Efficacy of the visual cognitive assessment test for mild cognitive impairment/mild dementia diagnosis: a meta-analysis.

Jui-Hung Hsu, Chien-Cheng Liu, I-Wen Chen, Jheng-Yan Wu, Po-Yu Huang, Ting-Hui Liu, Kuo-Chuan Hung

Journal: Frontiers in public health 2023;11():1293710

PMID: 38026272

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Plain Language Summary

Within the continuum of cognitive aging, mild cognitive impairment (MCI) represents the intermediate stage between normal aging and dementia. The visual cognitive assessment test (VCAT) is a brief language-neutral cognitive screening tool designed to detect MCI/mild dementia. It consists of 10 subtests using non-verbal, visually based items without complex verbal instructions The aim of this study was to investigate the efficacy of the VCAT in the diagnosis of patients with MCI/mild dementia. This study was a meta-analysis of five studies and reported VCAT values in patients with (n=857) or without (n=589) MCI/mild dementia. Results showed that the VCAT has moderate diagnostic accuracy in distinguishing individuals with MCI/mild dementia from cognitively normal controls. The pooled sensitivity and specificity were 80% and 75%, respectively. Authors concluded that further studies are required to confirm its applicability and validity across different populations and settings.

Abstract

BACKGROUND

Mild cognitive impairment (MCI) is an intermediate stage between normal ageing and dementia. The early identification of MCI is important for timely intervention. The visual cognitive assessment test (VCAT) is a brief language-neutral screening tool for detecting MCI/mild dementia. This meta-analysis evaluated the diagnostic efficacy of the VCAT for MCI/mild dementia.

METHODS

Medline, Embase, Google Scholar, and Cochrane Library were searched from their inception until August 2023 to identify studies using VCAT to diagnose MCI/mild dementia. The primary outcome was to assess the diagnostic accuracy of the VCAT for detecting MCI/mild dementia through area under the receiver operating characteristic curve (AU-ROC) analysis. The secondary outcome was to explore the correlation between VCAT scores and MCI/mild dementia presence by comparing scores among patients with and without MCI/mild dementia. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated.

RESULTS

Five studies with 1,446 older adults (mean age 64-68.3 years) were included. The percentage of participants with MCI/mild dementia versus controls ranged from 16.5% to 87% across studies. All studies were conducted in Asian populations, mostly Chinese, in Singapore and Malaysia. The pooled sensitivity was 80% [95% confidence interval (CI) 68%-88%] and the specificity was 75% (95% CI 68%-80%). The AU-ROCC was 0.77 (95% CI 0.73-0.81). Patients with MCI/mild dementia had lower VCAT scores than the controls (mean difference -6.85 points, < 0.00001).

CONCLUSION

VCAT demonstrated acceptable diagnostic accuracy in distinguishing MCI/mild dementia in cognitively normal older adults. As a language-neutral and culturally unbiased tool, the VCAT shows promise in detecting MCI/mild dementia. Further studies in non-Asian populations are required.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier: CRD42023453453.

Address: Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.; Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.; Department of Nursing, College of Medicine, I-Shou University, Kaohsiung, Taiwan.; School of Medicine, I-Shou University, Kaohsiung, Taiwan.; Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.; Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.; Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan.; Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.

DOI: 10.3389/fpubh.2023.1293710