Abstract
BackgroundSignificant cognitive changes as individuals’ age are not being identified in a timely manner, delaying diagnosis and treatments. Use of brief, multi-domain, self-administered, objective cognitive assessment tools may remove some barriers in assessing and identifying cognitive changes. We compared longitudinal Self-Administered Gerocognitive Examination (SAGE) test scores to non-self-administered Mini-Mental State Examination (MMSE) scores in 5 different diagnostic subgroups.MethodsA cohort study evaluating annual rates of change was performed on 665 consecutive patients from Ohio State University Memory Disorders Clinic. Patients with at least two visits 6 months apart evaluated with SAGE and MMSE and classified according to standard clinical criteria as subjective cognitive decline (SCD), mild cognitive impairment (MCI), or Alzheimer’s disease (AD) dementia were included. The pattern of change in SAGE scores was compared to MMSE. One way and repeated measures ANOVA and linear regression models were used.ResultsFour hundred twenty-four individuals (40 SCD, 94 MCI non-converters to dementia, 70 MCI converters to dementia (49 to AD dementia and 21 to non-AD dementia), 220 AD dementia) met inclusion criteria. SAGE and MMSE scores declined respectively at annual rates of 1.91 points/year (p < 0.0001) and 1.68 points/year (p < 0.0001) for MCI converters to AD dementia, and 1.82 points/year (p < 0.0001) and 2.38 points/year (p < 0.0001) for AD dementia subjects. SAGE and MMSE scores remained stable for SCD and MCI non-converters. Statistically significant decline from baseline scores in SAGE occurred at least 6 months earlier than MMSE for MCI converters to AD dementia (14.4 vs. 20.4 months), MCI converters to non-AD dementia (14.4 vs. 32.9 months), and AD dementia individuals (8.3 vs. 14.4 months).ConclusionsSAGE detects MCI conversion to dementia at least 6 months sooner than MMSE. Being self-administered, SAGE also addresses a critical need of removing some barriers in performing cognitive assessments. Limitations of our single-site cohort study include potential referral and sampling biases. Repetitively administering SAGE and identifying stability or decline may provide clinicians with an objective cognitive biomarker impacting evaluation and management choices.
Highlights
Significant cognitive changes as individuals’ age are not being identified in a timely manner, delaying diagnosis and treatments
We describe the annual rate of change of Self-Administered Gerocognitive Examination (SAGE) and Mini-Mental State Examination (MMSE) in different cognitive subgroups (subjective cognitive decline (SCD), mild cognitive impairment (MCI), dementia converters of all types, and Alzheimer’s disease (AD) dementia)
This study suggests that providers using SAGE instead of the MMSE can expect to identify cognitive changes sooner and be able to achieve that using a self-administered test that utilizes less provider and staff time, does not require any training to administer the test, and can be given outside heavily utilized exam rooms to prevent clinic workflow disruption
Summary
Significant cognitive changes as individuals’ age are not being identified in a timely manner, delaying diagnosis and treatments. Patients present to physicians an average of two to four years after definite cognitive symptoms begin. Two-thirds of patients have cognitive scores in dementia ranges when first assessed [5,6,7,8], suggesting that less severe cognitive symptoms may have been occurring for years. It is critical for providers to more recognize symptoms of brain dysfunction at the mild cognitive impairment (MCI) or early dementia stage [9,10,11]. A randomeffects meta-analysis including studies from community-based settings demonstrated that the cumulative incidence for the development of dementia in individuals with MCI and those described as cognitively impaired without dementia, older than age 65, and followed for 2 years was 14.9% [17]
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