physician may conclude that it is normal, given their medical history, and no further workup is necessary." Even if an individual's results come back as normal, they should still present it to their doctor to use as a baseline to help detect future cognitive concerns.
When asked who should take the test, Scharre says anyone experiencing problems with their memory or thinking ability might want to consider setting aside 15 minutes for the evaluation. He also suggests using the test as a baseline for anyone 65 or older, regardless of whether they have signs of dementia.
"I hope that individuals taking SAGE will present it to their doctors to start the conversation and be evaluated to diagnose brain conditions at a much earlier stage than is currently being done," he says. "In that way, needed treatments and supervision can be instituted earlier, which could improve quality of life for patients and caregivers."
A free version of the SAGE test can be found here.