Electronic self-administered gerocognitive examination (ESAGE)

Abstract

Use of sensitive and easily administered cognitive screening instruments is essential in overcoming the many obstacles encountered by physicians for early identification of cognitive disorders. Self-Administered Gerocognitive Examination (SAGE) is a valid, reliable, cognitive assessment tool used to identify individuals with MCI or early dementia (Scharre et al. Alzheimer Dis Assoc Disord 2010;24:64-71). SAGE's self-administered feature, internal consistency, balanced assessment, and four equivalent interchangeable forms is practically given in any setting (Scharre et al. J Neuropsychiatry Clin Neurosci 2014;26:369-375). SAGE, used worldwide, had over one million downloads (sagetest.osu.edu) the first 6 months of 2014 alone. Currently, SAGE is only available in paper format (max score=22). As more individuals use online resources, having validated online cognitive screening tests that are equivalent to the same test in paper format, may be very helpful for individuals and physicians to identify or follow cognitive impairment and allow timely interventions. We are studying the validity of an electronic version of SAGE (eSAGE) made for tablet use and comparing it to the paper form. Subjects, age over 49 were recruited from a variety of community settings. After paper SAGE screening, subjects were randomly selected to participate in a clinical evaluation consisting of a history, neurological examination, functional assessment, and neuropsychological batteries. Paper SAGE and eSAGE were administered using a cross-over design. 264 participants completed paper SAGE screening. 20 subjects so far (study ongoing) have completed the clinical evaluation with one excluded (left before testing completed). The remaining subjects were mean age 71.2±10.5 years, mean education 15.3±2.9 years, 84% female, 21% non-white, mean MMSE score 28.1±1.6, mean MOCA score 23.0±3.2, mean paper SAGE score 17.8 ± 2.6, and mean eSAGE score 16.8 ± 3.3. The median difference between paper SAGE and eSAGE score was 0 with the mean difference being 1± 2.6. There was no significant difference between paper SAGE and eSAGE using paired t-test (p=0.11). SAGE can be used in paper or electronic format without statistical difference. This study will continue to recruit 72 subjects for clinical evaluations to determine eSAGE validity as an online screening tool compared to standard neuropsychological evaluations.