To evaluate new rapid automatized naming (RAN) tests and measures of visual pathway structure and function for distinguishing mild cognitive impairment (MCI) due to Alzheimer’s disease (AD) from cognitively normal individuals. To examine how visual measures correlate with vision-specific quality of life.

Visual markers of AD are well-studied and can be sensitive and non-invasive.  RAN tasks have shown promise in detecting mild cognitive impairment and should be further examined with other visual measures for early disease detection.

Well-characterized MCI and cognitively normal participants performed rapid automatized naming using the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number (SUN) test, high and low-contrast letter acuity (LCLA) testing, and vision-specific quality of life scales, including the 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement. Individuals also underwent optical coherence tomography scans to assess peripapillary retinal nerve fiber layer and ganglion cell/ inner plexiform layer thicknesses. Qualitative assessment of hippocampal atrophy on MRI was also determined from participants’ research/clinical data.

MCI participants (n=14) had worse 1.25% LCLA (p=0.009) and worse MULES time (p=0.006) with more errors naming pictures (p=0.009) than controls (n=16). The two groups did not differ in other tests. MULES time (AUC=0.79), MULES errors (AUC 0.78), and 1.25% LCLA (AUC=0.78) had good diagnostic accuracy for differentiating MCI versus controls, with combined MULES time and 1.25% LCLA demonstrating best accuracy (AUC=0.87). These visual tests were better predictors of MCI versus control status than hippocampal atrophy on MRI. Greater MULES errors (r_s= -0.50, P=0.005) and worse 1.25% LCLA scores (r_s=0.39, P=0.03) were associated with worse NEI-VFQ-25 scores.

Rapid picture naming (MULES) and LCLA distinguish MCI due to AD from normal aging and reflect vision-specific quality of life.  These easily-administered tests may identify patients at risk for AD dementia and serve as measures in disease-modifying therapy clinical trials.