Worldwide, more than 55 million people are living with Alzheimer’s and other forms of dementia. This number is expected to increase to 78 millions by 2030 and 139,000,000 by 2050. These individuals are not being diagnosed by enough neurologists, psychiatrists and geriatricians as well as neuropsychologists and other specialists. Primary care providers must take the initiative.
This may seem like a simple and obvious solution. However, primary care providers I know remind me that they don’t have the time or the resources to perform complex cognitive tests. They can’t even do a simple test such as the MiniCog (a clock drawing and three words to recall) because it is too complicated. How are we going to identify the growing number of people with Alzheimer’s disease and other dementias over the next few decades.
Memory loss can be detected by a self-administered test
A cognitive test was developed by clinicians from The Ohio State University Wexner Medical Center to screen for memory impairment. Individuals can administer the test themselves. The self-administered cognitive tests can be a solution to the time-constrained primary care provider. The test can be taken at home by the individual and the results sent to the office. These results can be used to determine if additional treatment or referral to a specialist are necessary.
The authors did a retrospective chart overview of 655 patients seen at their memory disorders clinic. They also followed up for as long as 8.8 years. The SAGE test was compared to the MMSE.
They divided their clinic population into four categories based on follow-up and initial clinic visits. Let me first explain the terms.
- Dementia occurs when cognitive impairment causes impaired function.
- Mild cognitive impairment is when there are cognitive impairments but normal function.
- Subjective Cognitive Decline Individuals are concerned about their thinking, memory, and cognition. However, both cognitions and functions are normal.
They compared the four groups to individuals.
- Alzheimer’s disease dementia
- MCI who has been diagnosed with Alzheimer’s disease dementia
- MCI who has converted to another type dementia
- subjective cognitive decline.
The SAGE test and MMSE showed a surprising high correlation in their ability to predict the performance of each group over time. They also found that the SAGE test could predict if an individual with MCI would become dementia six months sooner than the MMSE.
What are the steps required to make this test a part of your current practice?
Training for primary care providers is required to use the test and interpret the results. It is clear that such training will prove to be valuable. The knowledge gained from the training should allow clinicians to save literally thousands hours and avoid making mistakes.
Another question is what individuals will do if they are asked to take a cognitive test at home for a 10 to 15-minute period and report the results to their doctor. Will they be able to do it? Or will they avoid it or cheat? I suspect that those who are worried will take the test. However, people who follow their doctor’s orders will also take it. While some people may not be able to benefit from the test’s information, many others wouldn’t take the time to do regular pencil-and-paper testing at the clinic or doctor.