Background: There is a need for a cognitive screening tool that can be used in multilingual populations without the need for language translation. VCAT has been recently demonstrated to be useful for this purpose in a single‐center study. The objective of this study is 1) to evaluate performance of VCAT in detecting early cognitive impairment (CI) across three countries, 2) study the usefulness of VCAT in differentiating pure AD from AD+CVD and 3) to develop a shorter version of VCAT (VCAT‐S).
Methods: For the multi‐country assessment, healthy controls (HC), mild CI (MCI) and mild AD subjects were recruited from Singapore, Malaysia and Indonesia. All subjects were evaluated using a single version of VCAT. To study the usefulness of VCAT in the detection of AD+CVD, CVD burden was quantified using a composite measure (Staal et al) that took into account white matter hyperintensities, lacunes, periventricular spaces and microbleeds. Factor analysis, regression and ROC analyses were used to develop VCAT‐S.
Results: In the multinational study, 78 subjects were analyzed. The single version of VCAT was found to be effective in separating HC, MCI and mild AD (23.17 vs 20.29 vs 11.47, p<.001) even after multi‐variate correction. AUC for MoCA and VCAT were comparable (refer figure 1). For detection of AD+CVD, 128 subjects analyzed. VCAT was effective in separating pure AD from AD+CVD (18.64 vs. 14.21, p<.001). VCAT sub‐domains of memory, language, executive function and attention were different between groups. Factor analysis yielded three factors: temporal task, frontal task and visuo‐spatial, accounting for 37.94% of total variance. Regression analyses showed group differences for temporal (B=‐.136, p<.05) and frontal tasks (B=‐.183, p<.05), from which five items based on highest factor loading were chosen for VCAT‐S. VCAT‐S showed significant group differences between AD and AD+CVD (10.03 vs 6.67, p<.001). AUC for VCAT Full and VCAT‐S were comparable (refer figure 2).