SAGE – Early Detection Of Alzheimer’s Disease And Dementia

April 27, 2024
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The Self- Administered Gerocognitive Exam (SAGE) is basically a reliable cognitive screening tool for detecting cognitive impairment in Alzheimer’s disease and dementia based on gold standard clinical and neuropsychological assessment.

It offers promising approach for identifying cognitive changes associated with Alzheimer’s disease at an earlier stage. It was developed by Douglas Scharre and his research team at the Ohio State University (OSU) Wexner Medical Centre.

The Self-Administered Gerocognitive Exam (SAGE) offers the opportunity for patients of Alzheimer’s disease (AD), mild cognitive impairment (MCI) and other forms of dementia in the form of a pen-and-paper test, as well as a same, digital companion version, called the Brain Test.


The significance of SAGE test in early detection of Alzheimer’s disease is linked to its ability to detect subtle cognitive changes that may specify early stages of the disease. Hence, early identification of cognitive impairment helps the healthcare professionals in initiating further diagnostic evaluations, interventions and support services directing towards the patient’s need.

It also aids in participation in clinical trials and research studies aimed at developing innovative treatments and improving outcomes for individuals with Alzheimer’s disease.


The SAGE test consists of various components that evaluate different aspects of cognitive function of the brain. The SAGE test measures:

  • Orientation (month, date, and year)
  • Language (verbal fluency and picture naming)
  • Reasoning and simple math skills
  • Visuospatial orientation
  • Executive function
  • Memory

SAGE measures cognitive function in the fields of orientation (date, 4 points), language (picture naming, 2 points and verbal fluency, 2 points), memory (2 points), executive function (modified Trails B, 2 points and problem-solving task, 2 points), calculations (2 points), abstraction (2 points), and visuospatial abilities (copying 3-dimentional constructions, 2 points and clock draw, 2 points) in a 4-page, 22-point test that is self-administered.(1)

There is a maximum score of 22 on the SAGE test. However, it is suggested by the researches to add one point to the score when the participant is over the age of 80, and another point if the participant has fewer than 12 years of education.


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  • Scores of 17 to 22 are within the normal range.
  • Scores of 15 to 16 indicate likely mild cognitive impairment.
  • Scores of 14 and below indicate a more serious cognitive problem.(2)

SAGE is best utilized in clinical setting where its results are evaluated on the basis of individual’s health history and baseline talents. However, it should be kept in mind that SAGE is not diagnostic of any specific condition although it can help the health care provider to decide if further evaluation is needed and provide a baseline score to compare with future scores(1).

Even if this test is taken at home it is strongly recommended that it should be given to individual’s primary physician for review.


There are some specific limitations linked to the SAGE test itself including the assessments of memory abilities in self-administered instruments are challenging. Certain factors such as age and educational level may also affect the test scores.

For-example individuals with low vision are unable to fully complete the test, a sixth-grade reading proficiency is required, and as no explanations of the test questions are allowed, some individuals may misinterpretate a question they would normally get correct.(3)


It is concluded that SAGE test exhibit significant advancement in the early detection and progression of Alzheimer’s disease and its management accordingly. It is therefore positioned as a valuable tool in the fight against Alzheimer’s due to its comprehensive cognitive assessment, accessibility and contribution to research.

By utilizing the cognitive screening tools like SAGE, healthcare professionals can improve outcomes and enhance patient’s care and ultimately proceed towards a future with better treatment strategies for Alzheimer’s disease.


  • Scharre DW, Chang SI, Nagaraja HN, Vrettos NE, Bornstein RA. Digitally translated Self-Administered Gerocognitive Examination (eSAGE): relationship with its validated paper version, neuropsychological evaluations, and clinical assessments. Alzheimer’s research & therapy. 2017;9(1):44.
  • Scharre DW, Chang SI, Murden RA, Lamb J, Beversdorf DQ, Kataki M, et al. Self-administered Gerocognitive Examination (SAGE): a brief cognitive assessment Instrument for mild cognitive impairment (MCI) and early dementia. Alzheimer disease and associated disorders. 2010;24(1):64-71.
  • Scharre DW, Chang SI, Nagaraja HN, Wheeler NC, Kataki M. Self-Administered Gerocognitive Examination: longitudinal cohort testing for the early detection of dementia conversion. Alzheimer’s research & therapy. 2021;13(1):192.

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Dr. Nadir Omara

Dr. Nadir Omara is a Sudanese/British citizen with over 16 years’ experience as a Consultant Psychiatrist in the UK Qatar, UAE and Sudan.

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