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Construct validity of the Visual Cognitive Assessment Test (VCAT)—a cross-cultural language-neutral cognitive screening tool

Published online by Cambridge University Press:  21 May 2019

Audrey Low ,
Levinia Lim ,
Linda Lim ,
Benjamin Wong ,
Eveline Silva ,
Kok Pin Ng  and
Nagaendran Kandiah
Audrey Low
Affiliation:
Department of Neurology, National Neuroscience Institute, Singapore
Levinia Lim
Affiliation:
Department of Neurology, National Neuroscience Institute, Singapore
Linda Lim
Affiliation:
Department of Neurology, National Neuroscience Institute, Singapore
Benjamin Wong
Affiliation:
Department of Neurology, National Neuroscience Institute, Singapore
Eveline Silva
Affiliation:
Department of Neurology, National Neuroscience Institute, Singapore
Kok Pin Ng
Affiliation:
Department of Neurology, National Neuroscience Institute, Singapore
Nagaendran Kandiah*
Affiliation:
Department of Neurology, National Neuroscience Institute, Singapore Duke-NUS, Singapore
*
Correspondence should be addressed to: Nagaendran Kandiah, Senior Consultant Neurologist, Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433. Phone: +65 6357 7199; Fax: +65 6357 7137. Email: [email protected].
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Abstract

Background:

The Visual Cognitive Assessment Test (VCAT) is a language-neutral cognitive screening tool designed for use in culturally diverse populations without the need for translations or adaptations. While it has been established to be language-neutral, the VCAT’s construct validity has not been investigated.

Methods:

471 participants were recruited, comprising 233 healthy comparisons, 117 mild cognitive impairment (MCI), and 121 mild Alzheimer’s disease (AD) patients. VCAT and domain-specific neuropsychological tests were administered in the same sitting. Construct validity was assessed by analyzing domain-specific associations between the VCAT and well-established cognitive assessments. Reliability (internal consistency) was measured by Cronbach’s alpha. Diagnostic ability (area under the curve) and recommended cutoffs were determined by receiver operating characteristic (ROC) analysis.

Results:

The VCAT and its subdomains demonstrated good construct validity in terms of both convergent and divergent validity and good internal consistency (α = .74). ROC analysis found that the VCAT was on par with the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at distinguishing between healthy comparisons, MCI, and mild AD. Consistent with previous studies, VCAT scores were not affected by language of administration or ethnicity in our cohort. Findings suggest the following cutoffs: Dementia 0–19, MCI 20–24, Normal 25–30.

Conclusion:

This study established the construct validity of the VCAT, which is vital to ensure its subdomains effectively measure the cognitive processes they were designed to. The VCAT is capable of detecting early cognitive impairments and allows for meaningful cross-cultural comparisons, especially useful for international collaborations and clinical trials, and for clinical use in diverse multiethnic populations.

Keywords

dementiamild cognitive impairmentAlzheimer diseaseneuropsychological assessmentreliabilitydiagnostic value
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 1: Issue Theme: Cultural Diversity in Psychogeriatrics , January 2020 , pp. 141 - 149
Copyright
© International Psychogeriatric Association 2019 

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References

Albert, M. S. et al. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7, 270–279. doi: 10.1016/j.jalz.2011.03.008.CrossRefGoogle Scholar
Boone, K. B. et al. (2007). The association between neuropsychological scores and ethnicity, language, and acculturation variables in a large patient population. Archives of Clinical Neuropsychology, 22(3), 355–365.10.1016/j.acn.2007.01.010CrossRefGoogle Scholar
Brickman, A. M., Cabo, R. and Manly, J. J. (2006). Ethical issues in cross-cultural neuropsychology. Applied Neuropsychology, 13, 91–100. doi: 10.1207/s15324826an1302_4.CrossRefGoogle ScholarPubMed
Clark, L. A. and Watson, D. (1995). Constructing validity: basic issues in objective scale development. Psychological Assessment, 7, 309–319. doi: 10.1037//1040-3590.7.3.309.CrossRefGoogle Scholar
Cronbach, L. J. and Meehl, P. E. (1955). Construct validity in psychological tests. Psychological Bulletin, 52, 281–302. doi: 10.1037/h0040957.CrossRefGoogle ScholarPubMed
Franzen, S. et al. (2017). Cross-cultural neuropsychological assessment of dementia: directions for test development. Alzheimer’s & Dementia, 13, 1141–1142. doi: 10.1016/j.jalz.2017.06.1666.CrossRefGoogle Scholar
Gibbons, L. E. et al. (2002). Cross-cultural comparison of the mini-mental state examination in United Kingdom and United States participants with Alzheimer’s disease. International Journal of Geriatric Psychiatry, 17, 723–728. doi: 10.1002/gps.683.CrossRefGoogle ScholarPubMed
Henry, J. D. and Crawford, J. R. (2004). A meta-analytic review of verbal fluency performance following focal cortical lesions. Neuropsychology, 18, 284–295. doi: 10.1037/0894-4105.18.2.284.CrossRefGoogle ScholarPubMed
Hoosain, R. (1982). Correlation between pronunciation speed and digit span size. Perceptual and Motor Skills, 55, 1128. doi: 10.2466/pms.1982.55.3f.1128.CrossRefGoogle Scholar
Kandiah, N. et al. (2015). Early detection of dementia in multilingual populations: Visual Cognitive Assessment Test (VCAT). Journal of Neurology, Neurosurgery & Psychiatry, 87, 156–160. doi: 10.1136/jnnp-2014-309647.Google Scholar
Lim, L. et al. (2018). A novel language-neutral Visual Cognitive Assessment Test (VCAT): validation in four Southeast Asian countries. Alzheimer’s Research & Therapy, 10, 6. doi: 10.1186/s13195-017-0333-z.CrossRefGoogle ScholarPubMed
Loewenstein, D. A. et al. (1994). Potential cultural bias in the neuropsychological assessment of the older adult. Journal of Clinical and Experimental Neuropsychology, 16, 623–629. doi: 10.1080/01688639408402673.CrossRefGoogle ScholarPubMed
Manly, J. J. (2005). Advantages and disadvantages of separate norms for African Americans. The Clinical Neuropsychologist, 19, 270–275. doi: 10.1080/13854040590945346.CrossRefGoogle ScholarPubMed
Manly, J. J. and Espino, D. V (2004). Cultural influences on dementia recognition and management. Clinics in Geriatric Medicine, 20, 93–119. doi: 10.1016/j.cger.2003.10.004.CrossRefGoogle ScholarPubMed
McKhann, G. M. et al. (2011). The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7, 263–269. doi: 10.1016/j.jalz.2011.03.005.CrossRefGoogle Scholar
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414. doi: 10.1212/wnl.43.11.2412-a.CrossRefGoogle ScholarPubMed
Ní Chaoimh, D. et al. (2015). Importance of different language versions of cognitive screening tests: comparison of Irish and English versions of the MMSE in bilingual Irish patients. European Geriatric Medicine, 6, 551–553. doi: 10.1016/j.eurger.2015.10.006.CrossRefGoogle Scholar
Prince, M. et al. (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s & Dementia, 9, 63–75. doi: 10.1016/j.jalz.2012.11.007.CrossRefGoogle ScholarPubMed
Romero, H. R. et al. (2009). Challenges in the neuropsychological assessment of ethnic minorities: summit proceedings. The Clinical Neuropsychologist, 23, 761–779. doi: 10.1080/13854040902881958.CrossRefGoogle ScholarPubMed
Shah, A., Oommen, G. and Wuntakal, B. (2008). Cross-cultural aspects of dementia. Psychiatry, 7, 94–97. doi: 10.1016/j.mppsy.2007.11.014.CrossRefGoogle Scholar
Sperber, A. D. (2004). Translation and validation of study instruments for cross-cultural research. Gastroenterology, 126, S124–S128. doi: 10.1053/j.gastro.2003.10.016.CrossRefGoogle ScholarPubMed
Stigler, J. W., Lee, S.-Y. and Stevenson, H. W. (1986). Digit memory in Chinese and English: evidence for a temporally limited store. Cognition, 23, 1–20. doi: 10.1016/0010-0277(86)90051-x.CrossRefGoogle ScholarPubMed
Streiner, D. L. (2003). Starting at the beginning: an introduction to coefficient alpha and internal consistency. Journal of Personality Assessment, 80, 99–103. doi: 10.1207/s15327752jpa8001_18.CrossRefGoogle ScholarPubMed
Tavakol, M. and Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. doi: 10.5116/ijme.4dfb.8dfd.CrossRefGoogle ScholarPubMed
Teng, E. L. (2002). Cultural and educational factors in the diagnosis of dementia. Alzheimer Disease & Associated Disorders, 16, S77–S79. doi: 10.1097/00002093-200200002-00007.CrossRefGoogle ScholarPubMed
Ting, S. K. S. et al. (2013). Digit span: a comparison of Chinese versus alphabetic language speakers in dysexecutive dementia patients. Journal of Neurology, Neurosurgery & Psychiatry, 85, 117–118. doi: 10.1136/jnnp-2013-305828.CrossRefGoogle ScholarPubMed
Whiteside, D. M. et al. (2015). Verbal fluency: language or executive function measure? Applied Neuropsychology: Adult, 23, 29–34. doi: 10.1080/23279095.2015.1004574.CrossRefGoogle ScholarPubMed