Abstract
BACKGROUND: Vascular mild cognitive impairment (VMCI) is a significant global health concern, particularly in Asia. The visual cognitive assessment test (VCAT) has shown promise as a language-neutral screening tool for cognitive impairment. OBJECTIVE: This study aims to assess the effectiveness of the VCAT in detecting VMCI and compare its diagnostic performance with the widely used and validated Montreal Cognitive Assessment (MoCA). METHODS: Cross-sectional data from 524 community-dwelling participants were analyzed from the BIOCIS (Biomarkers and Cognition Study, Singapore) and classified into cognitively unimpaired, non-VMCI, and VMCI groups. The participants underwent neuropsychological assessments and 3-T magnetic resonance imaging. The random forest technique and multivariable logistic regression were applied to assess the discriminative properties of the tests. RESULTS: Participants with VMCI exhibited significantly lower performance across various neuropsychological tests (P<.001) and higher rates of vascular risk factors (P<.001). At a cutoff of 27, the VCAT achieved near-perfect accuracy in discriminating the VMCI group from the cognitively unimpaired group (area under the receiver operating characteristic curve=1; sensitivity=1; specificity=0.991). For differentiating the VMCI group from the non-VMCI group, both the VCAT and the MoCA showed optimal performance at a cutoff of 25 (area under the receiver operating characteristic curve=1.00; sensitivity=1.00; specificity=1.00). CONCLUSIONS: The VCAT could be a valuable tool for detecting VMCI, particularly in diverse, multilingual populations. Its comparable or even superior performance to the MoCA, combined with its language-neutral design, positions the VCAT as a strong addition to cognitive assessment toolkits for VMCI. However, the complex nature of cognitive processing in VMCI suggests that a multifaceted approach that integrates both visual and verbal assessments may ultimately offer the most comprehensive evaluation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.14283/jpad.2024.89.