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Self-administered Gerocognitive Examination (SAGE): A Brief Cognitive Assessment Instrument for Mild Cognitive Impairment (MCI) and Early Dementia

Scharre, Douglas W. MD*; Chang, Shu-Ing PharmD*; Murden, Robert A. MD; Lamb, James MD; Beversdorf, David Q. MD* ‡; Kataki, Maria MD, PhD*; Nagaraja, Haikady N. PhD§; Bornstein, Robert A. PhD

Alzheimer Disease & Associated Disorders: January-March 2010 - Volume 24 - Issue 1 - p 64-71
doi: 10.1097/WAD.0b013e3181b03277
Original Articles

Objectives To develop a self-administered cognitive assessment instrument to facilitate the screening of mild cognitive impairment (MCI) and early dementia and determine its association with gold standard clinical assessments including neuropsychologic evaluation.

Methods Adults aged above 59 years with sufficient vision and English literacy were recruited from geriatric and memory disorder clinics, educational talks, independent living facilities, senior centers, and memory screens. After Self-administered Gerocognitive Examination (SAGE) screening, subjects were randomly selected to complete a clinical evaluation, neurologic examination, neuropsychologic battery, functional assessment, and mini-mental state examination (MMSE). Subjects were identified as dementia, MCI, or normal based on standard clinical criteria and neuropsychologic testing.

Results Two hundred fifty-four participants took the SAGE screen and 63 subjects completed the extensive evaluation (21 normal, 21 MCI, and 21 dementia subjects). Spearman rank correlation between SAGE and neuropsychologic battery was 0.84 (0.76 for MMSE). SAGE receiver operating characteristics on the basis of clinical diagnosis showed 95% specificity (90% for MMSE) and 79% sensitivity (71% for MMSE) in detecting those with cognitive impairment from normal subjects.

Conclusions This study suggests that SAGE is a reliable instrument for detecting cognitive impairment and compares favorably with the MMSE. The self-administered feature may promote cognitive testing by busy clinicians prompting earlier diagnosis and treatment.

*Division of Cognitive Neurology, Department of Neurology

Division of General Internal Medicine, Department of Internal Medicine

§Department of Statistics

Division of Neuropsychology, Department of Psychiatry, Ohio State University, Columbus, OH

Department of Radiology, Neurology and Psychology at the Thompson Center, University of Missouri, Columbia, MO

Funding for the study was provided by an Investigator Initiated Grant from Eisai/Pfizer, Inc. Douglas W. Scharre and Maria Kataki have received Grants in excess of $10,000 per year from Eisai for research using donepezil as part of a nationwide sponsor initiated study, which is not related to our study described in this manuscript. Douglas W. Scharre and David Beversdorf have received honoraria not in excess of $10,000 per year from Eisai/Pfizer for speaker bureau events regarding their product donepezil.

Reprints: Douglas W. Scharre, MD, Department of Neurology, 395 West 12th Avenue, 7th Floor, Columbus, OH 43210 (e-mail:

Received for publication October 2, 2008; accepted May 7, 2009

Disclosure: For all authors, there are no commercial associations with Eisai or Pfizer that might pose a conflict of interest in connection with this submitted article. There are no other potential or real conflicts of interest for any of the author. The sponsors (Eisai/Pfizer, Inc) had no role in the design or development of the SAGE test. They had no role in the study's design, conduct, methods, subject recruitment, data collections, management, analysis, or interpretation of the data. They did not participate in the preparation, review, or approval of the manuscript.

© 2010 Lippincott Williams & Wilkins, Inc.