• Visual Cognitive Assessment Test (VCAT) developed by the National Neuroscience Institute addresses the challenges of dementia screening in multi-lingual countries.
• VCAT is currently in use in Singapore, Malaysia, Indonesia and the Philippines, and validation is underway in Brazil, Canada, India and South Korea.
• The screening tool can detect Mild Cognitive Impairment (pre-dementia) and dementia, enabling earlier diagnosis for better treatment and facilitating dementia research within multi-lingual populations and across borders.

SINGAPORE, 08 November 2021 – Dementia is a long-standing global health problem, yet many clinicians around the world still face challenges diagnosing the condition. 
“Most cognitive tests were developed for monolingual Western populations and were written and validated in English. This poses a significant barrier for use in countries like Singapore with diverse cultures, languages and dialects, because translating the tests is often not possible without affecting its validity,” said Associate Professor Nagaendran Kandiah, Senior Consultant and Dementia Programme Director, National Neuroscience Institute (NNI).

For example, some of the widely used screening tests ask participants to name as many words as possible beginning with the letter F, but this is not possible with languages such as Chinese and Tamil which do not use the Latin alphabet. Also, words and images used to test memory recall and repetition are not always relevant in other cultures.
To address these challenges, staff at NNI developed the Visual Cognitive Assessment Test (VCAT). The screening tool uses pictures of common objects and scenes that are recognisable in nearly all countries around the world and the instructions can be translated into other languages without affecting the validity of the test. For an example of one of the questions used in the VCAT, see Annex 1.

“The VCAT has been shown to be a reliable and effective screening tool for Mild Cognitive Impairment (MCI) and dementia in Singapore, Malaysia, Indonesia and the Philippines. This makes it easier to screen for dementia in multi-lingual populations and also allows for comparable research to be conducted between different communities within a country and across borders to help advance dementia care,” said Assoc Prof Nagaendran.

The use of VCAT has now spread beyond Southeast Asia, with validation underway in Brazil, India, South Korea and Canada. A shorter version of the test, called VCAT-S, has also been created for the public to use as a primary screening tool. It is currently being validated in Singapore and more plans are in the pipeline to further improve access to the test.

“VCAT is easy to use and administer as it only requires pen and paper, however this poses a problem during the current COVID-19 pandemic as teleconsultations become increasingly common. So, we are currently developing a digital version which can be conducted remotely with the added benefit of reducing scoring errors and bias. Careful evaluation and validation will be done to assess the effectiveness of a digital VCAT.” said Dr Ng Kok Pin, Consultant, Department of Neurology, NNI.

VCAT was highlighted in the World Alzheimer Report 2021 Journey through the diagnosis of dementia, as a practical and effective way to screen for dementia in multi-lingual countries. The report was published on 21 Sept 2021 (World Alzheimer’s Day) by Alzheimer’s Disease International, the global voice on dementia.

Effective screening tools for MCI and dementia are critical, as early diagnosis can help both persons with MCI and dementia and their caregivers get the treatment and support they need to cope with this challenging condition.

With populations ageing in Singapore and most other countries, rates of dementia are rising sharply. The World Health Organization estimates that currently 55 million people have dementia – of which over 60 per cent live in low- and middle-income countries – and this is expected to rise to 139 million people by 2050.