CAGE Questionnaire Calculator
Four questions, thirty seconds, and a structured reason to ask about alcohol — a modifiable risk factor for hypertension, AF, ICH, and ischemic stroke, and the withdrawal syndrome that ambushes stroke admissions on day two.
Reviewed by Zaka Ahmed, MD Clinical reference · 3 min read
CAGE Questionnaire
Ask the four questions about lifetime experience; one point per yes. Two or more is a positive screen.
Answer every item to see the interpretation.
Educational tool only. CAGE screens for lifetime alcohol use disorder; it does not quantify current consumption, detect hazardous drinking below the disorder threshold (AUDIT-C does that better), or replace a clinical interview.
Clinical notes & interpretation Scoring guidance, pitfalls, FAQs, and references
Why a stroke site hosts an alcohol screen
Alcohol earns its place in the stroke risk-factor list twice over. Heavy use raises ischemic stroke risk through hypertension, atrial fibrillation, and cardiomyopathy, and raises hemorrhagic stroke risk more steeply still — heavy drinking is one of the strongest modifiable risk factors for ICH, compounding coagulopathy and hypertension. Asking about alcohol systematically at the secondary-prevention visit is therefore not moralizing; it is risk-factor modification with effect sizes comparable to the things we happily prescribe pills for.
The inpatient trap: withdrawal on day two
The practical inpatient reason to screen every stroke admission: alcohol withdrawal declares itself 48–96 hours in, and on a stroke unit it masquerades as "delirium," "agitation from the stroke," or a new seizure — each of which triggers a very different (and expensive) workup than the CIWA protocol the patient actually needed. A positive CAGE or a meaningful consumption history at admission buys prophylactic thiamine, scheduled reassessment, and a documented plan before the tremor starts. Post-discharge, brief interventions genuinely work in this population, and the stroke itself is the most teachable moment the patient will ever have.
Frequently asked questions.
What CAGE score is positive?
Two or more affirmative answers is the conventional threshold for a clinically significant screen; some settings act on one, trading specificity for sensitivity.
CAGE or AUDIT?
CAGE screens for lifetime alcohol use disorder in four questions; AUDIT (or AUDIT-C) quantifies current hazardous consumption and is more sensitive for at-risk drinking below the disorder threshold. They answer different questions — many clinics use AUDIT-C first.
Is any alcohol protective against stroke?
The older J-curve narrative has weakened substantially — Mendelian-randomization data suggest the apparent protection of light drinking was largely confounding, with stroke risk rising fairly linearly with intake. The defensible counseling position is that less is better and heavy use is unambiguously harmful.
References.
- Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252(14):1905–1907. PubMed
- Millwood IY, Walters RG, Mei XW, et al. Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China. Lancet. 2019;393(10183):1831–1842. PubMed
- Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2021;52(7):e364–e467. PubMed