A new study “Self-administered gerocognitive examination (SAGE) aids early detection of cognitive impairment at primary care provider visits” published today in Frontier in Medicine by researchers at The Ohio State University Wexner Medical Center finds that the practical and brief SAGE test was easily incorporated into primary care providers’ visits. This screening tool resulted in a significant increase in the detection of cognitive concerns. This latest discovery is crucial because primary care providers (PCPs) are typically the first to identify and evaluate patients with neurocognitive disorders such as Mild Cognitive Impairment (MCI), Alzheimer’s and dementia. However, the diagnosis of cognitive impairment has historically been challenging to establish in primary care settings due to lack of expertise to conduct robust cognitive measures, cost, and difficulties to incorporate these measures into time-limited PCP visits, cited by PCPs in a survey.
“PCPs need to have access to top-tiered diagnostic tools to effectively and confidently address neurocognitive disorders in patients, while also overcoming barriers to cognitive testing in their offices. Earlier detection, facilitated either by SAGE or its digital version BrainTest, accomplishes this challenge and allows for the possibility of more treatment options that can lead to better outcomes for patients who have MCI,” stated Dr. Doug Scharre, MD, Director of the Division of Cognitive Neurology at The Ohio State University Wexner Medical Center and lead author of the study. “This is especially significant given the ongoing development and approval of new disease-modifying therapeutics for dementia and Alzheimer’s disease that work best only in the earliest stages of the disease.”
According to Aaron D. Clark, DO, clinical associate professor of Family and Community Medicine at The Ohio State University College of Medicine, and one of the study co-authors, “although there are many cognitive tests available, the problem is that many PCPs have either or both very little time to administer one or no experience so the accuracy can be incorrect. Therefore, it’s important to use a test that can be proven to work to detect issues.”
SAGE or its digital version BrainTest are brief and self-administered and so can be used by patients in their provider’s office or even at home (and brought to their provider) and do not require trained individuals to administer the test. In a 2021 study published in Alzheimer’s Research & Therapy, the SAGE test, developed by researchers at The Ohio State University Wexner Medical Center, College of Medicine and College of Public Health, can identify the early, subtle signs of dementia sooner than the most commonly used office-based standard cognitive test.
“If we can diagnose MCI earlier, then we can increase patient supervision of finances, driving, and medication compliance. This will reduce potential poor judgment and scam risks, improve treatment of other chronic medical conditions, allow for earlier cognitive treatments, provide more opportunities for clinical trial enrolment, and ensure timely preparation of advance care planning. This provides a stronger chance to prolong the quality of life, as well as probably mitigate against the high costs of care,” said Dr. Scharre. “That is why it is important to empower both physicians and patients to proactively check up on their brain health regularly and annually, if they sense a problem. Early detection of cognitive impairment is beneficial to discover potentially reversible conditions and allow individuals to play an active role in decision-making planning for their future.”
According to a 2024 report by the Alzheimer’s Association, a large portion of those who would meet the diagnostic criteria of Alzheimer’s and dementia are underdiagnosed by their PCP. Some patients also appear to be unaware of their cognitive deficits and may not know they have MCI or dementia. Underdiagnosis is most pronounced at the earliest states of dementia when symptoms are mild.1
To improve awareness and increase earlier diagnosis, this study was conducted solely by PCPs in a real world (not research) setting. Both SAGE and BrainTest were offered during the process. When SAGE, a pen-and-paper test, was administered to 100 participating patients, the detection of new cognitive conditions increased 6-fold compared to the 200 patients not utilizing SAGE. Most importantly, the use of SAGE influenced PCPs to further evaluate for causes of cognitive impairment. Eighty-six percent of the primary care providers, who engaged in this study, would recommend using SAGE to their colleagues.
Scharre, a member of the Scientific Advisory Board and Head of Medical Affairs for BrainTest, has worked closely with BrainTest Inc SEZC to develop the digital version of the SAGE test, which can be taken anywhere on a tablet or touch screen computer. This digital version will soon be integrated within Ohio State Wexner Medical Center and many other provider’s electronic medical records systems to better facilitate self-testing, storing, and reviewing results by their health care team.
Even though SAGE and BrainTest may be taken at home, only BrainTest can be scored automatically and remotely. BrainTest’s core scoring lab can turn the results around quickly, providing a printable detailed report with a video explanation by a certified physician. Those results can be taken to their primary care physician, who can decide if any additional steps are needed. SAGE users will need to bring the hardcopy test to a physician, for scoring. Soon automatic scoring will also be available for takers of BrainTest in their provider’s office or hospital settings.
Mild cognitive impairment (MCI) is a condition where individuals display cognitive impairments that are more than expected with normal aging but not severe enough to interfere with daily functioning. (American Psychiatric Association).
Learn more about SAGE at wexnermedical.osu.edu/SAGE and BrainTest at BrainTest.com.
1 Alzheimer’s Association. 2024 Alzheimer’s Facts and Figures. Alzheimer’s Dement 2024, 20(5).
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