The burden of dementia on the U.S. healthcare system is projected to grow as the population ages. Current research predicts that the lifetime risk of developing dementia is 42% among Americans over the age of 55, placing estimates at over one million new cases per year by 2060 (Fang et al., 2025).
To prepare for the rise of cognitive decline among older patients, healthcare providers are turning to scientifically validated cognitive screening tools, like the Self-Administered Gerocognitive Exam (SAGE). Developed by researchers at the Ohio State University Wexner Medical Center (Scharre et al., 2010), the SAGE test is a tool that can be used to facilitate the detection of signs of mild cognitive impairment (MCI), including those associated with Alzheimer's disease and other forms of dementia.
The SAGE test for dementia is also freely and publicly available for self-administration, allowing patients to test themselves before getting the results interpreted by a physician.
It is well recognized that MCI can progress to Alzheimer's disease (Gauthier et al., 2006), making early detection of symptoms crucial. For providers looking to leverage the SAGE for early diagnosis, one question needs to be answered: does the test have the accuracy needed to detect the earliest signs of cognitive impairment?
With so many cognitive tools available, it can be difficult for primary care practitioners to know all of their options in detail. In this article, we break down exactly what the SAGE test for dementia is, how it works, and what research says about its overall effectiveness when compared to other cognitive testing solutions.
What Is the Self-Administered Gerocognitive Exam (SAGE) for Dementia Screening?
The SAGE is a cognitive screener originally developed by Dr. Douglas Scharre and his team (Scharre et al. 2010). This self-administered examination evaluates various cognitive domains through a 12-question test, taking around 10 to 15 minutes to complete. The test is freely available online and can be completed independently by patients to help identify signs of cognitive impairment.
The SAGE test’s self-administration feature allows busy clinicians to hand the testing process over to their patients and potentially prompt earlier detection compared to in-clinic testing, as patients don’t have to wait to get tested. In short, the SAGE test may appeal to patients because:
- It offers the convenience of testing on their own time and from the privacy of their home.
- It’s freely available and widely accessible online.
- It’s scientifically validated to support the detection of cognitive impairment.
Although these benefits may be appealing to patients and clinicians, the SAGE test still has its limitations.
How Does the SAGE Work?
As mentioned above, the SAGE test is self-administered, giving providers time back in their schedule for interpreting test results and conducting critical follow-up testing. While the SAGE can be used as an effective assessment tool for detecting cognitive impairment, it may not be the most optimal tool available, or even the most efficient. Here’s what you need to know about the SAGE before implementing it into your practice.
What does the SAGE evaluate?
The SAGE test evaluates the following areas of cognition:
- Language
- Reasoning/computation
- Visuospatial
- Executive
- Memory
- Orientation
How is the SAGE administered and interpreted?
The SAGE is administered and interpreted in the following stages:
- A clinician may recommend that their patient take the SAGE to evaluate their cognitive abilities or establish a baseline.
- On their own time, the patient can download the SAGE test online.
- The test must be printed out and completed on a piece of paper.
- The patient follows the instructions on the form without the assistance of others, answering questions to the best of their ability.
- There is no time limit for the SAGE, though most patients complete the form within 10 to 15 minutes.
- Once the form is complete, the patient can book an appointment with their care provider for results to be interpreted.
- The clinician interprets the results. Depending on the patient’s overall score, they will determine whether the patient is in need of further evaluation or if the results suggest normal cognitive function.
The SAGE also has four different variations to limit any potential test-retest effects (Kessels et al., 2025) and to collect longitudinal data.
How to Score the SAGE Test
When scoring the SAGE test, there are three possible categories for patients’ scores to fall into:
- 17 to 22: Likely to have normal cognitive function
- 15 or 16: Likely to have mild memory or thinking impairment
- 14 and below: Likely to have a more severe memory or thinking condition
For patients who score a 16 or below, further evaluation by a physician is recommended.
The Strengths and Limitations of the SAGE
When considering the SAGE test for dementia, it’s important to have a clear understanding of its features, limitations, and appropriate uses. This is especially true if a physician is comparing the SAGE to other cognitive testing tools.
The SAGE’s Strengths
- Privacy and accessibility: Patients can self-administer the SAGE test at any time— whenever and wherever they feel most comfortable. Combined with its free, online availability, the SAGE has few barriers to access.
- Scientifically validated: The SAGE has demonstrated high sensitivity when differentiating between healthy individuals and those with MCI (Scharre et al., 2010; Kessels et al., 2025). Research also suggests it can predict the progression of mild cognitive impairment to dementia at least six months earlier than the MMSE (Scharre et al. 2021).
- Language availability: Language differences can hinder results for any cognitive test. The SAGE has been translated into nine different languages, making it accessible to more people.
The SAGE’s Limitations
- In-person clinic appointments are still required: Even though the SAGE allows patients to take the test from anywhere, they will need to book an appointment for result interpretation, follow-up, and potential treatment planning.
- Not a diagnostic tool: Without detailed information on cognition and other diagnostic criteria, the SAGE can’t be used as a standalone tool to diagnose conditions like dementia. This means further neuropsychological testing will always be required before arriving at an official diagnosis.
- Limited specificity: While the SAGE can be an excellent initial screening tool, it lacks the specificity needed to assist with diagnosis. It may flag potential cognitive issues, but with a high false positive rate, patients with low SAGE scores may not have genuine impairment. This makes follow-up testing necessary to confidently identify signs of MCI.
The SAGE can be a critical resource for initial dementia screening. Its self-administration and its wide range of language options make it easily accessible to a wide range of patients. The test's limitations, however, mean that it should always be followed up with additional cognitive testing. Digital cognitive screeners like Creyos are a great addition to the SAGE, giving providers further insights to make more informed diagnostic decisions.
How the SAGE Test Compares to Other Cognitive Assessment Tools
The SAGE is not the only screening tool available to clinicians. When deciding which screening tools to use, it’s important to consider what screeners are actually assessing and how accurate and detailed they are.
Let's take a closer look at how the SAGE test compares to other cognitive tests for dementia.
Mini-Mental State Examination (MMSE)
Available in a wide variety of languages and only taking 5 to 10 minutes to complete, the MMSE is one of the most popular screening tools worldwide (Gallegos et al., 2022).
The MMSE lacks the self-administration feature of the SAGE test, requiring a healthcare provider to administer this pen-and-paper test. In a study directly comparing the SAGE and MMSE, research suggests the SAGE test is more sensitive to detecting early signs of dementia (Scharre et al. 2021).
Montreal Cognitive Assessment (MoCA)
The MoCA test is another common cognitive screener. It has widespread availability for many different patient groups, including in-person or online, with adapted versions available for individuals with hearing or visual impairment.
Unlike the MoCA, the SAGE test is self-administered and takes less time. The MoCA does require a fee for licensing and training; however, the SAGE is completely free to use.
Saint Louis University Mental Status Exam (SLUMS)
The SLUMS test is a cognitive screener for elderly patients aged 60 and above. It tests a similar range of cognitive areas to the SAGE, though it does so through different items. The SLUMS test also includes domains like extrapolation and abstraction.
While the SAGE can be administered to patients of most age groups, the SLUMS has no self-administration capabilities and is strictly designed to approximate global cognitive functioning among older adults aged 60 and up (Noyes et al., 2023), making its usability more limited.
Comparing Creyos and the SAGE
The SAGE test can be used as a general screening tool for cognitive impairment that grants patients the flexibility to self-administer the test at their own convenience. However, physicians and patients should recognize that it can't be used as a standalone diagnostic tool, and that simple pen-and-paper screeners have inherent limitations.
Traditionally, even after obtaining the SAGE results, patients who display signs of cognitive impairment could require an hours-long neuropsychological examination before an official diagnosis can be reached. Neuropsychological testing can take months to schedule, during which a patient's condition may further deteriorate.
There is an alternative solution that addresses the limitations of both simple screeners and neuropsychological testing: digitized cognitive testing. Creyos cognitive assessments can function as a form of preventive care, able to detect early signs of cognitive decline, even before significant structural brain changes occur. (Thienel et al. 2023).
Is the SAGE Test Enough for Modern Cognitive Care?
The SAGE test for dementia offers a practical, scientifically validated, and patient-friendly experience for early cognitive screening, particularly in primary care settings. Its self-administration format makes it accessible and convenient, but it falls short in diagnostic capability and its need for in-person results interpretation.
While the SAGE may work well as a preliminary cognitive screener, it can still require follow-up neuropsychological assessment and other steps before a diagnosis can be made. In contrast, digital cognitive tests like Creyos provide a more comprehensive and targeted approach, combining screening, neuropsychological testing, and other criteria to empower physicians to detect cognitive decline earlier and intervene faster, all while enhancing the accessibility of patient experiences through convenient, remote healthcare.
The Creyos Dementia Screener, Assessment, and Care Plan
Creyos has a variety of cognitive solutions and condition-focused protocols that are more flexible than the SAGE test, with easy-to-interpret reports available to physicians immediately. Physicians can more confidently make a diagnosis and determine next steps with help from the Creyos dementia screen and care plan, expediting treatment before their patients' conditions further deteriorate.
The Screener
This brief, self-administered cognitive screening instrument contains two digital cognitive tasks that take only three minutes to complete. It uses machine learning-based algorithms to detect subtle signs of cognitive impairment, flagging individuals who may require further testing based on their performance.
The Assessment
Creyos has a 20-minute computerized assessment that provides detailed insight into a patient's cognition. This scientifically validated six-task protocol generates an easy-to-interpret report based on DSM-5 criteria for mild and major neurocognitive disorders. The report is comparable to the data gathered via neuropsychological exam, though much faster and available from anywhere, without the need for referrals and months-long appointment wait times.
The Care Plan
Looking beyond diagnosis, the Creyos platform also comes with a cognitive care planning tool. The care plan is based on guidelines by the Alzheimer's Association, and lets providers easily build personalized care plans for their patients.
When to Use Creyos
Compared to traditional cognitive tests like the SAGE, the digitized cognitive testing at Creyos provides healthcare professionals with more detailed insight into a patient's cognition while giving them the convenience of being tested wherever they’re most comfortable.
Additional benefits include:
- Both objective results from cognitive assessments and subjective measures from questionnaires for a comprehensive insight into critical diagnostic criteria for dementia.
- Tests that are non-memorizable and ideal for retesting, while also providing an accessible user experience for both patients and clinicians.
- Electronic medical record (EMR) integrations, instant results, and easy-to-interpret reports.
Get Started With Creyos Cognitive Assessments Today
Support better patient outcomes and learn how you can bring the Creyos dementia screener, assessment, and care plan into your workflows, whether to patients' homes or to your clinic. Speak to our product and reimbursement experts today for more details.
Written by Lawrence Stewen
Lawrence Stewen is an SEO copywriter and content marketer based in Vancouver, Canada. Transforming complex, technical concepts into copy that’s simply human is what he does best. In his free time, you can find him hiking, reading at a local café, or working on his many creative writing projects.
Reviewed by Sydni Paleczny, Staff Scientist
Sydni earned her MSc in Neurosciences at Western University under Dr. Adrian Owen. Her research explores neuropsychological outcomes after cardiac surgery, with interests in cognitive neuroscience, critical care, and brain health. At Creyos, she supports scientific validity, health technology, and ongoing research.