Having trouble finding the right words…showing up for visits on the wrong day…getting confused while balancing a checkbook. For people who are getting on in years, such experiences can spark worries about whether cognitive skills are starting to slip.
Still, no one likes to think that dementia might be on the horizon—which is one reason why cognitive decline often goes undiagnosed in the early stages. In fact, patients typically don’t mention such problems to their doctors until three or four years after symptoms begin. What’s more, doctors themselves often fail to pick up on the early, subtle signs of dementia during routine medical exams…and many doctors don’t do the time-consuming tests necessary to diagnose cognitive impairment until the problem has progressed to later stages. That’s too bad—because early intervention may help delay the progression of mild cognitive impairment and/or provide the best opportunities for patients and their loved ones to make appropriate plans for the future regarding caregiving, finances, legal matters, etc.
Game changer: Now there’s a simple screening test for cognitive impairment or dementia that you or a loved one can take anywhere, using just paper and pencil. It takes only about 10 minutes to complete, and it provides your doctor with the info he/she needs to determine whether more thorough testing is needed.
Professionally administered screening tests for mild cognitive impairment do exist, but many take lots of time and attention—which is one reason why more than 40% of people with mild cognitive impairment are not diagnosed by their primary doctors. In addition, some tests place too much emphasis on memory and too little on evaluating other cognitive skills. There also are Web-based tests that people can take on their own, but many people are not comfortable enough with computers to use these…and often such tests have not been validated.
To address these problems, researchers from The Ohio State University developed a screening tool called the Self-Administered Gerocognitive Examination (SAGE). The test was designed to identify mild cognitive impairment (which sometimes progresses to full-blown dementia) as well as dementia. In studies, SAGE has been shown to detect cognitive problems as accurately as other established but more time-consuming screening tools, correctly identifying nearly 80% of people with cognitive impairment and excluding 95% of those without impairment.
SAGE was designed to be a self-administered exam, with simple instructions written in plain language. It is a four-page, 12-question test that looks at abilities in six different areas that can be used as early predictors of mild cognitive impairment—orientation, language, reasoning/computation, spatial ability, problem solving and memory. Some examples: Test takers are asked to name certain objects…do simple math…draw lines that follow a pattern…remember one easy task…and so forth. The test takes about 10 to 15 minutes to complete (though there is no time limit), and scoring can be done in less than one minute.
The maximum score possible is 22 points. A score of 17 to 22 is classified as normal cognitive ability…a score of 15 or 16 is classified as mild cognitive impairment…a score of 14 or less is classified as possible dementia. To compensate for age and education level, the researchers suggest adding one point to the score when the test taker is over age 80…and adding one point when the person has 12 years or less of education.
Recently the test designers recruited more than 1,000 volunteers over age 50 from venues such as health fairs, senior centers, assisted-living facilities and educational talks, and gave them the SAGE test. Results: 72% scored in the normal range…10% scored in the mild cognitive impairment range…and 18% scored in the dementia range. These percentages, the researchers said, are typical for the population that was tested.
SAGE can be taken in the privacy of your own home or at your physician’s office, without supervision or special instruction. Simply download the test from SageTest.OSU.edu and print it out. No calendars or clocks should be available during test-taking, but you can spend as much time as you need completing it.
Of course, there’s nothing to stop you from scoring your own test or from asking a loved one to score it for you. But in actuality, the test is intended to be scored and interpreted by your physician—so take your test paper with you the next time you see your doctor (scoring instructions can be downloaded from the same Web site). If you’ve done fine, ask your doctor to save the test in your file for future comparison. If your score suggests that some impairment has already occurred, talk with your doctor about getting a complete cognitive evaluation. Remember, the sooner such impairment is diagnosed, the more and better options you will have.
