Photo Credit: Makhbubakhon Ismatova

 SAGE and BrainTest are free, self-administered, and efficiently help primary care providers with early cognitive impairment detection.

The free, downloadable Self-Administered Gerocognitive Exam (SAGE) helps primary care providers efficiently improve early cognitive impairment detection, researchers who developed the test report.

“SAGE was easily incorporated into PCP visits and significantly increased identification of new cognitive conditions/concerns leading to new diagnoses, treatment, or management changes. The detection rate increased 15-fold for those with impaired SAGE scores combined with informant reports.” Douglas W. Scharre, MD, and his coauthors wrote in Frontiers of Medicine.

The SAGE test, available in several versions and languages, asks the respondent to complete a few basic questions about demographics, memory and thinking, and psychology. The 12 questions that follow ask the current date, the names of objects, how two items are similar and different, and how to do basic calculations, draw simple objects, name specific items in a category, and perform other cognitive tasks.

The questions are scored either correct or incorrect (1 or 0) or are scored as fully correct, partially correct, or incorrect (2, 1, or 0). BrainTest®, the digital version of SAGE, can send automatically scored, HIPPA-compliant results to the PCP’s office.

To help providers fit early cognitive impairment detection testing into their packed clinic schedules, the research team developed SAGE and tested its utility by comparing identification rates of new cognitive disorders in PCP visits that did vs. those that did not use the test.

They enrolled 300 patients between 65 and 89 years of age who had not been diagnosed with a cognitive disorder and who were completing a non-acute visit in one of two PCP offices. Each office conducted routine visits for 100 consecutive eligible patients, and one office used SAGE in an additional 100 patients to ask available informants about cognitive changes they had noticed over the previous year. The researchers conducted chart reviews 60 days later and used one-way analysis of variance and Fisher exact tests to compare the outcomes.

Using SAGE, Early Cognitive Disorder Diagnosis Increased Six-Fold

Using SAGE, PCPs detected new cognitive conditions or concerns six times as often (9% with SAGE vs. 1.5% without; P=0.003), with a detection rate nearly four-fold for scores indicating cognitive impairment (P=0.034). Patients with scores indicating impairment or an informant’s concern were 15-fold as likely to have new cognitive conditions or concerns documented (P=0.0007). Among providers using SAGE, 86% reported they would recommend the tool to their colleagues.

Physician’s Weekly (PW) talked with Douglas W. Scharre, MD, about SAGE, BrainTest, and the positive impacts he and his colleagues hope it will have on patients and providers.

PW: Why was it important to do your study and develop SAGE and BrainTest? 

Dr. Scharre: Currently, 50% to 75% of dementia cases are not diagnosed or identified at an early stage when potential treatments are the most effective. The self-administered nature of the test means you no one in the office needs to take time off to administer the test. Being self-administered, you do not need to train anyone on giving this test. It is easily used in underserved and under-resourced areas that have limited specialists. SAGE and BrainTest can efficiently be incorporated into time-limited PCP office visits.

PW: How may these tools improve patient care? 

Timely identification of cognitive disorders allows an appropriate workup to be done and causes looked for at an early stage. As with any condition, the earlier it is diagnosed, the more treatment options are available, and the better the outcomes for the patient.

This holds true even if the cognitive disorder is one of the neurodegenerative conditions, like Alzheimer’s disease. The FDA has just approved the first disease-modifying drugs to remove amyloid from the brains of Alzheimer’s patients, and these therapies work only if given in the very earliest stages, called mild cognitive impairment or mild dementia. SAGE and BrainTest are designed to identify mild cognitive Impairment stages of disease and are useful in identifying appropriate patients for these therapies at those early stages.

PW: What is the primary care physician’s role in diagnosing and managing patients with dementia? At when is it appropriate to refer their patients to specialists? What other specialists should be involved? 

PCPs play a critical role in the early detection and management of cognitive disorders. The first provider a patient with cognitive disorders will see is likely their PCP. The PCP needs to be able to identify cognitive conditions at an early stage to be able to further evaluate for the potential causes and start appropriate treatments.

Typically, the PCP may order some lab tests including B12 and thyroid as well as an MRI brain scan. They likely will order other tests depending on the health history of their patient. If they are not able to find a cause, then referral to specialists is the logical next step. These might include a neurologist or a psychiatrist, depending on the patient’s symptoms.

PW: What unanswered questions do you have about your study, and what further related research might you be planning? 

Since this was a cross-sectional study, we do not know what happened to the patients in the long term. For the patients who were identified by SAGE or Brainiest as having cognitive issues, we do not have data on their ultimate diagnoses or treatment plans. Our next study will be to combine electronic medical records information with the SAGE or BrainTest scores to hopefully devise a more accurate risk prediction for a patient’s future cognitive health.

PW: What other comments would you like to share with clinician readers? 

Over the next 10 years, scientists will develop improved treatments for cognitive disorders, but they will not be useful or effective if the patient is identified at a delayed cognitive stage, which is too late. We need new treatments and new ways to practically identify early cognitive issues. SAGE and BrainTest allow an efficient way to test without the need for trained administrators, and it is practical to fit into time-limited PCP office visits.