033-SAGE: Self Administered Cognitive Assessment


 Assessment for mental status and cognition are vital if we are to spot the early warning signs of disease. The problem is if we wait until we have trouble remembering where we put the keys we may be well along the path to dementia with lots of damage done. ​

Also as we’ve discussed in other videos, the changes of Alzheimers disease start decades before subjective cognitive impairment so tests like these will help us to create a valuable baseline to pick up any changes well before they would otherwise be diagnosed. Today we will be looking at the SAGE exam which stands for Self-Administered Gerocognitive Examination. It is designed to detect early signs of cognitive, memory or thinking impairments.










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Robert Lufkin 0:02
In this segment, we’re going to be looking at a useful test for mental status and cognition that can be performed with a paper and pencil in about 15 minutes. But best of all, you can administer it yourself without needing to be in a doctor’s office. Stay tuned and find out how. Assessments for mental status and cognition are vital if we’re to spot the early warning signs of Alzheimer’s, as well as conditions such as metabolic dysfunction, inflammation, toxins and deficiencies, which can all affect our thinking. The problem is, if we wait until we, you know, have trouble remembering where we put the keys, we may be well along the path to dementia, with lots of damage already done. It’s sort of like waiting until the car engine ceases rather than checking and topping up the oil periodically. So think of this as checking the oil. Now, I realized that my daughter’s generation raised on Tesla’s and other electric cars will miss this analogy of oil and engines, but most of the rest of us I think, will still get it. As we’ve discussed in other videos, the changes of Alzheimer’s disease start decades before subjective cognitive impairment. So tests like we’re going to discuss today will help us create a valuable baseline to pick up any changes well before they would otherwise be diagnosed. Today we will be looking at the sage exam, which stands for the self administered Jarrow cognitive examination. It’s designed to detect early signs of cognitive memory or thinking impairments. The test evaluates our thinking abilities and helps physicians to know how our brain is working. It was developed by Douglas Shaarei, MD, and neurologist at Ohio State University. Now, the popular Montreal cognitive assessment or Mocha that we’re covering in other videos is also a great test. But sage has one key advantage. Sage is designed to be self administered while Mocha is designed to be administered by a third party. Both tests can be done for free and take just under about 15 minutes each to perform. You don’t need special equipment to take sage just dependent a paper. There are four forms of the sage test. This test is self administered, it should be filled out in ink without the assistance of others. The four versions are so that it can be repeated over time without people memorizing the questions. You only need to take one it doesn’t matter which one you take. They’re they’re really all interchangeable. Calendars and clocks should not be available during the testing.


So what does this sage test actually evaluate? We’ll take a look at some sample questions to illustrate each area. The test offers questions that challenge is series of cognition skills. Some of these are fairly basic, while others are proven strategies seen in many of the leading tests for dementia and Alzheimer’s. So first off basic medical history. Before anybody begins, the assessment is important to fill out the brief medical history section at the top. This is useful information record, and it also gets the subject warmed up for the test. Next, memory and recall skills. There are aspects of the test that will test the memory of the user and their ability to recall names. For example, in some tests, they will have to give the names of objects in a picture or recall the names of animals. This ladder example is a common test in many dementia assessments. There’s also a short term memory exercise where users have to remember a statement and then right at the bottom of the page or at the end of the test. Another exercise involves listing a series of objects that relate to a given subject. Next, reasoning and sequencing. There are also tests that determine a user’s ability to show reasoning and make connections. Some of these are language bases. Some are numerical calculations, and others showcase the ability to construct An argument. For example, users may have to show an understanding of the change they would receive in a commercial transaction. This highlights mental arithmetic, but also is an important real world skill. There’s also an exercise to explain the similarities between two objects such as a bicycle and a train. Next are drawing tests. There are some tests that require users to draw, which is one of the reasons that it’s so helpful to print out this test and and use a pencil. Three of the exercises are again common options that may be used in many national assessments. One is the cube drawing where test subjects simply have to copy the shape of the 3d structure on the page. Another is the clock drawing test. Here subjects draw a clock face, and then add the numbers in the right place and put the hands at a given time. This may sound like a simple request, but actually tests a lot of skills. Many people with dementia cannot complete this test. Then there is the trail making test where users have to draw a line in a determined route between numbers and letters. Finally, general orientation. There will also be some basic questions on orientation. This means providing the know current date with the month day and year without looking at a calendar. Of course, the problem with an online version of this test is that it’d be too easy to read the correct date from the corner of the screen. Next, scoring. For scoring, the ideal method is to have someone else score the exam who is trained in interpretation, but in reality, if needed, you can score it for yourself, you need to be careful of bias. If you score this test yourself, for example, someone might say that the answer was well close enough because they don’t want to get a bad score. Now, the maximum score is 20 to a score of 17 is an above is considered normal. Know that the sage screening is not a diagnostic test of any condition. Strictly speaking, reacher research is so shown that sage can but not always indicate whether individuals fall into the normal range have mild cognitive impairments or memory problems or have more severe memory or thinking conditions. Now if you feel that you have memory impairment, even if your Sage score is normal, you really should be checked out by a physician. We’ll be covering other cognitive exams such as the mocha in other videos, but for a simple, easy to use and self administered exam. The sage is the one to use. Thanks for watching, and we’ll see you next time.


Unknown Speaker 8:12
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