Dementia is a tricky beast and ranks on many families’ list of worst fears. It’s easy for family members or caregivers to dismiss issues or even fail to notice subtle declines. However, the earlier cognitive decline is identified, the better medical providers can treat symptoms and track progression.
The Self-Administered Gerocognitive Exam (SAGE) test is designed to detect early signs of cognitive, memory or thinking impairments—and it’s simple enough to administer and take at home.
What is the SAGE test?
The SAGE test is a simple, paper-and-pen assessment that generally takes a person between 10 and 15 minutes to complete. The person answers simple questions, including today’s date and simple math problems, as well as responds to short-term memory questions, recalls names of objects, solves problem-solving questions and even completes a clock drawing test, which asks an individual how to draw a clock showing a time with a verbal cue like “5 past 9.”
The SAGE test is meant to be reviewed by a medical professional but any adult can look at the answers and get a sense of the test taker’s performance and whether it’s time to make an appointment with a physician. While the maximum score is 22, any score under 17 is considered an indicator of cognitive difficulties.
“I think the use of the SAGE and other similar tools is helpful as it raises awareness of the symptoms of neurocognitive decline,” said Sandra Petersen, DNP, health and wellness director with Pegasus Senior Living. “While none of these tools are ‘perfect,’ and results are most useful when combined with expert clinical assessment, they may lead some to hasten their efforts to seek help from a provider.”
Yet, the benefit of spotting signs early can’t be overstated, Petersen said:
“Recent studies have shown that an early diagnosis of neurocognitive decline can lead to treatment or therapies that help manage progression of the disease and, at the very least, explore treatment options that can help with some of the symptoms,” she said. “From a quality-of-life perspective, this is critically important, as early diagnosis and treatment of symptoms can support independence for a longer period of time, improve brain function, and reduce the severity of symptoms, in some cases. Additionally, if an early diagnosis is made, the person may be able to participate in clinical trials and receive benefit from that, as well as contributing to the body of research that will help us in the future.”
While the test is generally enthusiastically recommended by medical providers, Petersen warns the test is not used to diagnose specific illness.
“Tools of this sort may also cause unnecessary alarm in the hands of a lay person who could ‘diagnose’ a loved one with cognitive impairment when their issue might be a sensory loss such as impaired hearing or vision, poor sleep, or even medication side effects, for example. Hopefully, in either case, it would result in the person in question getting the help they need. From that perspective, the SAGE and other similar tools ultimately have an inherent value in early diagnosis and treatment of neurocognitive decline.”
Benefits of early detection
Typically recommended to be taken every six months, the SAGE test is excellent at picking up mild cognitive impairment, which is often difficult for anybody but the individual and their closest family and friends to identify. People living with mild cognitive impairment are more likely to develop Alzheimer’s disease or other dementias, but in other cases cognitive impairment can revert to normal cognition or the condition leads to no further decline.
“If a senior scores poorly on the SAGE test, the next step is to meet with a health care provider to review the score and give feedback,” Petersen said. “The provider may be able to determine that a specific part of the brain is not functioning as well as other parts; that will also help them in their diagnostic considerations. Depending on results the provider may order additional neurological testing, labs or brain imaging to rule out other conditions that may affect thinking or memory.
Petersen said that hypothyroidism, strokes, Parkinson’s, normal pressure hydrocephaly, or even a brain tumor are examples of conditions that can impair thinking and should be ruled out as potential underlying causes.
Approaching the SAGE
Initiating a conversation about cognitive ability is not a fun task for many family members. However, this hard conversation can lead to improved quality of life for both you and your loved one.
“Anyone who is having trouble with memory, thinking, language skills and problem-solving skills should consider taking the SAGE,” Petersen recommended. “Many individuals notice that they are having symptoms and may share this concern with loved ones; if that’s the case, a suggestion that the SAGE is readily available online offers an effective and immediate solution.”
Petersen added that encouraging a loved one that the test is designed to detect cognitive issues early may be a good solution to their concerns and open the door to an appointment with a health care provider, where you can discuss the results of the SAGE test with a professional. And by making the SAGE test a routine activity, you can eliminate the pressure surrounding it.
“Some families find that taking the test every six months (the suggested time frame between SAGE assessments) together is a more strategic approach to the loved one who may be reluctant,” she said. “Printing off a copy for each person to complete as a part of a ‘family assessment’ may help the reluctant senior to feel more comfortable about joining in.”
While the thought of your loved one experiencing cognitive disabilities is scary, it’s never a thing to ignore. The SAGE test provides an unobtrusive starting point to address cognitive issues, stay informed about a loved one’s cognitive conditions and approach potential treatments as needed.