**SAGE© 2007-2013 The Ohio State University ****D. Scharre MD, version 6.13 http://sagetest.osu.edu**

SAGE is a brief self-administered cognitive screening instrument to identify Mild Cognitive Impairment (MCI) and early dementia. Average time to complete the test is 15 minutes. The maximum score is 22. A score of 17 and above is considered normal.

**Administration:**

The test is self-administered. It should be filled out in ink without the assistance of others. There are four pages to complete. Calendars and clocks should not be available during the testing. Do the best that you can.

**Non-Scored Items**:

- Demographics
- Insight: Have you had any problems with memory or thinking?
- Family History
- Motor symptoms
- Stroke symptoms
- Depression symptoms
- Personality changes
- Functional abilities

**Scored Items:**

*1. Orientation:* Total possible points are 4

- Month: 1 = Correct / 0 = Incorrect
- Date: 2 = exact / 1 = ± 3 days / 0 = All else
- Year: 1 = Correct / 0 = Incorrect

2. *Naming*: Total possible points are 2. Correct spelling not required.

- Each Picture: 1 = Correct / 0 = Incorrect

3. *Similarities*: Total possible points are 2. Correct spelling/grammar not required.

- 2 = Abstract / 1 = Concrete / 0 = All else

4. *Calculation*: Total possible point is 1.

- 1 = Correct / 0 = Incorrect

5. *Calculation*: Total possible point is 1.

- 1 = Correct / 0 = Incorrect

6. *Memory*:

- Points given below in number twelve.

7. *Construction*: Total possible points are 2 for 3-D figure.

- 2 = 3-D, parallel lines within 10° and correct shape
- 1 = 3-D but lines not parallel within 10° or otherwise incorrect shape
- 0 = All else

8. *Construction*: Total possible points are 2. The clock has 4 components: Clock face, clock numbers (all 12 numbers incorrect order clockwise and approximately correct quadrant position), hand positions (hands to correct time and must be joined near clock center), and hand size (actual or if labeled correctly)

- 2 = 4 of 4 components correct
- 1 = 3 of 4 components correct; one of the three correct components must be hand positions
- 0 = All else

9.* Verbal fluency*: Total possible points are 2. Correct spelling not required.

- 2 = 12 different items listed
- 1 = 10 or 11 different items listed
- 0 = 9 or less different items listed

10. *Executive*: Total possible points are 2. Modified Trails: An error is if two items that should be connected are not or if two items that should not be connected are.

- 2 = Perfect or self-corrected errors only
- 1 = 1 or 2 errors
- 0 = More than 2 errors

11. *Executive*: Total possible points are 2.

Problem solving: Forms 1 and 2:

- 2 = Correct lines moved or marked and final diagram correct
- 1 = Correct lines moved or marked and no final diagram drawn Or Correct lines moved or marked but final diagram incorrect Or No lines moved or marked and final diagram correct
- 0 = All else including lines moved or marked incorrectly but final diagram correct

Problem solving: Forms 3 and 4:

- 2 = Correct lines crossed out and final diagram correct
- 1 = Correct lines crossed out and no final diagram drawn Or Correct lines crossed out but final diagram Incorrect Or No lines crossed out and final diagram correct
- 0 = All else including lines crossed out incorrectly but final diagram correct

12. *Memory*: Total possible points are 2.

Forms 1 and 2:

- 2 = Exact wording only, nothing extra: “I am done”
- 1 = Must contain the word “done”: “Yes, I am done”, “done”, others
- 0 = All else

Forms 3 and 4:

- 2 = Exact wording only, nothing extra: “I have finished”
- 1 = Must contain the word “finished”: “Yes, I havefinished”, “I am finished”, “finished”, others
- 0 = All else

Total points = 0 (minimum) – 22 (maximum)