Detection of Vascular Mild Cognitive Impairment in Southeast Asia Using the Visual Cognitive Assessment Test: Machine Learning Analysis From the BIOCIS (Biomarkers and Cognition Study, Singapore)

As Malaysia undergoes a demographic transformation of population aging, the prevalence of dementia is expected to rise, posing a major public health threat issue. Early screening to detect cognitive impairment is important to implement appropriate clinical interventions. The Visual Cognitive Assessment Test (VCAT) is a language-neutral cognitive assessment screening tool suitable for multilingual populations. This study was aimed to validate the VCAT screening tool for the detection of cognitive impairment amongst the population of Malaysia. A total of 184 participants were recruited, comprising 79 cognitively healthy participants (CHP), 46 mild cognitive impairment (MCI) patients, and 59 mild dementia (Alzheimer’s disease and Vascular Dementia) patients from five hospitals between May 2018 and December 2019 to determine the usefulness of VCAT. Diagnostic performance was assessed using area under the curve (AUC), and receiver operating characteristic (ROC) analysies was performed to determine the recommended cutoff scores. ROC analyses for the VCAT was comparable with that of MoCA (Montreal Cognitive Assessment) in differentiating between CHP, MCI, and mild dementia (AD and VaD) participants. The findings of this study suggest the following optimal cutoff score for VCAT: Dementia 0–19, MCI 20–23, Normal 24–30. The mean ± SD time to complete the VCAT was 10.0 ± 2.75 min in the CHP group and 15.4 ± 4.52 min in the CI group. Results showed that 76.0% of subjects thought that the instructions in VCAT were similar or easier to understand compared with MoCA. This study showed that the VCAT is a valid and useful screening tool for patients with cognitive impairment in Malaysia and is feasible to be used in the clinical settings.

Early detection of cognitive impairment is essential for timely intervention. Currently, most widely used cognitive screening tests are influenced by language and cultural differences; therefore, there is a need for the development of a language-neutral, visual-based cognitive assessment tool. The Visual Cognitive Assessment Test (VCAT), a 30-point test that assesses memory, executive function, visuospatial function, attention, and language, has demonstrated its utility in a multilingual population. In this study, we evaluated the reliability, validity, and diagnostic performance of the VCAT for screening early cognitive impairment in Chongqing, China METHODS: A total of 134 individuals (49 healthy controls (HCs), 52 with mild cognitive impairment (MCI), and 33 with mild dementia) completed the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), VCAT, and domain-specific neuropsychological assessments. The diagnostic performances of MMSE, MoCA, and VCAT were evaluated using the area under the curve (AUC), sensitivity, and specificity. Construct validity of the VCAT was assessed with well-established domain-specific cognitive assessments. Reliability was measured using Cronbach's alpha. The VCAT and its subdomains demonstrated both good construct validity and internal consistency (α=0.577). The performance of VCAT was comparable to that of MoCA and MMSE in differentiating mild dementia from nondemented groups (AUC: 0.940vs. 0.902 and 0.977, respectively; p=.098 and .053) and in distinguishing cognitive impairment (CI) from HC (AUC: 0.929vs. 0.899 and 0.891, respectively; p=.239 and .161), adjusted for education level. The optimal score range for VCAT in determining dementia, MCI, and HC was 0-14, 15-19, and 20-30, respectively. The VCAT proves to be a reliable screening test for early cognitive impairment within our cohort. Being both language and cultural neutral, the VCAT has the potential to be utilized among a wider population within China.

BackgroundCognitive tests play a crucial role in evaluating mild cognitive impairment (MCI) and dementia. As most tests are originally developed in English‐speaking cohorts, their application in multilingual populations will need to be translated and may affect the test psychometrics. Therefore, the VCAT was developed as a language‐neutral visual‐based assessment to mitigate this issue. Although the VCAT has been validated in Southeast Asian countries, its performance in wider language cohorts remains unclear. Here, we aim to compare the utility of VCAT with established screening tests, Montreal Cognitive Assessment (MoCA) and Mini‐Mental State Examination (MMSE), in distinguishing MCI and dementia from cognitively normal (CN) individuals in a multinational study.MethodThis collaboration between Canada, China, India, Korea and Singapore recruited 614 participants (306 CN, 212 MCI, 94 Dementia). The administration of the cognitive tests were standardized across all study sites. Participants underwent the MMSE, MoCA, and VCAT on the same day, with their scores and demographic data (age, gender, years of education, ethnicity, primary written and spoken language) collected in the centers respectively. The performance of VCAT in distinguishing MCI and dementia from CN were assessed within each sites using the area under the curve (AUC).ResultBaseline demographics of the participants in each site were summarized in Table 1. The mean (SD) MMSE, MoCA and VCAT scores in each diagnostic group across all countries were summarized in Table 2. The mean (SD) VCAT scores across all countries for CN, MCI and dementia were 25.91 (3.14); 21.00 (5.36) and 11.91 (4.79) respectively. Corresponding scores for MoCA were 26.09 (2.76); 22.62 (4.43); 14.02 (5.17) and corresponding scores for MMSE were 28.34 (1.79); 26.55 (2.90); 18.91 (4.81). The AUC of VCAT in detecting cognitive impairment (MCI+Dementia) was found to be 0.83 (95%CI 0.80 to 0.86), which is comparable to the MoCA 0.82 (95%CI 0.78 to 0.85) and the MMSE 0.78 (95%CI 0.74 to 0.81).ConclusionVCAT was comparable to the MoCA and MMSE in distinguishing cognitive impairment from CN in a multinational, multilingual population. Further studies with wider language populations are needed to further validate the utility of VCAT globally.

BackgroundAssessing amyloid-β (Aβ) deposition in individuals with mild cognitive impairment (MCI) is critical for early Alzheimer's disease (AD) intervention. The Visual Cognitive Assessment Test (VCAT), a language-neutral visual-based tool, effectively identifies MCI, but its correlation with Aβ pathology remains unverified.ObjectiveThis study aimed to evaluate the ability of VCAT to distinguish between amyloid-positive (Aβ+) and amyloid-negative (Aβ-) people with different cognitive status and compare its performance with the Montreal Cognitive Assessment (MoCA).MethodsIn this cross-sectional analysis conducted at the First Affiliated Hospital of Sun Yat-sen University, 139 cognitively normal (CN) individuals and 231 patients with MCI were enrolled. Participants underwent baseline data registration, VCAT, Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination, Clinical Dementia Rating, amyloid PET assessments, and MRI scans. The main outcome measures considered the ability of the VCAT to distinguish between amyloid-positive and amyloid-negative MCI patients, as indicated by the area under the curve (AUC) values.ResultsVCAT and MoCA showed comparable efficacy in differentiating MCI from CN. For Aβ deposition discrimination, VCAT showed numerically higher accuracy than MoCA for detecting Aβ+ MCI (AUC 0.830 versus 0.797; sensitivity 72.7% versus 66.7%). VCAT's discriminative ability relied on memory and executive function domains. Shortened VCAT versions demonstrated reduced efficacy compared to the full VCAT.ConclusionsVCAT correlates well with PET-detected Aβ deposition and shows marginally superior performance to MoCA in identifying Aβ+ MCI. However, abbreviated VCAT versions are less effective for Aβ detection in MCI, highlighting the need for full-test administration in clinical practice.

BackgroundCognitive assessments are essential for the diagnosis of mild cognitive impairment (MCI) and dementia. However, existing tests are mostly developed in English‐speaking cohorts. Hence, their application in multilingual populations will need translation which may affect their test psychometrics. VCAT is a language‐neutral visual‐based assessment that is developed to address this issue. While VCAT was validated in Southeast Asian countries, its performance in diverse language cohorts remains unclear. Here, we aim to compare the utility of VCAT with established screening tests, Montreal Cognitive Assessment (MoCA) and Mini‐Mental State Examination (MMSE), in distinguishing MCI and dementia from cognitively normal (CN) individuals in a multinational study.MethodsThis study supported by the Alzheimer’s Association has recruited 670 participants (294 CN, 244 MCI, 132 Dementia) from Brazil, Canada, China, India, Korea and Singapore and recruitment is ongoing. We standardized the administration of MMSE, MoCA and VCAT across all study sites. Participants answered a questionnaire on their demographics and underwent cognitive assessments (MMSE, MoCA and VCAT) on the same day. The performance of VCAT in distinguishing MCI and dementia from CN were assessed within each sites using the area under the curve (AUC) analysis.ResultsThe demographics, diagnosis and cognitive scores of the participants from each site were summarized in Table 1. The AUCs of VCAT in detecting MCI+Dementia vs CN were 0.979 for Brazil, 0.708 for Canada, 0.929 for China, 0.956 for Korea, 0.808 for India and 0.731 for Singapore. In comparison, the AUCs of MoCA in detecting MCI+Dementia vs CN were 0.771 for Brazil, 0.751 for Canada, 0.899 for China, 0.964 for Korea, 0.806 for India and 0.682 for Singapore, while the AUCs for MMSE in detecting MCI+Dementia vs CN were 0.896 for Brazil, 0.721 for Canada, 0.891 for China, 0.895 for Korea, 0.712 for India and 0.640 for Singapore.ConclusionVCAT showed satisfactory discriminative validity in differentiating MCI+Dementia from CN participants within multinational, multilingual cohorts. VCAT was also comparable to the MoCA and MMSE. Further analysis in a larger cohort within our study will be performed to validate the utility of VCAT globally.

A VISUAL COGNITIVE ASSESSMENT TOOL FOR THE DIAGNOSIS OF YOUNG-ONSET DEMENTIA: A BIOMARKER-SUPPORTED STUDY

Administering an abbreviated global cognitive test, such as the Montreal Cognitive Assessment (MoCA), is necessary for the recommended first-level diagnostic criteria for mild cognitive impairment (MCI) in Parkinson's disease (PD). Level II requires administering cognitive functioning neuropsychological tests. The MoCA's suitability for identifying PD-MCI is questionable and, despite the importance of cognitive deficits reflected through daily functioning in identifying PD-MCI, knowledge about it is scarce. To explore neuropsychological test scores of patients with PD who were categorized based on their MoCA scores and to analyze correlations between this categorization and patients' self-reports about daily functional-related cognitive abilities. A total of 78 patients aged 42 to 78 years participated: 46 with low MoCA scores (22-25) and 32 with high MoCA scores (26-30). Medical assessments and level II neuropsychological assessment tools were administered along with standardized self-report questionnaires about daily functioning that reflects patients' cognitive abilities. A high percentage of the low MoCA group obtained neuropsychological test scores within the normal range; a notable number in the high MoCA group were identified with MCI-level scores on various neuropsychological tests. Suspected PD-MCI according to the level I criteria did not correspond well with the level II criteria. Positive correlations were found among the 3 self-report questionnaires. These results support the ongoing discussion of the complexity of capturing PD-MCI. Considering the neuropsychological tests results, assessments that reflect cognitive encounters in real life daily confrontations are warranted among people diagnosed with PD who are at risk for cognitive decline.

The presence of time pressures and lack of accessible, brief and accurate screening tools contribute to high rates of underdiagnosis of dementia in primary and community care settings.1 This is...

BackgroundEarly diagnosis of cognitive impairment allows timely intervention with pharmacological and non-pharmacological measures. However, current cognitive evaluation tools do not cater for multilingual populations.ObjectiveTo develop and validate a visual-based cognitive...

Objective:The Montreal Cognitive Assessment (MOCA) is a brief cognitive screener, widely used by providers to detect mild cognitive impairment (MCI). It encompasses 30 questions, assessing executive functioning, visuospatial skills, language, memory, attention, and orientation. Although the MOCA has been shown to have high sensitivity (90%) and specificity (87%) for detecting MCI, existing studies have primarily included participants who were already diagnosed with amnestic MCI via neuropsychological testing. Since several factors beyond the presence of MCI can contribute to low performance on the MOCA (e.g., premorbid IQ, fatigue, mood symptoms), over-reliance on the MOCA runs the risk of falsely identifying individuals as having cognitive impairment. The MOCA’s memory subtest raises particular concern as there are several language-based tasks between the learning and delay trials, introducing the potential for interference effects. Thus, the MOCA’s ability to accurately identify those at risk for MCI in the community remains unclear. The objective of the present study was to evaluate: (1) the MOCA’s association with neuropsychological memory measures; and (2) its ability to distinguish between neurocognitive groups (intact vs. MCI vs. dementia).Participants and Methods:This study involved a retrospective analysis of fifty-one patients (M age=72.58 [7.90]; M education= 16.37 [16.37]) who underwent neuropsychological evaluation. Standardized scores for total list-learning (HVLT; CVLT-bf) were used to capture memory encoding; retention % scores were used to capture memory storage. MOCA scores included Total MOCA, MOCA-Orientation, and the MOCA Memory Index (MOCA-MEM). MOCA-MEM was calculated based on Julayanont et al., 2014— (Free-Delayed Recall*3) + (Category-Cued Recall*2) + Multiple Choice-Cued Recall. Bivariate correlations were conducted for the MOCA and neuropsychological test scores. Participants were divided into three diagnostic groups, classified by the neuropsychologist: (1) Cognitive Intact (CI; n=13); (2) MCI (n=26); and (3) Major Neurocognitive Disorder/Dementia (MNCD; n=11). Analysis of covariance was used to analyze differences between the cognitive groups on Total MOCA, MOCA-Orientation, and MOCA-MEM.Results:Total MOCA correlated with word-list learning (r=.434, p=.004) and retention% (r=.306, p=.049). MOCA-MEM was correlated with word-list learning (r=.367, p=.042); it did not significantly correlate with retention%. MOCA-Orientation had the strongest correlation with retention0/) (r=.406, p=.009). Means of Total MOCA significantly differed between CI (25.31[2.56]), MCI (22.04[4.14]), and MNCD (15.44[4.13]). MOCA-MEM only differentiated CI (10[3.66]) and MNCD (5.71[2.14]); it did not differentiate MCI (6.94[3.13]) from either CI or MNCD.Conclusions:Our findings suggest that the MOCA has limitations in accurately classifying memory deficits in older adults. First, our study suggests that the MOCA-MEM reflects encoding rather than memory storage. Given that deficiency in encoding may be secondary to other cognitive deficits, such as attention and executive dysfunction, performance on MOCA-MEM cannot readily delineate the presence of an amnestic process. Second, the findings show that MOCA-MEM does not differentiate between patient groups with intact cognition versus MCI, nor those with MCI versus MNCD. These findings argue the importance of neuropsychological evaluation in deciphering patterns of memory performance and the presence of an amnestic process.

Construct validity of the Visual Cognitive Assessment Test (VCAT)-a cross-cultural language-neutral cognitive screening tool.

Hope for Catching Alzheimer’s Early

COGNITIVE TESTS TO DETECT MILD COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective To compare the accuracy,sensitivity,specificity of the Mini-Mental State Examination (MMSE) and Montreal cognitive assessment (MoCA) in screening of mild cognitive impairment(MCI) and dementia in community survey. Methods This study was conducted among residents aged 65 years and above in the urban and rural areas selected by stratified sampling from 6 urban and 2 rural communities.The 2 111 cases who finished the Neuropsychological tests included MMSE,MoCA,and Clinical Dementia Rating scale(CDR) were divided into groups normal control,MCI,and dementia.The accuracy,sensitivity and specificity was compared by the area under the curve (AUC) of receiver-operating characteristic curve.The clinical diagnoses of MCI was made according to Petersen′s criteria. Results The areas under curve were between 0.72 to 0.99 for MMSE and MoCA on discriminated MCI or dementia (Z=2.75，P 0.05). In MCI survey,the cutoff values and sensitivity/specificity of MMSE vs.MoCA in education levels of illiterate,primary,secondary and above were 21(84%/64%) vs.15(88%/54%),26(91%/70%) vs.20(94%/68%),27(93%/86%) vs.23(93%/80%) respectively;but in dementia survey,the cutoff values and sensitivity/specificity of MMSE vs. MoCA in education levels of illiterate,primary,secondary and above were 16(98%/85%) vs.11(98%/70%),20(100%/94%) vs.14(100%/87%),22(100%/98%) vs.16(100%/95%) respectively. Conclusions MMSE and MoCA are good cognitive assessment tools in the survey of MCI or dementia with high accuracy,sensitivity and specificity.But the cutoff value is different according to one′s education level.MoCA may be more suitable for MCI survey but MMSE for dementia. Key words: Cognition disorders; Dementia; Mini-Mental State Examination; Montreal cognitive assessment

Background:Cognitive impairment is common in patients receiving dialysis and is associated with morbidity and mortality. Existing approaches to administering face-to-face cognitive screening assessments like the Montreal Cognitive Assessment (MoCA) may be challenging to undertake in dialysis. Virtual reality (VR) technology may be a novel way to assess cognitive function in patients on dialysis.Objective:In a cohort of patients undergoing hemodialysis, the primary objective of this study is to evaluate the test-retest reliability, diagnostic performance, and agreement of an MoCA, generated using VR-based cognitive testing, to a face-to-face MoCA. Secondary objectives are to (1) evaluate changes in cognitive function over time using the VR-generated MoCA, (2) examine associations between cognitive impairment and mortality or hospitalization, and (3) assess the usability of VR-based cognitive testing.Design:This is a prospective cohort study (conducted from 2025-2028).Setting:Hemodialysis units affiliated with the Nova Scotia Health Renal Program.Patients:Incident (within 3 months of dialysis initiation) and prevalent patients receiving hemodialysis.Measurements:Cognitive function will be assessed using the React Neuro VR Headset and the paper-based MoCA. The VR cognitive assessment will include tests such as Smooth Pursuit, Trail Making A/B, Letter/Category Fluency, Boston Naming, Stroop, and Digit Span (Forward/Backward). The results of these tests will be used to generate an MoCA score using device software.Methods:The VR cognitive tests and face-to-face MoCA assessments will be conducted at baseline and week 2, with the order of assessments randomly determined. Subsequent VR cognitive assessments will be conducted once every 3 months (up to 12 months). Agreement will be assessed using Cohen’s kappa (dichotomizing the MoCA at <24), and existing approaches for continuous MoCA scores. Test-retest reliability will be assessed using a similar approach comparing baseline and 2-week scores. Associations between the VR-generated MoCA and outcomes will be analyzed using appropriate regression methods.Results:To date, we have recruited 84 patients, 75 of whom have completed at least their baseline assessment.Limitations:Potential challenges in VR implementation and patient adaptation, as well as the loud and distracting dialysis environment, could impact performance in cognitive assessments.Conclusions:This proposed study aims to evaluate test-retest reliability, performance, and agreement between a VR-generated and face-to-face MoCA. The VR technology may provide a reliable alternative to traditional cognitive testing in dialysis patients. The findings can be used to assist in the early identification of patients with cognitive impairment and may also pave the way for future research, including VR-delivered interventions to improve cognitive function and health outcomes in this population.