Evaluating the Acceptability and Pilot Diagnostic Accuracy of a Visually Independent Test Battery of Neurocognition (VISION-Cog)

Background: Cognitive impairment (CI) may be overdiagnosed in individuals with vision impairment (VI) due to the vision-dependent design of current cognitive assessment tools. This cross-sectional study evaluated the acceptability and diagnostic accuracy (pilot) of the Visually Independent Test Battery of Neurocognition (VISION-Cog) protocol, against gold-standard neurologist diagnosis. Methods: Community-dwelling older adults with near binocular presenting VI (near visual acuity [NVA] ≥0.2 logarithm of the minimum angle of resolution [LogMAR] units) were recruited from the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study. Participants underwent VISION-Cog and the Singapore-validated Montreal Cognitive Assessment (MoCA-SG) testing and were referred for neurologist evaluation based on standardized referral protocols. The acceptability of the VISION-Cog was assessed through study completion rates, test duration, and the qualitative feedback. Vision-Cog’s diagnostic accuracy (pilot) against neurologist evaluation was analyzed using binary logistic regression and C-statistics to estimate area under the receiver operating curve (AUC) with corresponding sensitivity and specificity. Results: Out of forty-five participants (mean age [SD]: 73.8 [6.1 years]; mean NVA [SD]: 0.47 [0.14] LogMAR; and 54.1% female), 37 (82.2%) completed the protocol. The mean VISION-Cog completion time [SD] was 59 m 57 s (7 m 18 s). Qualitatively, participants found the testing time acceptable. The VISION-Cog achieved an AUC of 0.930 against neurologist diagnosis, with 100.0% sensitivity and 78.0% specificity. Conclusions:The VISION-Cog demonstrated satisfactory preliminary diagnostic accuracy and good acceptability indices in older Asian adults, supporting the need of larger studies to confirm its diagnostic accuracy of CI and clinical utility in those with VI.: