Douglas Scharre, MD

“Our hypothesis was that SAGE would do better than a Mini-Mental State Exam; it was designed that way. It was designed to pick up mild cognitive impairment, whereas the Mini-Mental State is not really great at doing that. So, our thought was that we should be able to pick up people that would eventually develop dementia earlier, and that's, in fact, what we found.”

The utility of the Self-Administered Gerocognitive Exam (SAGE) is in its ability to identify patients with mild cognitive impairment (MCI) earlier on, allowing for treatment and therapies to be implemented closer to the onset of dementia. Douglas Scharre, MD, director, Division of Cognitive and Memory Disorders, department of neurology, the Ohio State Wexner Medical Center, discussed findings from recent study of SAGE in comparison with the Mini-Mental State Exam, where investigators concluded SAGE could detect early dementia at least 6 months sooner than its comparator. 

In the first 6 months of publication, SAGE was downloaded over 1 million times, Scharre said, signaling that there is a demand for assessments to help understand MCI, whether that concern is coming from the patient, a spouse, or another family member. The test is also an effective tool for providers in treating the “worried well,” allowing them to screen concerned patients and provide validated results to allay fears. 

Scharre also mentioned the application of SAGE and its digital companion, BrainTest, before and after chemotherapy to detect cognitive issues. According to Scharre, the assessment aids in understanding whether or not treatment is impacting a patient’s brain, being easily accessed for use online or in hardcopy form. 

REFERENCE
Scharre DW, Chang S, Nagaraja HN, Wheeler NC, Kataki M. Self-Administered Gerocognitive Examination: longitudinal cohort testing for the early detection of dementia conversion. 

. 2021;13(1):192. doi:10.1186/s13195-021-00930-4

Videos

Outlining the findings from a recent study comparing SAGE to the Mini-Mental State Examination, the director of the Division of Cognitive and Memory Disorders at the Ohio State Wexner Medical Center stressed the importance of identifying patients at-risk for dementia early on. [WATCH TIME: 6 minutes] 

Using SAGE to Detect Mild Cognitive Impairment Earlier: Douglas Scharre, MD

“They're both self-administered, so you do not need an administrator, which is one of the biggest advantages of this test. Unlike the Mini-Mental State [Examination] or other tests where you needed an administrator, the SAGE test, the BrainTest are self-administered, and it takes away administrator bias.”

The Self-Administered Gerocognitive Exam (SAGE) was developed as a pen-and-paper test to measure cognitive function and identify individuals with mild cognitive impairment. A companion assessment, the BrainTest, accomplishes the same goal with the same questions, but is instead taken on a tablet or touchscreen computer.

, Douglas Scharre, MD, director of the Division of Cognitive and Memory Disorders, department of neurology, the Ohio State Wexner Medical Center, outlined the functionality of both tests, which he described as “basically equivalent,” just differing in how they are presented. The primary advantage of both versions, he said, is the capability to be self-administered, thereby removing the need for an administrator, and eliminating potential administrator bias. 

SAGE is downloaded from a website and is free to use, but BrainTest, as a commercialized product, has an associated cost. The digital version is also automatically scored, whereas SAGE requires a health care provider to evaluate results, Scharre said. SAGE can be used as an effective case-finding tool for clinical trials, he added, allowing providers to screen more patients simultaneously than they would be able to with a test like the Mini-Mental State Examination, which requires an administrator to test each patient individually.  

The director of the Division of Cognitive and Memory Disorders at the Ohio State Wexner Medical Center discussed benefits of both the pen-and-paper and digital assessments. [WATCH TIME: 7 minutes]

SAGE and BrainTest for Cognitive Assessment and Clinical Trial Enrollment: Douglas Scharre, MD

“The reason I developed and invented this test was because, as a neurologist, seeing cognitively impaired patients and/or with memory disorders, the number of individuals that would come into our clinic that had had issues for 3-4 years by the time they actually came to see us. It was clear to me that patients weren't right on top of it all the time, and primary care doctors weren't always referring.”

Detecting signs of dementia early can have a crucial impact on patients’ outcomes, allowing for health care providers to intervene with resources and treatment, if necessary. Several tests have emerged to identify signs of mild cognitive impairment (MCI), with the 

Self-Administered Gerocognitive Examination (SAGE)

 recently showing success in a longitudinal study of its efficacy compared to the Mini-Mental State Examination (MMSE).

Douglas Scharre, MD, director, Division of Cognitive and Memory Disorders, department of neurology, the Ohio State Wexner Medical Center, sat down with 

 to discuss SAGE, which is a pen-and-paper assessment, and its digital companion assessment, BrainTest, which can be performed on a tablet or touchscreen computer. According to Scharre, he was prompted to develop SAGE and BrainTest upon recognizing that patients had cognitive issues that had persisted for several years and had not sought treatment, therefore creating a delay in their identification and treatment. 

Also discussed were findings from the study, where investigators concluded that SAGE identified MCI conversion to dementia at least 6 months ahead of the MMSE, which is not self-administered. The patients that were identified as being likely to eventually develop dementia had a 2- to 3-point decline in SAGE scores 12-18 months from baseline, which was a significant decline, Scharre said. 

The director of the Division of Cognitive and Memory Disorders at the Ohio State Wexner Medical Center discussed motivations behind creating the pen-and-paper test, as well as its digital companion. [WATCH TIME: 2 minutes]

Douglas Scharre, MD

Articles

Using SAGE to Detect Mild Cognitive Impairment Earlier: Douglas Scharre, MD

SAGE and BrainTest for Cognitive Assessment and Clinical Trial Enrollment: Douglas Scharre, MD

Development of SAGE for Early Dementia Detection: Douglas Scharre, MD