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

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.