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Self Administered Gerocognitive Examination SAGE Form 2 How Well Are You Thinking? Please complete this form in ink without the assistance of others. Name Date of Birth / / How far did you get in.

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How to fill out the Sage Form 2 online

The Sage Form 2 is a self-administered gerocognitive examination designed to evaluate cognitive function. Completing this form online can help streamline the assessment process, ensuring accurate and efficient data collection.

Follow the steps to fill out the Sage Form 2 online.

  1. Press the ‘Get Form’ button to access the Sage Form 2 and open it in the online editor.
  2. Begin by entering your name and date of birth in the designated fields.
  3. Indicate your highest level of education completed.
  4. Select your gender by checking the appropriate box.
  5. Identify your ethnicity by checking the corresponding box.
  6. Answer the question regarding any memory or thinking problems you have experienced.
  7. Indicate whether any blood relatives have had memory or thinking problems.
  8. Respond to the question about balance problems.
  9. If applicable, specify the cause of your balance problems.
  10. Confirm whether you have had a major or minor stroke.
  11. Indicate your current feelings regarding sadness or depression.
  12. Respond to whether you have noticed any changes in your personality.
  13. Indicate if you find it harder to perform everyday activities due to thinking problems.
  14. Answer the questions that require recall, such as today's date and naming pictures.
  15. Complete the memory test as instructed.
  16. Finish tasks involving drawing and problem-solving.
  17. Review the entire form to ensure accuracy and completeness.
  18. Once completed, save your changes, download the file, print it, or share it as needed.

Complete the Sage Form 2 online to ensure a streamlined evaluation process.

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SAGE Test Sample Questions Draw the face of a clock and put in the numbers. Position the hands for 5 minutes after 11 o'clock, On your clock, label the long hand with an "L" and the short hand with an "S." Write down the names of 12 different animals.

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.

The Self-Administered Gerocognitive Exam (SAGE) is a brief self-administered cognitive screening instrument used to identify mild cognitive impairment (MCI) from any cause and early dementia.

How to take the SAGE test Download the test. Print it out and answer the questions in ink without the assistance of others. When you're done, take your answer sheet to your doctor so he or she can score it and talk to you about the results.

Interpreting the Results The maximum score on the SAGE is 22, and any score under 17 is considered an indicator of thinking difficulties that should be checked by a specialist. A score of 15 or 16 indicates the person might have a mild cognitive impairment, or MCI. Fourteen or below indicates probable dementia.

Scoring the MoCA Test A score of 26 and higher is considered normal. In the initial study data, normal controls had an average score of 27.4. People with mild cognitive impairment (MCI) scored an average of 22.1. People with Alzheimer's disease had an average score of 16.2.

MMSE: This test is graded by severity and has been used extensively in memory clinics to measure response to medication and guide decisions: 20-26 = mild cognitive impairment; 10-20 = moderate impairment; and less than 10 indicates severe impairment. ACE III: This is a much more detailed test, scored out of 100.

Scoring of the MMSE Scores on the MMSE range from 0 to 30, with scores of 26 or higher being traditionally considered normal. 1 Scores less than 9 generally indicate severe impairment, while scores between 10 and 20 indicate moderate dementia.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232