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

Abstract

BackgroundThe 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.MethodsSubjects 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.ResultsOf 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.ConclusionsTablet-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 registrationClinicalTrials.gov, NCT02544074. Registered on 18 March 2015.

Digital Screening for Cognitive Impairment – A Proof of Concept Study

“…Both tests were excellent at discriminating dementia patients from SCI patients with a sensitivity of 1 for both GSCT and MoCA while showing a specificity of 0.9 and 0.56, respectively. This result is similar to the differential capabilities of other digital cognitive test showing sensitivity and specificity scores ranging from 0.85-1 and 0.81-1 respectively (31)(32)(33). Both tests also showed similar capabilities when discriminating between SCI and MCI patients with AUC scores of 0.74.…”

Mobile Technology for Cognitive Assessment of Older Adults: A Scoping Review

“…Most questions were scored by the eSAGE software, but trained assessors scored drawings. Results showed that the eSAGE was highly correlated with the validated SAGE and other neuropsychological tests (Scharre et al, 2017).…”

“…Six articles described translating paper-based or personal computer (PC)-based neuropsychological tests to mobile platforms. Five articles focused on converting paper-based tests (Berg et al, 2018; Ruggeri et al, 2016; Scharre et al, 2017; Wu et al, 2015, 2017) and one investigated converting a PC-based test (Mielke et al, 2015).…”

“…Translating paper-based tests to mobile devices increased test completion rate, decreased administration cost, enabled automatic score calculation, allowed immediate access to results, and supported easy tracking of patient outcomes (Berg et al, 2018; Mielke et al, 2015; Ruggeri et al, 2016; Scharre et al, 2017; Wu et al, 2015, 2017). Mobile devices also allowed cognitive assessment outside of clinics with rapid data transfer to health care providers (Scharre et al, 2017), and even older adults with low technology literacy were readily able to complete tests using tablets with touchscreens in a clinic setting (Mielke et al, 2015). Lessening the burden on professional examiners can further increase administration of cognitive assessments outside of clinic settings (Makizako et al, 2013).…”

“…We also saw tradeoffs in terms of sensitivity and specificity, required effort, and adherence. Mobile assessments range from those that are normed and validated with high sensitivity and specificity that are suited to diagnosis (Scharre et al, 2017; Wu et al, 2017); to those with high adherence rates that are attractive for monitoring outside the clinic (Allard et al, 2014; Jongstra et al, 2017; Lange & Suss, 2014; Rentz et al, 2016); to those with higher sensitivity and lower specificity that are appropriate for screening (Scanlon et al, 2016). Some assessments impose high cognitive burden whereas others are less demanding, and passive assessments leveraging unobtrusive metadata require no additional effort.…”