Medical Technology

DIY Test Flags for Dementia 6 months prior to the Gold Standard

The 11-item Self-Administered Gerocognitive Examination (SAGE) picks up cognitive impairment 6 months sooner than the more complex, gold-standard Mini-Mental State Examination (MMSE), allowing for earlier intervention, new research indicates.

“SAGE is easily incorporated into clinical provider visits and may result in significantly earlier awareness of new cognitive conditions/concerns leading to new diagnoses, treatment, or management changes,” the investigators write.

“People who declined about 2 to 3 points over 12 to 18 months on SAGE had a very high likelihood of eventually developing dementia,” Douglas Scharre, MD, who developed SAGE and is director of the Division of Cognitive Neurology, Ohio State University Wexner Medical Center in Columbus, told Medscape Medical News.

Individuals with relatively normal cognitive function or some mild cognitive issues who have stable SAGE scores over time are likely not going to develop dementia, Scharre noted.

The study was published online December 6 in Alzheimer’s Research & Therapy.

Longitudinal Study

The researchers compared longitudinal changes in SAGE scores and MMSE scores over more than 8 years in patients from Ohio State University Memory Disorders Clinic.

The cohort included 424 patients who had at least two visits 6 months apart and were evaluated with both SAGE and MMSE and classified via standard clinical criteria as subjective cognitive decline (SCD), mild cognitive impairment (MCI), or Alzheimer disease (AD) dementia.

The study findings are based on 40 patients with SCD, 94 MCI nonconverters, 70 MCI converters, and 220 patients with AD dementia. Of the 70 patients who converted from MCI to dementia, 49 developed AD dementia and 21 were diagnosed with other non-AD causes of dementia.

Because only two SCD patients converted to MCI over the study period it wasn’t possible to draw any conclusions with respect to this group, the researchers note.

Among those who converted from MCI to AD dementia, both SAGE and MMSE scores declined significantly over time at annual rates of 1.91 points/year (P < .0001) and 1.68 points/year (P < .0001), respectively, they report.

For patients who converted from MCI to other dementias, the annual rate of decline in SAGE and MMSE was 2.33 (P < .0001) and 1.83 (P < .0001), respectively.

For patients with AD dementia, SAGE and MMSE scores declined 1.82 points/year (P < .0001) and 2.38 points/year (P < .0001), respectively.

SAGE and MMSE scores remained stable in patients with SCD and MCI nonconverters.

Of note, “statistically significant decline from baseline in SAGE scores occurred at least 6 months earlier than MMSE for MCI converters to AD dementia (14.4 vs 20.4 months), MCI converters to non-AD dementia (14.4 vs 32.9 months), and those with AD dementia (8.3 vs 14.4 months),” the investigators write.

Provider-administered cognitive tests like the MMSE can be burdensome in busy clinical settings.

“The main characteristic of SAGE is that it’s self-administered and so it’s more practical for practitioners because you don’t need a medical assistant, a nurse, or a doctor to administer it. Patients can take the test home and bring it back ahead of their appointment,” said Scharre.

“If the patient is not having any thinking issues, but maybe there’s a family history of dementia, you might get a baseline at age 65 and then maybe yearly. If a patient has any cognitive issues, we suggest usually taking it every 6 months,” he said.

SAGE takes about 10 to 15 minutes to complete and is available online at no cost.

Support for the study was provided by internal funds from the Division of Cognitive Neurology at Ohio State University. Ohio State University holds the copyright for SAGE. A digital version of SAGE for tablet use is commercially available at through a licensing agreement with Ohio State University.

Alzheimer’s Res Ther. Published online December 6, 2021. Full text

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