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Development and validation of a brief visual based cognitive screening tool for dementia: the Visual Cognitive Assessment Test short-form (VCAT-S)
  1. Wilbur Koh1,
  2. Levinia Lim1,
  3. Audrey Low1,
  4. Benjamin Wong1,
  5. Linda Lim1,
  6. Eveline Silva1,
  7. Kok Pin Ng1,
  8. Nagaendran Kandiah1,2
  1. 1Department of Neurology, National Neuroscience Institute, Singapore
  2. 2Duke-NUS Medical School, Singapore
  1. Correspondence to Dr Nagaendran Kandiah, Neurology, National Neuroscience Institute, Singapore 308433, Singapore; nagaendran_kandiah{at}nni.com.sg

https://doi.org/10.1136/jnnp-2020-323106

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    Introduction

    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 particularly problematic in multilingual societies such as Asia where there is a pressing need for such tools.2 As the Visual Cognitive Assessment Test (VCAT) is a visual-based and language-neutral test, it represents an attractive screener for early cognitive impairment and dementia, particularly in multilingual populations.3 4 However, because it takes about 15 min to administer,3 the VCAT may not be well-suited for use in busy clinical settings. We therefore aimed to develop a short-form VCAT (VCAT-S) and validate it against the original VCAT, and local versions of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).

    Methods

    We retrospectively extracted data for 663 healthy controls (HC) and participants with clinically diagnosed mild cognitive impairment (MCI) or mild dementia of the Alzheimer’s type (mDAT). Diagnoses were provided by neurologists and supported by clinical examination, neuropsychological assessment and structural MRI imaging where available. All participants were recruited from the community or a specialist outpatient memory clinic between October 2013 and January 2018, ≥ 50 years old and had completed the original VCAT, MMSE and MoCA tests at a single sitting. Participants were randomly assigned to either the development or validation study arms; demographic details are provided in online supplementary tables e-1 and e-2; .

    Supplemental material

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    Footnotes

    • Contributors WK contributed to the study design, statistical analysis, interpretation of the data, drafting and revision of the manuscript. LL contributed to the data collection and revision of the manuscript. AL contributed to the study design and the revision of the manuscript. BW contributed to the data collection and revision of the manuscript. LL contributed to the data collection and revision of the manuscript. ES contributed to the data collection and revision of the manuscript. KPN contributed to the study design, drafting and revision of the manuscript. NK contributed to the study design, statistical analysis, interpretation of the data, drafting and final approval of the manuscript.

    • Funding This study was supported by the National Neuroscience Institute, Singapore. The study was funded by the Singhealth Foundation Research Grant (SHF/FG483P/2012). Audrey Low is funded by the Lee Kuan Yew Fitzwilliam Scholarship and the Tan Kah Kee Postgraduate Scholarship. The funders had no role in the initiation or design of the study, collection of samples, analysis, interpretation of data, writing of the paper or the submission for publication.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethics approval was provided by the SingHealth Centralised Institutional Review Board (2012/750/A).

    • Provenance and peer review Not commissioned; externally peer reviewed.