A memory test like the SAGE exam can help show whether your forgetfulness is normal, age-related memory loss or a sign of something more serious.(Photo by Deborah Cardena on Unsplash)
Does this describe you?
You're older now, and your memory seems to be slipping. You hope it's nothing serious, but it nags at you. Could it be . . . Alzheimer's?
Or perhaps this describes you.
Your aging parent doesn't seem as sharp these days. He forgets things, loses stuff, overdraws his checking account. "I'm just getting old," he says. But based on what you're seeing, it feels like something more than that.
Either way, wondering and worrying isn't the answer.
Not when you can find out, using a short, simple memory test that can be found online, downloaded for free and taken in the comfort of your own home.
It's called the Self-Administered Gerocognitive Exam, or the SAGE test for short. It's been downloaded nearly 1.7 million times, and it's remarkably accurate at helping detect when there's a serious memory problem — and just as importantly, when there isn't.
Most people who take the SAGE exam score cognitively normal for their age, and that can be a big relief.
"Maybe one of the greatest services it provides is to relieve the 'worried well,'" says Dr. Douglas Scharre, an Ohio State University neurologist who helped create the SAGE test.
But if there is a genuine problem with memory or other thinking skills, the SAGE test can signal that, giving doctors an opportunity to identify what's going wrong and address it early on, when treatments have the best chance of helping you.
That's a better option than ignoring the problem, which people often do. Statistics show that even after families first notice a memory problem, they often wait several years before seeking medical help.
Dr. Douglas Scharre
Scharre, director of cognitive neurology at the OSU Wexner Medical Center, says the SAGE test was designed to help prevent that from happening. It gives families a quick, easy way to pinpoint whether there might be a problem as soon as they start noticing worrisome signs.
"You can download the test and do it right now, at home, or the son or daughter or spouse can get the test off the web and give it to the person," he says.
"Then you're catching the symptoms at year one, instead of what usually happens, which is (the family) notices problems and it's not until three or four years later until they get to a primary doctor for the first time. The consequences are horrible, and the brain has been ravaged. Right now, the medications work better the earlier you give them. As with anything, the earlier you identify it, the better."
If you're wondering whether it's time for you or a loved one to take a home memory test like the SAGE exam, here's what you need to know.
Who should get memory screening?
Some health experts say everyone over the age 65 should get a memory screen every year as a precaution, just like getting your blood pressure or cholesterol level checked regularly. But there's no consensus on that, and Scharre sees both sides of the question.
"The trouble with screening of the general population is that you could have people with no issues being told they have cognitive issues, which may create more cost if you do more testing," he says. "On the other hand, it will pick up people who should be tested."
Where a test like SAGE can be most beneficial, he says, is in cases where families are seeing some cause for concern, and a test that's free and convenient to take can quickly indicate if what's occurring is normal, age-related memory loss or something more serious.
"Right now, the low-hanging fruit is all the people who delay and don't get tested," Scharre says. "Instead of general population screening, it's more valuable to do what we call case-finding. It's someone who has some issue, some complaint that memory isn't as sharp as you used to be, these tests like SAGE are fabulous at case-finding."
But if the problem is something other than normal aging, wouldn't the family doctor detect that during an annual physical?
Ideally, yes. But in actuality, they often don't. Studies shown more than 40 percent of cases of cognitive impairment or early-stage dementia are not diagnosed by a primary care physician. There are many possible reasons for that.
For one thing, people with cognitive impairment can become quite good at hiding their memory problems. Or their memory loss may be serious enough that they don't remember to mention it when their doctor asks them if they're having any problems.
Family doctors don't necessarily have the training or tools to detect mild dementia during a routine check-up, and the limited amount of time they have to spend with each patient may not permit them to thoroughly assess for all of the health problems that older adults are at risk for.
A test like SAGE can help fill the gap, calling attention to a problem your doctor might miss.
There are a lot of free memory tests available online. What makes the SAGE test the right one to consider?
Free home memory tests are a booming industry, but many of the tests offered online have no scientific basis and some are outright scams, preying on people worried about memory loss.
The SAGE test has been validated by scientific research, and the study results are available on the website for you to review. You should look for that kind of scientific backing for any test you consider.
While SAGE is the best known and widely recommended, there are other valid tests available. You can learn more about them by reading this article on the website BeBrainFit.
Where do I get the SAGE test and how do I take it?
The test can be downloaded from the site of the Wexner Medical Center, where it was developed. You can find it here: sagetest.osu.edu
Here are examples of questions you'll see on the SAGE memory test.
The test is available in a variety of languages, and for each language, there are four different version of the test. It doesn't matter which version you choose. All of them are designed to test the same things.
The test is not timed. The site says the average person takes 10 to 15 minutes to complete it, but you can take as much time as you need. The test isn't designed to be super easy so don't get frustrated if some of the questions feel too challenging. Just do the best you can.
The simple rules for taking the test include:
OK, I'm done with the test. How do I get the results?
After you complete the test, you should take it to your doctor, and have your doctor score it. Scharre says that's the best way to make sure the test is scored accurately, and that you walk away with the proper understanding of what your score means.
People are sometimes disappointed they can't score the test on their own, and get the result right away. Actually, it's not that you can't score yourself, it's just not advisable to.
The SAGE website has instructions that show doctors how to score the exam, and anyone can follow those steps. But if you use that information to score yourself, the risk is that you'll score it inaccurately or misinterpret the results.
"The instruction are there to grade it, but you may be grading it incorrectly if your mind isn't working so well," Scharre says. "We don't mind if you score it, but it's best to take it to a doctor so they can put it in the context of your medical history."
What is the scoring system for the SAGE exam, and what will the results show me?
The SAGE test isn't just a memory test. It's designed to assess six cognitive domains. In addition to memory, those domains are: orientation, language, reasoning/computation, visuospatial and executive function.
Each domain is scored from 0 to 4 points, except for memory, which is scored from 0 to 2. The test also includes a few questions about your medical and family history and any cognitive problems you may be having. These questions aren't scored, but can help a doctor understand possible reasons for any cognitive deficit the test may detect.
The maximum score on the SAGE exam is 22 points, and a score between 17 and 22 suggests you are cognitively normal. A score of 15 or 16 points to the possibility of minor memory impairment. A score of 14 or below indicates there may be a more serious memory problem.
OK, but what if I score below 17? Does that mean I have dementia?
No, you shouldn't jump to that conclusion. It's an indicator that there might be a problem, and your doctor can recommend further evaluation. Many of the potential causes of cognitive loss are treatable, and may include such conditions as: depression, a sleep disorder, a vitamin deficiency or a thyroid problem.
You can be assessed for possible causes like these, so they can be identified, or at least ruled out. Should additional testing show some degree of cognitive impairment not explained by causes like this, you're still better off having identified it now, so your doctor can discuss other treatment options with you, including lifestyle changes that can potentially help slow cognitive loss, or perhaps participation in a clinical trial if you're eligible.
So if I score 17 or higher, does that mean I've got nothing to worry about?
Your doctor will discuss that with you, but generally, yes, it's good news, and you can breathe a sigh of relief. Plus, you now have a baseline score that identifies what cognitively normal is for you. So now, you can continue to take the test once a year, and if your mind begins to slip at any point, that can be detected and addressed right away.
But don't become complacent about brain health. The greatest risk for dementia is aging. Be glad your mind is cognitively normal now, but take steps to keep it that way. Eat a healthy diet, keep your blood pressure under control, and guard against such common threats to cognition as sleep apnea or hearing loss.
"Two things I stress are physical activity and social activity," Scharre adds. "They involve so many areas of the brain. You brain is working heavily with any type of exercise program, and it affects such a large part of the brain. Socialization also is a heavy brain activity. All sorts of (regions of) the brain are being used for socialization."
Tony Dearing may be reached at email@example.com. Follow him on Twitter @TonyDearing. Find NJ.com on Facebook.
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