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Advanced Techniques for Assessing Memory Loss at Home: A Worthwhile Endeavor?

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An Alarming Projection

It is estimated that there are currently over 55 million individuals worldwide living with Alzheimer's disease and other forms of dementia. Shockingly, these numbers are projected to exponentially increase, reaching 78 million by 2030 and a staggering 139 million by 2050. Unfortunately, the medical community is ill-equipped to handle this growing epidemic due to a shortage of specialists like neurologists, psychiatrists, geriatricians, neuropsychologists, and others who are vital in diagnosing cognitive decline and dementia. As a result, primary care providers must rise to the occasion and take on a more significant role in addressing this pressing issue.

The Challenges Faced by Primary Care Providers

Primary care providers, already burdened with a myriad of responsibilities such as managing blood pressure and diabetes, find themselves with limited time to administer comprehensive cognitive tests. Even a relatively simple test like the Mini-Cog, which involves tasks like clock drawing and remembering three words, proves lengthy for these time-constrained professionals. Therefore, we must contemplate how we can effectively diagnose the increasing number of individuals affected by Alzheimer's and other dementias in the coming decades.

A Revolutionary Solution: Self-Administered Cognitive Testing

In response to this pressing need, the division of cognitive neurology at The Ohio State University Wexner Medical Center created a self-administered cognitive test in 2010. This innovative approach allows individuals to screen themselves for memory loss within the comfort and privacy of their own homes. The results obtained from this test, known as the Self-Administered Gerocognitive Examination (SAGE), can then be brought to primary care providers, enabling them to determine if further evaluation or referral to a specialist is necessary.

The Validity of SAGE

Extensive comparisons have been made between SAGE and clinician-administered tests such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), as well as standard neuropsychological testing. These comparisons have consistently shown that SAGE yields comparable results to these established tests. However, the critical question remains unanswered ─ can SAGE accurately predict the development of Alzheimer's disease or other causes of dementia?

Predicting the Future: A Retrospective Analysis

To address this question, researchers conducted a retrospective chart review of 655 individuals who visited the memory disorders clinic at The Ohio State University Wexner Medical Center. These individuals were followed up for a maximum of 8.8 years, during which time their SAGE test results were compared to those obtained from the MMSE.

The study population was divided into four groups based on initial and follow-up clinic visits, each representing a different cognitive state. These groups included individuals with Alzheimer's disease dementia, those with mild cognitive impairment (MCI) who converted to Alzheimer's disease dementia, those with MCI who converted to another type of dementia, and those who experienced subjective cognitive decline.

Promising Results: SAGE as a Predictor

Remarkably, a strong correlation was found between the results of the SAGE test and the MMSE in predicting the cognitive progression of individuals in each group over time. Furthermore, SAGE proved capable of predicting the development of dementia in individuals with MCI six months earlier than the MMSE. These findings highlight the potential of SAGE as a valuable tool for predicting future cognitive decline.

Implementing SAGE: The Road Ahead

Even though SAGE is a self-administered test, its successful implementation still necessitates training for primary care providers, enabling them to understand its proper usage and interpret the test results accurately. Undoubtedly, this training will be a worthwhile investment, potentially saving thousands of clinician hours and preventing missed or incorrect diagnoses.

One concern that arises is how individuals will react when informed of the need to perform a 10-to-15-minute cognitive test at home and bring the results to their doctor's office. Will they willingly comply, or will those who truly require the test avoid taking it or attempt to deceive the results? It is reasonable to assume that individuals who are genuinely concerned about their cognitive health and are accustomed to following their doctor's instructions will willingly participate. While it is possible that some individuals who could benefit from this information may choose not to take the test, it is worth noting that these individuals may also exhibit reluctance towards "traditional" pencil-and-paper testing at a doctor's office or clinic.

A Paradigm Shift in Cognitive Screening

Traditionally, cognitive impairment screening consisted of clinician-administered tests and questionnaires for family members or caregivers. However, the advent of self-administered tests, such as SAGE, provides a crucial third option. The utilization of these self-administered tests will be instrumental in identifying the ever-increasing number of individuals affected by Alzheimer's disease and other causes of dementia in the coming decades.

Curious to Test Yourself?

If you are interested in testing your own cognitive abilities, you can download the SAGE test here. As indicated on the official website, you should bring the answer sheet to your doctor, who will score it and discuss the results with you. Remember, early detection and intervention are key in managing cognitive decline and ensuring the best possible outcome.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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