Scoring Accuracy of the Self‐Administered Gerocognitive Examination by Primary Care Providers

Abstract

AbstractBackgroundPrimary Care Providers (PCPs) are critical for case finding of Mild Cognitive Impairment to provide management, referrals, and treatments. Conducting cognitive assessments are time consuming and difficult to incorporate into time‐limited visits. The Self‐Administered Gerocognitive Examination (SAGE) is a reliable and valid, pen and paper, cognitive assessment tool easily incorporated into a PCP visit without time required for staff to administer. Accurate scoring by PCP or staff is critical to interpreting the degree of impairments and any changes over time.MethodsPatients over 64 years‐old without a diagnosed cognitive disorder, presented for a non‐acute care visit with their PCP and were given a SAGE test during their appointment. The SAGE was administered as part of the provider’s standardized method for screening for cognitive impairment. Detailed scoring instructions were provided to the PCP office before subject enrollment. Differences in SAGE scoring between the PCP office and the Ohio State University Memory Disorders Research Center (MDRC) were evaluated. Paired t test and 95% confidence interval were used to compare the mean SAGE scores.ResultsOf the 110 potential recruits, 93 SAGE tests were graded by the PCP office and by MDRC. Scoring discrepancies, the MDRC scored SAGE minus PCP office scored SAGE, ranged from ‐7 points to +3 points with a total of 80% of the SAGE tests resulting in a scoring error by the PCP office; 74% of the total score discrepancies were within ± 2 points. The mean difference was ‐1.49 with a 95% CI (‐1.82, ‐1.17) and p<0.0001 with PCPs scores tending about 1.5 points higher. The largest discrepancies between the scores occurred with the problem‐solving question (40%) and the 3‐D figure question (29%).ConclusionsThe PCP office provided an incorrect score (typically higher) 80% of the time which downplays cognitive deficits. When scoring mistakes are made, accuracy is diminished, impacting the interpretation of the test results and perceived changes over time. PCP offices need to emphasize accurate scoring or consider utilizing the digital format of SAGE, called eSAGE or BrainTest® (available at https://braintest.com). It can send HIPPA compliant automatically scored results to the PCP office.