Validation of the Visual Cognitive Assessment Test (VCAT) for the Early Diagnosis of Cognitive Impairment in Multilingual Population in Malaysia

Li Yun Ng ,Irene Looi,Monica Danial,Gaaitheri Karupiah,Chiann Ni Thiam,Prema Muninathan,Laavanya Vijaya Kumar,Szer Lik Yeap,Sreevali Muthuvadivelu,Al-Zilal Abdul Wahid,Ewe Eow Teh,Stephenie Ann Albart,Alan Swee Hock Ch’Ng,Purnima Devi Suppiah,Helvinder Kaur,Kurubaran Ganasegeran,Basanta Kumar Mohanty,Nagaendran Kandiah,Wen Mei Choong ,Xin Hui Choo ,Hooi Ling Tan ,Chen Joo Chin ,Wei Theng Tan ,Jia Hui Loh ,Khian Boon Ng ,Wee Kooi Cheah ,Hoon Lang Teh ,Hung Eun Hoo ,Mohammad Nabhan Khalil ,Esther Gunaseli M Ebenezer

doi:10.3390/psych4010003

Abstract

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.

Highlights

Worldwide, over 46 million people are living with dementia and the number is estimated to increase to reach approximately 131.5 million people by 2050
We aimed to evaluate the diagnostic performance of Visual Cognitive Assessment Test (VCAT), its feasibility, and its reliability within multilingual rural and urban population settings in Malaysia
The sample size was calculated in accordance to logical justifications as proposed by Lakens [20], and the calculation was calculated based on the probability proportionate to size sampling (PPS) technique

Summary

Introduction

Over 46 million people are living with dementia and the number is estimated to increase to reach approximately 131.5 million people by 2050. In Malaysia, the prevalence of dementia was 123,000 people in 2015. This number is projected to be double to about 261,000 people by 2030 and will continue to increase to 590,000 people by 2050 [2]. An urban community study done in Kuala Lumpur among the older Malay people revealed that the prevalence of dementia was 6% [3]. The early diagnosis of cognitive impairment can reduce healthcare costs and dementia care burden for patients, caregivers, and the health system [2,5,6,7,8]

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