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Volume 14
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10.3390/medsci14030344
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Brief Report

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

by
Hiromi Yee
1,
Aricia Xin Yi Ho
1,
Chiew Meng Johnny Wong
1,
Wei Lin Tan
1,
Eva K. Fenwick
1,2,
Preeti Gupta
1,2,
Adeline S. L. Ng
2,3,
Tai Anh Vu
2,
Kinjal Doshi
4,
Ecosse L. Lamoureux
1,2,5,* and
Ryan E. K. Man
1,2
1
Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore 169856, Singapore
2
Duke–NUS Medical School, National University of Singapore, Singapore 169857, Singapore
3
National Neuroscience Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
4
Department of Psychology, National University of Singapore, Singapore 117572, Singapore
5
Department of Ophthalmology, University of Melbourne, Parkville, VIC 3010, Australia
*
Author to whom correspondence should be addressed.
Med. Sci. 2026, 14(3), 344; https://doi.org/10.3390/medsci14030344 (registering DOI)
Submission received: 21 May 2026 / Revised: 21 June 2026 / Accepted: 23 June 2026 / Published: 24 June 2026
Versions Notes

Abstract

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.:
Keywords: cognitive impairment; visual impairment; cognitive assessment; neuropsychology cognitive impairment; visual impairment; cognitive assessment; neuropsychology

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MDPI and ACS Style

Yee, H.; Ho, A.X.Y.; Wong, C.M.J.; Tan, W.L.; Fenwick, E.K.; Gupta, P.; Ng, A.S.L.; Vu, T.A.; Doshi, K.; Lamoureux, E.L.; et al. Evaluating the Acceptability and Pilot Diagnostic Accuracy of a Visually Independent Test Battery of Neurocognition (VISION-Cog). Med. Sci. 2026, 14, 344. https://doi.org/10.3390/medsci14030344

AMA Style

Yee H, Ho AXY, Wong CMJ, Tan WL, Fenwick EK, Gupta P, Ng ASL, Vu TA, Doshi K, Lamoureux EL, et al. Evaluating the Acceptability and Pilot Diagnostic Accuracy of a Visually Independent Test Battery of Neurocognition (VISION-Cog). Medical Sciences. 2026; 14(3):344. https://doi.org/10.3390/medsci14030344

Chicago/Turabian Style

Yee, Hiromi, Aricia Xin Yi Ho, Chiew Meng Johnny Wong, Wei Lin Tan, Eva K. Fenwick, Preeti Gupta, Adeline S. L. Ng, Tai Anh Vu, Kinjal Doshi, Ecosse L. Lamoureux, and et al. 2026. "Evaluating the Acceptability and Pilot Diagnostic Accuracy of a Visually Independent Test Battery of Neurocognition (VISION-Cog)" Medical Sciences 14, no. 3: 344. https://doi.org/10.3390/medsci14030344

APA Style

Yee, H., Ho, A. X. Y., Wong, C. M. J., Tan, W. L., Fenwick, E. K., Gupta, P., Ng, A. S. L., Vu, T. A., Doshi, K., Lamoureux, E. L., & Man, R. E. K. (2026). Evaluating the Acceptability and Pilot Diagnostic Accuracy of a Visually Independent Test Battery of Neurocognition (VISION-Cog). Medical Sciences, 14(3), 344. https://doi.org/10.3390/medsci14030344

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