All About the SAGE Test for Alzheimer’s and Dementia Detection

Should you take this screening test for mild cognitive impairment?

senior man taking SAGE test
If you notice memory or thinking problems, taking this pen-and-paper test can help identify potential issues.Getty Images

The Self-Administered Gerocognitive Exam, known as SAGE, is a short pen-and-paper test to detect the early signs of cognitive, memory, or thinking impairments. The exam is meant to evaluate your thinking abilities and can help your doctors understand how well your brain is functioning.

Douglas Scharre, MD, a clinical professor of neurology at the Ohio State University Wexner Medical Center in Columbus, developed the test with colleagues based on clinical experience and a review of scientific literature.

“Questions were designed to evaluate every part of a patient’s brain,” Dr. Scharre says.

The scoring for SAGE gives equal weight to questions that assess brain function for the front, back, and left and right sides of the brain, so no area is overrepresented.

SAGE will not diagnose any specific condition. It will not tell your doctor if you have?Alzheimer’s disease?or any other condition that can impact your thinking.

But it is a helpful cognitive screening tool — including for?mild cognitive impairment (MCI) from any cause, as well as for early-stage dementia.

What Is Mild Cognitive Impairment?

MCI is a condition characterized by a minor decline in mental abilities, according to the National Institute on Aging. These changes are often noticeable to the person experiencing them, family members, or close friends, but they are not severe enough to interfere with normal daily life and activities.

According to the Alzheimer’s Association, approximately 12 to 18 percent of people age 60 or older have MCI.

People living with MCI are more likely to develop Alzheimer’s disease or other dementias.?About 10 to 15 percent of individuals with MCI go on to develop dementia each year, notes the Alzheimer’s Association.

Symptoms of MCI are often vague but may include the following:

  • Memory loss, such as forgetting certain words
  • Forgetting important events, like appointments
  • Losing your train of thought in conversation, when reading a book, or watching a movie
  • Becoming disoriented in familiar surroundings
  • Becoming more impulsive or showing poor judgment

MCI does not always lead to dementia. In some people, MCI reverts to normal cognition, while in others, the condition stabilizes and they experience no further cognitive decline.

There are no medications for MCI — unless it’s determined to be an early stage of Alzheimer’s disease — but establishing a diagnosis can be important to help identify and manage any progression of your symptoms. In some cases, a diagnosis of MCI may help identify reversible or treatable causes of memory issues like depression, sleep apnea, or high blood pressure.

10 Behaviors That Trouble Alzheimer’s Caregivers

By understanding and addressing Alzheimer's behaviors, we can help improve the quality of life for both patients and caregivers.
10 Behaviors That Trouble Alzheimer’s Caregivers

How Does the SAGE Test Work?

SAGE evaluates your thinking abilities by asking you questions related to language, reasoning, problem-solving, and memory.

Scharre explains that the questions cover a wide range of cognitive domains, especially abilities that are early predictors of mild cognitive impairment.

SAGE measures cognitive function by assessing the following areas:

  • Orientation (month, date, year)
  • Language (verbal fluency and picture naming)
  • Reasoning and computation (abstraction and calculation)
  • Visuospatial function (three-dimensional construction and clock drawing)
  • Executive function (problem-solving)
  • Memory

Examples of questions include:

  • How many nickels are in 60 cents?
  • Write down the names of 12 animals.

In addition to the scored items on the test, SAGE asks questions about your medical history, such as “Have you suffered a stroke?” The test asks if you have a family history of cognitive impairment. You’re also asked about any current symptoms you may be having, such as problems with memory or balance, or if you’ve experienced any personality changes.

These answers can help your healthcare provider identify possible causes of cognitive decline.

Who Should Consider Taking the SAGE Test?

According to Scharre, anyone who is experiencing memory, language, problem-solving, or thinking problems should consider taking SAGE.

“This may be especially important if you are noticing very mild symptoms, since SAGE is designed to pick up early deficits and allow your healthcare providers to diagnose and manage any potential conditions at an early stage,” he says.

Friends or family members may want to encourage a loved one to take the test if they notice issues related to memory or thinking.

You may also wish to take SAGE to establish a baseline cognitive assessment to use for comparison in the future if you have a family history of dementia or thinking problems.

“Typically, we would suggest repeating the test every six months unless significant cognitive changes are occurring,” says Scharre.

Where Can I Find the Test?

You can download the?test for free at the Wexner Medical Center website.

There’s also a digital version made for tablets, produced by a company called BrainTest. It consists of identical test questions. This version is scored by a panel, and results are sent to you so you can take them to your doctor for further discussion. You can download the test as an app or access the online version at?BrainTest.com by signing up for a free trial (but note that you must provide payment information to complete registration for the trial period).

How to Take the SAGE Test

If you’re taking the paper version of the test, you’ll find four slightly different variations on the Wexner?website. It doesn’t matter which one you take. The test consists of four pages. Print it out and answer the questions in ink without the assistance of others. Don’t look at a clock or calendar while taking the test, and just do the best you can.

You can take the test in virtually any setting. It will usually take about 10 to 15 minutes, but there’s no set time limit.

To get an accurate assessment, it’s important not to cheat.

In some cases, you might choose to take the test at your doctor’s office so it can be evaluated right away.

What Are the Next Steps After Taking It?

After you complete the test, you should take it to your healthcare provider, who can score the test and give you feedback.

According to Scharre, your doctor may suspect that a specific part of your brain is not working as well as other parts, depending on how you answer specific questions. “That may help them in their diagnostic considerations,” he says.

Depending on your test results, your doctor may schedule additional neurological tests or brain imaging —?such as a?MRI or CT?scan — to rule out other conditions that may be impairing your thinking or memory, such as a stroke, Parkinson’s disease,?a brain tumor, or another illness like?hypothyroidism.

How Accurate and Reliable Are the Results?

Like any test, SAGE is not perfect. Scharre points out that people have a wide variety of cognitive talents, and this needs to be taken into account.

“There will be individuals who score well but have a decline from their previous abilities. Repeat testing over time will find those that are progressing” in loss of cognitive function, he says.

“Some individuals will not score as well, but that may represent their baseline talents, and their score would not suggest any specific brain condition,” Scharre adds. This is why it’s important to have the test interpreted by a healthcare provider who can take your personal medical history into account.

It’s important to note that factors other than mild cognitive impairment or dementia could be affecting your memory and thinking on any given day.

“Perhaps you don’t have a memory impairment but are quite depressed, ill, or sleep-deprived,” says?Jessica Caldwell, PhD, director of the Women's Alzheimer's Movement Prevention Center at the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, Nevada.

If you have concerns about your memory but are also experiencing symptoms of depression or sleep difficulties, Dr. Caldwell suggests seeing your doctor.

The Takeaway

The SAGE test is a simple self-administered screening tool to assess your cognitive function and look for signs of mild cognitive impairment or early-stage dementia. You can take the test at home and ask your doctor to score it, or take it at your doctor’s office. While SAGE can’t diagnose any specific condition, it can help your doctor decide what other tests you might need to identify the cause of cognitive problems.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Revolutionizing Memory Disorder Detection With a Paper and Pen. Ohio State University. May 9, 2022.
  2. What Is Mild Cognitive Impairment? National Institute on Aging. April 12, 2021.
  3. Mild Cognitive Impairment (MCI). Alzheimer’s Association.
  4. Mild Cognitive Impairment (MCI). Mayo Clinic. February 13, 2023.
  5. SAGE: A Test to Detect Signs of Alzheimer's and Dementia. Ohio State University.
Show Less
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news
news