Q&A: SAGE test catches cognitive impairment early in a ‘critical time’

Key takeaways:

• When using SAGE, PCPs documented new cognitive conditions six times as often.
• The tool’s developer highlighted the test’s efficacy and practicality in a primary care setting.

A self-administered assessment tool was effective in identifying cognitive impairment vs. routine care in primary care settings, according to results recently published in Frontiers in Medicine.

“Primary care providers 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,” Doug Scharre, MD, a professor of clinical neurology and psychiatry at The Ohio State University Wexner Medical Center, said in a press release.

Scharre and colleagues compared detection rates of new cognitive disorders during non-acute-care visits when the self-administered gerocognitive examination (SAGE) was administered vs. visits when it was not.

Two PCP offices each completed 100 routine visits. One office completed an additional 100 visits using SAGE and asked any informants who accompanied the patients about cognitive changes over the past year. The patients were aged 65 to 89 years and did not have diagnosed cognitive disorders.

When SAGE was used, PCPs documented new cognitive conditions and concerns six times more often than during routine visits (9% vs. 1.5%).

Additionally, the detection rate was 3.96-fold for patients who had cognitively impaired SAGE scores. Patients with cognitively impaired SAGE scores and informant concerns were 15.5-fold as likely to have new cognitive conditions or concerns documented.

Overall, 86% of PCPs said they would recommend SAGE to colleagues.

Speaking to Healio, Scharre discussed the feasibility of the tool’s implementation, the takeaways of the study and more.

Healio: How is SAGE different from other cognitive diagnostic tools?

Scharre: Its true claim to fame is the self-administered part. Before I developed it, I was noticing that it was taking individuals much too long after their cognitive symptoms started to get in to see their providers, and it seemed very difficult for primary care doctors and other providers to administer cognitive testing in an efficient, robust and sophisticated way. People's cognitive impairment wouldn't be tested, and they’d delay until their cognitive impairment was obvious to everyone.

So, the self-administered component of SAGE was the most important aspect. It could be used very practically in any setting. It could be done at home, or it could be done in the doctor's office. We do it at health fairs. We use it in our memory clinic. So, it works in any real-world setting because you don't need someone trained to know how to give it, because you just say, “do the best you can,” and have them do it.

Healio: What led you to conduct this in a primary care setting, and were you surprised by or expecting the findings?

Scharre: I was expecting SAGE to do well, but I didn't know how well it would do. We first designed this test and published it in 2010, then published the digital version in 2017. So, it’s been out for a long time. But we wanted to test it, not in a memory center but in a real-world PCP office. They have these very time-limited visits (my hat’s off to them). We tell PCPs, “here’s one other thing you should be checking,” you need to assess how well patients are thinking, especially as people get older, but we wanted to make it efficient and practical for them.

We knew that SAGE and its digital version BrainTest had excellent efficacy and characteristics in identification of early cognitive impairments. It’s not too easy of a test where everyone is going do well until they’re really demented, and it’s not super hard where everyone would fail. It had to be designed so that it picks up mild, cognitive impairment at an early stage. I had high hopes that it would accomplish those aims, and it seemed to do so.

Healio: Apart from SAGE’s efficacy, what should PCPs take away from the results?

Scharre: Now is a critical time because we're beginning to have medications that can maybe modify degenerative processes like Alzheimer's disease. They work only at the earliest stages, so now there’s more of a reason to think, “we can do something about it if we diagnosis early” as opposed to, “Well, what can we do about it anyway? What’s the hurry?”

We’re developing — and going to develop in the future — many more medications that I think can have an impact on patients’ lives, quality of life, caregivers’ lives and decrease or delay the impact of the disease.

This study should tell PCPs that there’s a practical tool out there that’s not going to impact their time-limited visits. We can maybe identify people at a very early stage and then get them to the specialists and appropriate treatment.

Healio: Where does research on SAGE go from here?

Scharre: We’re doing next phase research now. We have grants secured and funding. The next step is really to look at metadata. Now that we have the digital form, BrainTest, it should be available soon in a lot of electronic medical record systems across the United States and the world, as SAGE is translated into many different languages.

We're using AI to look at this metadata behind the scenes. The patient still takes the same test for the same amount of time. It doesn't lengthen anything. But behind the scenes, we're going to try to extract data that might say, “they're still getting perfect on these test scores, but how they got there was a little long or a little circumvent.” This is a key thing, where we're catching impairment even earlier and we can identify individuals who have a neurodegenerative condition and perhaps start them on medications earlier to help get better outcomes for their disease.

References:

• New study finds that empowering primary care providers with data-driven cognitive screening tools increases identification of cognitive impairment. https://braintest.com/new-study-finds-that-empowering-primary-care-providers-with-data-driven-cognitive-screening-tools-increases-identification-of-cognitive-impairment/. Published June 18, 2024. Accessed June 19, 2024.
• SAGE: A test to detect signs of Alzheimer's and dementia. https://wexnermedical.osu.edu/brain-spine-neuro/memory-disorders/sage. Accessed June 19, 2024.
• Scharre D, et al. Front Med. 2024;doi:10.3389/fmed.2024.1353104.