Subject ID:

Initials:
Date:
Administered by:

Language administered: English / Mandarin / Malay / Hokkien/ Teochew / Cantonese / Others (Please
specify): _______________
Time Start: ____________

Memory
1) Scenario
Please look at the picture below and (1 min):
- Name the location
- Name me the items that you can see
Dog Coconut Tree Kite Crab Lady Bone

Visuospatial
2)
Which of the following option (A, B, C or D) when folded up will result in the figure below? Please circle one
option.

______ / 1

3) Grid
Please copy the figure from on the left to the empty one on the right as fast as you can.

______ / 2

A Visual Based Cognitive Assessment Tool (VCAT) for the Early Diagnosis of Dementia in a Multilingual
Asian Population, Answer Sheet
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 Subject ID:
Initials:
Date:
Administered by:
Attention/ Working Memory
4) Shape Cancellation

Cancel the following shapes: and . You have 1 minute.

____ / 3

5) Delayed Recall: Scenario

You were shown a picture of a scenario earlier. There are 3 objects below that were NOT present in the picture
earlier. Please circle these three items.

____ /3

Memory
6) Shapes
Please look at the shapes and try to remember as many elements as you can. I will ask you about it later (10s).

A Visual Based Cognitive Assessment Tool (VCAT) for the Early Diagnosis of Dementia in a Multilingual
Asian Population, Answer Sheet
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 Subject ID:
Initials:
Date:
Administered by:
Language
7) Naming
Please name the items below.
Paperclip Bicycle Lightbulb
____ /3

8) Semantic Fluency
Please name as many vegetables as you can.

Vegetables Total

____/ 2

Executive Function
9) Gears
(a) If Gear 1 is turning in the indicated direction, please draw the arrow in which will Gear 2 turn.

(b) If Gear 1 turns in the indicated direction, in which direction will Gear 3 turn?

____ / 3

A Visual Based Cognitive Assessment Tool (VCAT) for the Early Diagnosis of Dementia in a Multilingual
Asian Population, Answer Sheet
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 Subject ID:
Initials:
Date:
Administered by:
10) Delayed Recall: Shapes
I showed you some shapes earlier. Please try to recall and fill in the boxes below with the shapes you saw.

____ / 2

Memory
11) Objects
Please name the objects. * Repeat this twice. I’d like you to remember these FOUR objects, I will ask you
about them later (20s).
Executive Function
12) Patterns
Take a look at the patterns below and fill in the empty boxes with the correct patterns.
(a) (b)

____ / 2

A Visual Based Cognitive Assessment Tool (VCAT) for the Early Diagnosis of Dementia in a Multilingual
Asian Population, Answer Sheet
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 Subject ID:
Initials:
Date:
Administered by:
13) Category
Which of the following options (A, B or C) is the best option to place inside the empty box? Please circle your
option.

____ / 1

Please turn over.

A Visual Based Cognitive Assessment Tool (VCAT) for the Early Diagnosis of Dementia in a Multilingual
Asian Population, Answer Sheet
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 Subject ID:
Initials:
Date:
Administered by:
Delayed Memory: Objects
14) I showed you four objects earlier. Can you recall what the four objects are?

Hamburger Bench Broom Teapot Score

Uncued (2 points) ____ /8
Cued (1 point)

Time End: ____________

A Visual Based Cognitive Assessment Tool (VCAT) for the Early Diagnosis of Dementia in a Multilingual
Asian Population, Answer Sheet
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