Toward Inclusive Screening of Cognitive Impairment: Validating the Visual Cognitive Assessment Test Among U.S.-Based...

Black/African American and Latino populations are disproportionately affected by Alzheimer's disease (AD), yet underrepresented in research due to biases in cognitive assessments like the Montreal Cognitive Assessment (MoCA). The Visual-based Cognitive Assessment Test (VCAT) minimizes these biases through a culturally neutral, visual-based approach. This study evaluates VCAT's comparability to MoCA and its association with plasma p-tau217, a validated AD biomarker. Cross-sectional study assessing cognitive performance in two cohorts, with plasma p-tau217 levels available in Cohort 2 only. Memory disorders clinic. Fifty-six ethnoracially diverse individuals diagnosed with normal cognition (NC), mild cognitive impairment (MCI), or dementia. Cognitive performance was assessed using VCAT and MoCA. Linear regression models analyzed differences in cognitive scores across diagnostic groups and associations with p-tau217 levels. VCAT scores were comparable to MoCA across diagnostic groups. In Cohort 1, NC had higher VCAT (β = 23.22, p < 0.001) and MoCA scores (β = 25.56, p < 0.001), while dementia had lower VCAT (β = -10.86, p < 0.001) and MoCA scores (β = -10.37, p < 0.001). Similar patterns were observed in Cohort 2. Plasma p-tau217 inversely correlated with both VCAT (β = -13.63, p < 0.001) and MoCA (β = -16.26, p < 0.001) in dementia, with no significant differences in MCI. VCAT strongly aligns with MoCA, providing a culturally unbiased alternative for cognitive screening. Its association with plasma p-tau217 highlights its potential to reflect AD pathology, supporting its clinical and research applications.