Visual Cognitive Assessment Test correlates with brain amyloid status in Alzheimer's disease-related mild cognitive impairment

Abstract

Background

Assessing amyloid-β (Aβ) deposition in individuals with mild cognitive impairment (MCI) is critical for early Alzheimer's disease (AD) intervention. The Visual Cognitive Assessment Test (VCAT), a language-neutral visual-based tool, effectively identifies MCI, but its correlation with Aβ pathology remains unverified.

Objective

This study aimed to evaluate the ability of VCAT to distinguish between amyloid-positive (Aβ+) and amyloid-negative (Aβ−) people with different cognitive status and compare its performance with the Montreal Cognitive Assessment (MoCA).

Methods

In this cross-sectional analysis conducted at the First Affiliated Hospital of Sun Yat-sen University, 139 cognitively normal (CN) individuals and 231 patients with MCI were enrolled. Participants underwent baseline data registration, VCAT, Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination, Clinical Dementia Rating, amyloid PET assessments, and MRI scans. The main outcome measures considered the ability of the VCAT to distinguish between amyloid-positive and amyloid-negative MCI patients, as indicated by the area under the curve (AUC) values.

Results

VCAT and MoCA showed comparable efficacy in differentiating MCI from CN. For Aβ deposition discrimination, VCAT showed numerically higher accuracy than MoCA for detecting Aβ+ MCI (AUC 0.830 versus 0.797; sensitivity 72.7% versus 66.7%). VCAT's discriminative ability relied on memory and executive function domains. Shortened VCAT versions demonstrated reduced efficacy compared to the full VCAT.

Conclusions

VCAT correlates well with PET-detected Aβ deposition and shows marginally superior performance to MoCA in identifying Aβ+ MCI. However, abbreviated VCAT versions are less effective for Aβ detection in MCI, highlighting the need for full-test administration in clinical practice.