Digitally translated Self-Administered Gerocognitive Examination (eSAGE): relationship with its validated paper version, neuropsychological evaluations, and clinical assessments

Douglas W Scharre, Shu Ing Chang, Haikady N Nagaraja, Nicole E Vrettos, Robert A Bornstein, Douglas W Scharre, Shu Ing Chang, Haikady N Nagaraja, Nicole E Vrettos, Robert A Bornstein

Abstract

Background: The original paper Self-Administered Gerocognitive Examination (SAGE) is a valid and reliable cognitive assessment tool used to identify individuals with mild cognitive impairment (MCI) or early dementia. We evaluated identical test questions in a digital format (eSAGE) made for tablet use with the goals of calibrating it against SAGE and establishing its association with other neuropsychological tests and clinical assessments of cognitive impairment.

Methods: Subjects aged 50 and over who had taken SAGE were recruited from community and clinic settings. Subjects were randomly selected to participate in a clinical evaluation including neuropsychological evaluations. SAGE and eSAGE were administered using a crossover design. Subjects were identified as dementia, MCI, or normal based on standard clinical criteria. Associations were investigated using Spearman correlations, linear regression, and sensitivity and specificity measures.

Results: Of the 426 subjects screened, 66 completed the evaluation. eSAGE score correlation to a battery of neuropsychological tests was 0.73 (p < 0.0001) with no significant difference between the paper and digital format. Spearman correlation of SAGE versus eSAGE was 0.88 (p < 0.0001), and they are related by the formula: eSAGE score = -1.05 + 0.99 × SAGE score. Since the slope is very close to 1 (p = 0.86) there is strong evidence that the scaling is identical between eSAGE and SAGE, with no scale bias. Overall, eSAGE scores are lower by an average of 1.21 and the decrease is statistically significant (p < 0.0001). For those subjects familiar with smartphones or tablets (one measure of digital proficiency), eSAGE scores are lower by an average of 0.83 points (p = 0.029). With a score 16 and higher being classified as normal, eSAGE had 90% specificity and 71% sensitivity in detecting those with cognitive impairment from normal subjects.

Conclusions: Tablet-based eSAGE shows a strong association with the validated paper SAGE and a neuropsychological battery. It shows no scale bias compared to SAGE. Both have the advantage of self-administration, brevity, four interchangeable forms, and high sensitivity and specificity in detecting cognitive impairment from normal subjects. Their potential widespread availability will be a major factor in overcoming the many obstacles in identifying early cognitive changes.

Trial registration: ClinicalTrials.gov, NCT02544074 . Registered on 18 March 2015.

Keywords: Cognitive assessment; Cognitive screening; Computerized testing; Early dementia; Mild cognitive impairment; Neuropsychological evaluation; Self-administered test.

Figures

Fig. 1
Fig. 1
Participant flowchart. eSAGE Electronic Self-Administered Gerocognitive Examination, SAGE Self-Administered Gerocognitive Examination
Fig. 2
Fig. 2
eSAGE scores compared to SAGE scores as a function of subject’s digital proficiency. For those subjects not familiar with either smartphones or tablets (one measure of digital proficiency), the scores (open triangles) are related by the formula: eSAGE score = –1.38 + 0.98 × SAGE score (dashed line); the coefficient of determination (R2) is 0.80; the slope is not significantly different from 1 (p = 0.85), and the intercept is not significantly different from 0 (p = 0.33). For those subjects familiar with smartphones or tablets, the scores (filled circles) are related by the formula: eSAGE score = –0.21 + 0.96 × SAGE score (solid line); the coefficient of determination (R2) is 0.81; the slope is not significantly different from 1 (p = 0.64); the intercept is not significantly different from 0 (p = 0.88). When combined, the scores are related by the formula: eSAGE score = –1.05 + 0.99 × SAGE score with R2 = 0.81; the slope is not significantly different from 1 (p = 0.86), and the intercept is not significantly different from 0 (p = 0.28) (line not shown). eSAGE electronic Self-Administered Gerocognitive Examination, SAGE Self-Administered Gerocognitive Examination

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