Self-administered exam more quickly identifies MCI conversion to dementia
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A self-administered test detected mild cognitive impairment conversion to dementia at least 6 months sooner than the Mini-Mental State Examination, according to results of a cohort study published in Alzheimer’s Research & Therapy.
“Early identification of [mild cognitive impairment (MCI)] and dementia is enhanced greatly by brief (10 to 15 minutes), office-based, multidomain objective cognitive assessments, including the Mini-Mental State Examination (MMSE) and Self-Administered Gerocognitive Examination (SAGE) to detect the degree, type and changes over time of deficits,” Douglas W. Scharre, MD, director of the division of cognitive and memory disorders in the department of neurology at Ohio State University, and colleagues wrote. “SAGE has been shown to be a reliable instrument for detecting cognitive impairment based on gold standard clinical and neuropsychological assessments (ROC AUC of 0.92, 95% specificity, and 79% sensitivity). SAGE is self-administered and can be taken at a person’s home, in a physician’s office or virtually anywhere.”
The investigators compared longitudinal SAGE test scores with non-self-administered MMSI scores across five different diagnostic subgroups in a cohort study that examined annual rates of change among consecutive patients at the Ohio State University Memory Disorders Clinic. They included patients with two or more visits 6 months apart who completed SAGE and MMSE and were classified based on standard clinical criteria, including subjective cognitive decline, MCI or Alzheimer’s disease dementia.
Among 424 included patients, the researchers observed declines in SAGE and MMSE scores at annual rates of 1.91 points per year (P < .0001) and 1.68 points per year (P < .0001), respectively, for those who converted from MCI to AD dementia, as well as 1.82 points per year (P < .0001) and 2.38 points per year (P < .0001) for those with AD dementia. Among subjective cognitive decline and MCI nonconverters, SAGE and MMSE scores remained stable. Scharre and colleagues noted that statistically significant decline from baseline scores in SAGE happened at least 6 months more quickly compared with MMSE among those with MCI who converted to AD dementia (14.4 vs. 20.4 months), those with MCI who converted to non-AD dementia (14.4 vs. 32.9 months) and those with AD dementia (8.3 vs. 14.4 months).
“For the clinical provider who longitudinally manages those with cognitive issues, use of SAGE provides a cognitive assessment tool that identifies cognitive changes sooner than MMSE, has advantages of time efficiencies in busy clinical practices and consequently may more likely be administered and repeated regularly over time,” the researchers wrote. “The ease of repetitively giving the self-administered SAGE and identification of score stability or decline may provide clinicians with an objective cognitive biomarker impacting their evaluation and management choices. SAGE has the advantage of self-administration, brevity, four interchangeable forms, and widespread availability to be a factor in overcoming the many obstacles in identifying cognitive changes in patients.”