{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:50:01Z","timestamp":1785408601018,"version":"3.56.0"},"reference-count":22,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019579","name":"SingHealth","doi-asserted-by":"crossref","award":["#CGOct22S01"],"award-info":[{"award-number":["#CGOct22S01"]}],"id":[{"id":"10.13039\/100019579","id-type":"DOI","asserted-by":"crossref"}]},{"award":["#CGOct22S01"],"award-info":[{"award-number":["#CGOct22S01"]}],"id":[{"id":"https:\/\/ror.org\/04me94w47","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>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] \u2265 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\u2019s 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.<\/jats:p>","DOI":"10.3390\/medsci14030344","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T03:20:21Z","timestamp":1782357621000},"page":"344","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Acceptability and Pilot Diagnostic Accuracy of a Visually Independent Test Battery of Neurocognition (VISION-Cog)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4019-4842","authenticated-orcid":false,"given":"Hiromi","family":"Yee","sequence":"first","affiliation":[{"name":"Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, Singapore 169856, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aricia Xin Yi","family":"Ho","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, Singapore 169856, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiew Meng Johnny","family":"Wong","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, Singapore 169856, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Lin","family":"Tan","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, Singapore 169856, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0417-2048","authenticated-orcid":false,"given":"Eva K.","family":"Fenwick","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, Singapore 169856, Singapore"},{"name":"Duke\u2013NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Gupta","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, Singapore 169856, Singapore"},{"name":"Duke\u2013NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adeline S. L.","family":"Ng","sequence":"additional","affiliation":[{"name":"Duke\u2013NUS Medical School, National University of Singapore, Singapore 169857, Singapore"},{"name":"National Neuroscience Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tai Anh","family":"Vu","sequence":"additional","affiliation":[{"name":"Duke\u2013NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3017-8841","authenticated-orcid":false,"given":"Kinjal","family":"Doshi","sequence":"additional","affiliation":[{"name":"Department of Psychology, National University of Singapore, Singapore 117572, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8674-5705","authenticated-orcid":false,"given":"Ecosse L.","family":"Lamoureux","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, Singapore 169856, Singapore"},{"name":"Duke\u2013NUS Medical School, National University of Singapore, Singapore 169857, Singapore"},{"name":"Department of Ophthalmology, University of Melbourne, Parkville Victoria 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5028-605X","authenticated-orcid":false,"given":"Ryan E. K.","family":"Man","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute (SERI), Singapore National Eye Centre, The Academia, Singapore 169856, Singapore"},{"name":"Duke\u2013NUS Medical School, National University of Singapore, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1159\/000533636","article-title":"Synergistic Impact of Visual and Cognitive Impairments on Health-Related Quality of Life in a Multiethnic Asian Population","volume":"70","author":"Vu","year":"2024","journal-title":"Gerontology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1177\/1010539512443698","article-title":"Comorbid visual and cognitive impairment: Relationship with disability status and self-rated health among older Singaporeans","volume":"26","author":"Whitson","year":"2014","journal-title":"Asia Pac. J. Public Health"},{"key":"ref_3","unstructured":"Li, S. (2024). Population Aging and Living Arrangements in Asia: Facts, Observations, and Responses, Xi\u2019an Jiaotong University."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1076\/jcen.20.3.310.823","article-title":"The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Preliminary clinical validity","volume":"20","author":"Randolph","year":"1998","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1017\/S104161021700120X","article-title":"Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: A scoping review","volume":"29","author":"Pye","year":"2017","journal-title":"Int. Psychogeriatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/01688639408402633","article-title":"Effect of visual impairment on neuropsychological test performance","volume":"16","author":"Kempen","year":"1994","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4033","DOI":"10.1038\/s41598-022-07924-8","article-title":"The effect of age-related macular degeneration on cognitive test performance","volume":"12","author":"Macnamara","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1097\/OPX.0b013e3181fe64d7","article-title":"Simulated Visual Impairment Leads to Cognitive Slowing in Older Adults","volume":"87","author":"Wood","year":"2010","journal-title":"Optom. Vis. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1093\/ageing\/afs157","article-title":"The assessment of cognition in visually impaired older adults","volume":"42","author":"Killen","year":"2013","journal-title":"Age Ageing"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S0895-4356(02)00449-3","article-title":"Adaptation of dementia screening for vision-impaired older persons: Administration of the Mini-Mental State Examination (MMSE)","volume":"55","author":"Busse","year":"2002","journal-title":"J. Clin. Epidemiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1177\/0145482X1010400606","article-title":"Sensitivity and Specificity of the Montreal Cognitive Assessment Modified for Individuals who are Visually Impaired","volume":"104","author":"Wittich","year":"2010","journal-title":"J. Vis. Impair. Blind."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/00013614-200407000-00007","article-title":"Neuropsychological Assessment in Individuals With Severe Visual Impairment","volume":"20","author":"Bylsma","year":"2004","journal-title":"Top. Geriatr. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e070850","DOI":"10.1136\/bmjopen-2022-070850","article-title":"Content development of the VISION-Cog: A novel tool to assess cognitive impairment in visually impaired older adults in Singapore","volume":"13","author":"Vu","year":"2023","journal-title":"BMJ Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.14336\/AD.2020.0206","article-title":"Rationale and Methodology of The PopulatION HEalth and Eye Disease PRofile in Elderly Singaporeans Study [PIONEER]","volume":"11","author":"Gupta","year":"2020","journal-title":"Aging Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"h5527","DOI":"10.1136\/bmj.h5527","article-title":"STARD 2015: An updated list of essential items for reporting diagnostic accuracy studies","volume":"351","author":"Bossuyt","year":"2015","journal-title":"BMJ Br. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.]. DSM-5.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e130","DOI":"10.1016\/S2214-109X(20)30425-3","article-title":"Trends in prevalence of blindness and distance and near vision impairment over 30 years: An analysis for the Global Burden of Disease Study","volume":"9","author":"Blindness","year":"2021","journal-title":"Lancet Glob. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"616","DOI":"10.11622\/smedj.2013220","article-title":"Effectiveness of Montreal Cognitive Assessment for the diagnosis of mild cognitive impairment and mild Alzheimer\u2019s disease in Singapore","volume":"54","author":"Ng","year":"2013","journal-title":"Singap. Med. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1002\/bimj.200410135","article-title":"Estimation of the Youden Index and its associated cutoff point","volume":"47","author":"Fluss","year":"2005","journal-title":"Biom. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1017\/S1041610218001370","article-title":"Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer\u2019s Disease (AD) in the elderly?","volume":"31","author":"Pinto","year":"2019","journal-title":"Int. Psychogeriatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1176\/ajp.156.12.1944","article-title":"Repeatable Battery for the Assessment of Neuropsychological Status as a Screening Test in Schizophrenia, I: Sensitivity, Reliability, and Validity","volume":"156","author":"Gold","year":"1999","journal-title":"Am. J. Psychiatry"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/344\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T04:17:47Z","timestamp":1783397867000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medsci14030344"],"URL":"https:\/\/doi.org\/10.3390\/medsci14030344","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}