All about the SAGE test and dementia red flags

This article has been medically reviewed by Dr. Martin Duggan in 2021.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Identifying early signs of dementia can be tricky, and many people above the age of 65 have difficulty making it to the doctor. So, to help bridge the gap, there’s a simple at-home test that can assess whether you or a loved one may require further testing for dementia symptoms. It’s called the SAGE test and it can help identify the presence of dementia. Once the test has been taken, a primary care doctor can review the results and decide if further testing is necessary. Let’s look into the details of the SAGE test and other dementia red flags to keep in mind.

About the SAGE test

What is the SAGE test?

The SAGE test stands for the Self-Administered Gerocognitive Exam. As the name suggests, this test can be taken by a person at home. No special tools or grade books are needed. The goal of the test is to help your primary doctor assess your brain health and flag any cognitive problems or memory impairment. It’s often used to identify early signs of dementia, especially in older adults who might be at risk. 

Is the SAGE test only used for dementia?

The SAGE test is designed to recognize early symptoms of Alzheimer’s or other forms of dementia. Specifically, it’s looking for signs of mild cognitive impairment (MCI), which often precedes dementia disorders. 

However, it’s important to note that this test doesn’t necessarily mean the individual has dementia, nor is the test meant to be interpreted by anyone other than a physician. Additionally, the test is meant to be part of a larger evaluation for dementia. It is important to remember that the SAGE test doesn’t diagnose any specific condition. It is mostly meant to be used as a tool to help primary doctors decide who may require additional testing for dementia.

When should I take the SAGE test?

If you’re worried that you or a loved one is showing signs of dementia, the SAGE test, along with a trip to the doctor, are good first steps. While some memory loss is normal with aging, it can also be a symptom of a larger health problem. According to Ohio State University, some early signs you should watch out for include:

• Forgetting appointments or recently learned information
• Trouble finding words or losing train of thought
• Forgetting the day of the week
• Misplacing items
• Getting lost in a familiar place
• Changes in personality or mood
• Becoming impulsive or showing poor judgment

If you’ve noticed any of these signs, the SAGE test is a must. It may reveal an underlying cognitive disorder, or some other health issues that need to be addressed.

Why would anyone want an early dementia diagnosis?

Finding out you or your loved one have dementia can be scary. However, an early diagnosis can be extremely beneficial. Some forms of dementia are more treatable if diagnosed early and symptoms can be reduced or minimized.

Even with Alzheimer’s disease, having an early diagnosis can help manage symptoms and facilitate planning for the future. Equally important, some medications, when administered early on, can improve cognitive function and also improve the ability to perform activities of daily living. Moreover, you can better prepare for dementia’s progression as treatments are often more effective at this stage. You can also work with your doctor to create a personalized care plan. 

What are the benefits of taking the SAGE test?

The SAGE test can be an excellent tool for assessing cognitive health. Taking this test can help in a variety of ways, including:

• Getting an early diagnosis. This test was designed to help primary care doctors get a head start on dementia and related disorders. As mentioned above, early management is better management when it comes to dementia. 
• Start taking action. People, especially seniors, resist seeing a doctor. However, the SAGE test can be done at home as a first step. It’s inexpensive and can be taken within minutes.
• Get peace of mind. If you’re concerned you or a loved one has cognitive impairment, the SAGE test can put your doubts to rest or move you into action. 

However, specialists in the field are clear: this test is NOT a substitute for seeing the doctor. It was designed to be used as one of many available tools to help assess for the presence of symptoms concerning for dementia. With that said, the test can facilitate an early diagnosis. As we’ve discussed above, getting that early diagnosis can improve the quality of life for seniors with dementia.

Taking the SAGE test

How do I take the SAGE test?

The SAGE test is easy to take and you don’t need anything fancy. You must first download the official SAGE test, print it, and have a pen handy to answer the questions. There are currently four versions of the test available – only take one; they’re interchangeable. 

The instructions for the test are straightforward. Simply answer the questions without the help of others and don’t look at a clock or calendar. There’s no time limit, but it typically takes about 10-15 minutes. That’s it! 

Can I take the SAGE test online?

An online version of the SAGE test, called BrainTest, is also available. If you prefer, you can take the BrainTest instead. Either way, the results of the test will give accurate results.

Is the online SAGE test accurate?

It’s important to note that the SAGE test was made by Dr. Scharre at Ohio State University. You should take the official SAGE test on their site or the online BrainTest version. Other “Alzheimer’s tests” online may not be accurate indicators of brain health. In fact, researchers have rated 75% of online dementia tests as poor or very poor. For the best assessment, take the official tests on the Ohio State University site. 

Is it available in languages other than English?

Fortunately, the SAGE test is available in several languages. You can download it from the official site in English (US), English (NZ), Spanish, Italian, Dutch, Croatian, French, or German. Just choose from the options when you go to download the test.

What sort of questions will be on the SAGE test?

The SAGE test uses basic questions to get a sense of cognitive health. For example, you may find questions on the following core themes:

• Orientation in time (knowing the day of the week, etc.)
• Simple math
• Short-term memory
• Naming objects/animals
• Identifying similarities 
• Basic problem-solving
• Drawing a 3-D object
• The trail-making test
• The clock drawing test

Of course, telling someone exactly what is in the test and therefore allowing them to prepare answers ahead of time defeats the purpose of the test! Suffice it to say, there are questions that dementia patients may get wrong in characteristic ways that an adult without dementia would be unlikely to miss. 

Understanding SAGE test results

How does SAGE test scoring work?

After you’ve completed the SAGE test, you should schedule an appointment with your doctor to talk about the results. They will score your test and take any relevant actions. 

If your score raises concern for dementia, the doctor may order follow-up tests, such as an MRI or CT scan. If the score was normal, it might be kept on file to compare with future tests. 

Why can’t I make a home diagnosis?

The SAGE test doesn’t diagnose one condition and there may be multiple correct answers. There’s no answer sheet for this test. Only a doctor can know for sure what the results mean and determine next steps. 

With that said, an adult can look over the exam at home and be able to tell if the test taker struggled to answer or performed the tasks well. But it’s your doctor’s responsibility to properly score the SAGE test. 

How accurate is the SAGE test?

While no test is perfect, SAGE is quite accurate in indicating whether someone has dementia. Studies show that the test results in 95% accuracy – which is higher than many in-person dementia tests. It’s an important first step in determining whether you or a loved one may be at risk for dementia disorders.

Conclusion

Early detection of dementia and other conditions related to cognitive impairment is essential. The SAGE test is an excellent way to get the conversation started with your doctor and look into any underlying causes of dementia symptoms. 

If you’re interested in getting more resources about dementia, go to MyCaringPlan. Here you’ll find guides to dementia care to give you the bigger picture on senior health and caregiving. 

Sources:

1. SAGE: A Test to Detect Signs of Alzheimer’s and Dementia, Wexner Medical Center, wexnermedical.osu.edu
2. Scharre DW, Chang SI, Murden RA, et al. Self-administered Gerocognitive Examination (SAGE): a brief cognitive assessment Instrument for mild cognitive impairment (MCI) and early dementia. Alzheimer Dis Assoc Disord. 2010;24(1):64-71. doi:10.1097/WAD.0b013e3181b03277
3. Birks JS, Harvey RJ. Donepezil for dementia due to Alzheimer’s disease. Cochrane Database Syst Rev. 2018;6(6):CD001190. Published 2018 Jun 18. doi:10.1002/14651858.CD001190.pub3