Test detects signs of dementia 6 months sooner than more commonly used exam

January 07, 2022

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The Self-Administered Gerocognitive Examination identified signs of dementia in patients 6 months earlier than the Mini-Mental State Examination, according to results from a cohort study published in Alzheimer’s Research & Therapy.

Approximately two-thirds of older patients have cognitive scores in dementia ranges when first assessed, which may indicate less severe cognitive symptoms may have been occurring for years, according to the study authors.

Older adult looking confused
Data show the Self-Administered Gerocognitive Examination identified signs of dementia in patients 6 months earlier than the Mini-Mental State Examination.
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“It is critical for providers to more easily recognize symptoms of brain dysfunction at the mild cognitive impairment or early dementia stage,” they wrote.

“Clinical providers wish to provide the best assessments and care to their patients in a timely fashion within their existing time constraints,” Douglas Scharre, MD, director of the division of cognitive neurology at The Ohio State Wexner Medical Center, told Healio. “Administered tests like the [Mini-Mental State Examination (MMSE)] and others are more burdensome in busy clinical settings than the [Self-Administered Gerocognitive Examination (SAGE)] and consequently are less likely to be administered and repeated regularly over time.”

The MMSE was described as the “most commonly used office-based standard cognitive test” in a press release.

Scharre and colleagues conducted a retrospective chart review on 655 consecutive patients who attended a memory disorders clinic. The researchers excluded patients aged younger than 50 years; those with mental retardation, epilepsy, brain tumors, schizophrenia, ADHD and non-Alzheimer’s disease dementia or mixed dementia; and those with baseline MMSE or SAGE scores deemed “not meaningful for a change over time analysis” — leaving 424 patients with available data for the final analysis. This smaller group of patients was classified as either having subjective cognitive decline, mild cognitive impairment or Alzheimer’s disease dementia.

The researchers compared the patients’ SAGE test scores to those from the MMSE, which is administered by health care professionals. The SAGE test gauges the test taker’s orientation, language, calculations, memory, abstraction, executive and constructional abilities. It takes approximately 10 to 15 minutes for patients to complete. The MMSE does not gauge abstractions or executive abilities It takes about 7 to 10 minutes to administer. A lower score on either test indicates increased likelihood of cognitive decline.

The patients were followed for up to 8.8 years, the researchers said.

Scharre and colleagues reported that SAGE and MMSE scores declined at annual rates of 1.91 points annually (P < .0001) and 1.68 points annually (P < .0001) respectively, for patients with mild cognitive decline that converted to Alzheimer’s disease dementia over the course of the study. SAGE and MMSE scores dropped 1.82 points annually (P < .0001) and 2.38 points annually (P < .0001), respectively, for patients who had Alzheimer’s disease dementia. Both test scores remained stable for patients who did not progress to Alzheimer’s disease dementia. Statistically significant declines from baseline scores occurred at least 6 months earlier with SAGE vs. MMSE for patients with mild cognitive decline that converted to Alzheimer’s disease dementia (14.4 points vs. 20.4 points), patients with mild cognitive impairment that did not convert to non-Alzheimer’s disease dementia (14.4 points vs. 32.9 points) and patients with Alzheimer’s disease dementia (8.3 points vs. 14.4 points).

“If the clinical provider who is regularly obtaining SAGE assessments records a two- to three-point drop or more in 12 to 18 months, this represents a significant decline in their patient’s score and is predictive (over 80% specificity) that the individual will eventually develop dementia,” Scharre said. “This provides some time for intervention. Effective screening using a tool like SAGE leads to early identification of mild cognitive impairment, which allows the provider to consider more potential treatment options for the patient and to be able to treat earlier in the disease course, all of which typically provides improved patient outcomes.”

He recommended that primary care physicians administer SAGE when they or a caregiver notice that patients are “declining in their cognitive abilities from their usual baseline skills,” such as forgetting things more frequently, experiencing greater difficulty finding a word, “losing their sense of direction more easily, having more trouble using technology, or not making as wise decisions or judgments as they are accustomed to making.” Scharre also said that SAGE, which is available online or in paper form, should be administered every 6 months to monitor for changes in scores or when cognitive issues arise.

References

Scharre DW, et al. Alzheimer’s Res Therp. 2021;doi:10.1186/s13195-021-00930-4.

Self-administered cognition test predicts early signs of dementia sooner. https://news.osu.edu/self-administered-cognition-test-predicts-early-signs-of-dementia-sooner/. Published Dec. 7, 2021. Accessed Dec. 7, 2021.

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