Treatments for Alzheimer's and dementia are more effective when they are introduced in the earliest stage of the disease, Dr. Scharre said. Unfortunately, he often doesn't see patients until more than three years after the first symptoms of cognitive impairment have started to appear.

"It's a recurring problem," he said. "People don't come in early enough for a diagnosis, or families generally resist making the appointment because they don't want confirmation of their worst fears. Whatever the reason, it's unfortunate because the drugs we're using now work better the earlier they are started."

While many of the assessment tools for cognitive disorders available today are accurate, certain aspects deter people from using them. "Seldom are physicians reimbursed for the time and effort it takes to give such tests, or they tie up personnel to physically administer the test," said Dr. Scharre, who advocates the use of routine screening for cognitive disorders in the primary care setting. Other diagnostic tests require the patient to use a computer, which can add heightened anxiety to some older adults who may be infrequent users of technology.

SAGE is a practical tool for a busy primary care office, said Dr. Scharre, who makes the test available free of charge to health care personnel at www.sagetest.osu.edu. All that is required to take the test is a paper, a pen and a few minutes. Because the test is self-administered, it doesn't take time away from an appointment. Patients can take it in the waiting room while waiting for the doctor.

Missing six or more points on the 22-point SAGE test usually warrants follow-up by the physician. Abnormal results also can prompt an early search for reversible and treatable conditions that may be causing the patient's thinking and cognitive impairment. Many conditions besides Alzheimer's, such as stroke and some thyroid conditions, can impact memory as well.

There are potential cost savings to using the test in a primary care setting. A person who fares poorly on the self-exam likely will be less compliant taking medications on time, taking them in the proper dosage, and following other recommendations such as maintaining healthy diets.

"Abnormal test results can serve as an early warning to the patient's family," stated Dr. Scharre. "The results can be a signal that caregivers may need to begin closer monitoring of the patient to ensure their safety and good health is not compromised and that they are protected from financial predators."

Results of the new test compare favorably with current standard cognitive assessments that are not self-administered. To validate the findings and accuracy of the exam, researchers at Ohio State evaluated 254 people using SAGE and then evaluated the subjects with a battery of established, well-documented assessment tools.

Of the study participants, age 59 and older, who took SAGE, 63 were selected at random to undergo a one-day clinical evaluation utilizing a battery of physical, neurological and cognitive tests. SAGE scores compared favorably with the Mini-Mental State Examination (MMSE), a brief questionnaire commonly used in medicine to screen for cognitive impairments and dementia.

Both tests were able to differentiate subjects with clinically defined normal and mild cognitive impairment (MCI) from those with dementia. However, SAGE also was able to distinguish between clinically defined normal and MCI.

Reference

1. Scharre, D.W., Chang, S., Murden, R.A., et al. (2010). Self-Administered Gerocognitive Examination (SAGE): A brief cognitive assessment instrument for mild cognitive impairment (MCI) and early dementia. Alzheimer Disease & Associated Disorders, 24 (1): 64-71.