Extensive research has demonstrated that eye-tracking tasks can effectively indicate cognitive impairment. For example, lab-based eye-tracking tasks, such as the antisaccade task, have robustly distinguished between people with Alzheimer’s disease (AD) and healthy older adults. Due to the neurodegeneration associated with AD, people with AD often display extended saccade latencies and increased error rates on eye-tracking tasks. Although the effectiveness of using eye tracking to identify cognitive impairment appears promising, research considering the utility of eye tracking during naturalistic tasks, such as reading, in identifying cognitive impairment is limited. The current review identified 39 articles assessing eye-tracking distinctions between people with AD, mild cognitive impairment (MCI), and healthy controls when completing naturalistic task (reading, real-life simulations, static image search) or a goal-directed task involving naturalistic stimuli. The results revealed that naturalistic tasks show promising biomarkers and distinctions between healthy older adults and AD participants, and therefore show potential to be used for diagnostic and monitoring purposes. However, only twelve articles included MCI participants and assessed the sensitivity of measures to detect cognitive impairment in preclinical stages. In addition, the review revealed inconsistencies within the literature, particularly when assessing reading tasks. We urge researchers to expand on the current literature in this area and strive to assess the robustness and sensitivity of eye-tracking measures in both AD and MCI populations on naturalistic tasks.

People with dementia can be disadvantaged in accessing health and social care services for diagnosis and care depending on where they live (including rural vs suburban vs. urban; postcode; country). Without an existing comprehensive synthesis of the evidence to date, the aim of this systematic review was to explore the evidence on geographical inequalities in accessing services for dementia diagnosis and care. Five databases were searched in June 2024, including studies conducted in any country, published from 2010 onwards, and in English or German. Titles and abstracts, and then full texts, were screened by at least two reviewers each. Any discrepancies were resolved in discussion with a third reviewer. Data were extracted by two researchers and synthesised narratively. From 1321 studies screened and 49 full texts read, 32 studies were included in the final review. Most studies were conducted in the US, followed by the UK. Geographical inequalities in dementia are most often evidenced in relation to availability and suitability of services in different regions within a country, or a lack thereof. People with dementia residing in rural areas often experience challenges in receiving a timely diagnosis and accessing health and social care. No research has addressed geographical inequalities in accessing residential care. Innovative models on improving efficiency and quantity of diagnosis rates in rural Canada and Australia emerged. Health and social care services in rural areas need to be increased and made more suitable to the needs of people with dementia. More research needs to explore inequalities experienced by people with rarer forms of dementia. National strategies to overhaul the health and social care system need to focus on the rurality issue and recommend strategies to improve service access.

Various studies have shown that Alzheimer’s disease (AD) is associated with an impairment of inhibitory control, although we do not have a comprehensive understanding of the associated cognitive processes. The ability to engage and disengage attention is a crucial cognitive operation of inhibitory control and can be readily investigated using the “gap effect” in a saccadic eye movement paradigm. In previous work, various demographic factors were confounded; therefore, here, we examine separately the effects of cognitive impairment in Alzheimer’s disease, ethnicity/culture and age. This study included young (N = 44) and old (N = 96) European participants, AD (N = 32), mildly cognitively impaired participants (MCI: N = 47) and South Asian older adults (N = 94). A clear reduction in the mean reaction times was detected in all the participant groups in the gap condition compared to the overlap condition, confirming the effect. Importantly, this effect was also preserved in participants with MCI and AD. A strong effect of age was also evident, revealing a slowing in the disengagement of attention during the natural process of ageing.

In April 2022, mandatory kilocalorie (kcal) labelling in the out-of-home food sector was introduced as a policy to reduce obesity in England. Here we examined whether the implementation of this policy was associated with a consumer behaviour change. Large out-of-home food sector outlets subject to kcal labelling legislation were visited pre- and post-implementation, and customer exit surveys were conducted with 6,578 customers from 330 outlets. Kcals purchased and consumed, knowledge of purchased kcals and reported noticing and use of kcal labelling were examined. The results suggested that the introduction of the mandatory kcal labelling policy in England was not associated with a significant decrease in self-reported kcals purchased (B = 11.31, P = 0.564, 95% confidence interval (CI) −27.15 to 49.77) or consumed (B = 18.51, P = 0.279, 95% CI −15.01 to 38 52.03). Post-implementation, participants underestimated the energy content of their purchased meal less (B = 61.21, P = 0.002, 95% CI 21.57 to 100.86) and were more likely to report noticing (odds ratio 2.25, P < 0.001, 95% CI 1.84 to 2.73) and using (odds ratio 2.15, P < 0.001, 95% CI 1.62 to 2.85) kcal labelling, which may have wider public health implications.

Background and objectives On 6 April 2022, the UK government implemented mandatory kilocalorie (kcal) labelling regulations for food and drink products sold in the out-of-home food sector (OHFS) in England. Previous assessments of kcal labelling practices in the UK OHFS found a low prevalence of voluntary implementation and poor compliance with labelling recommendations. This study aimed to examine changes in labelling practices preimplementation versus post implementation of mandatory labelling regulations in 2022. Methods In August–December 2021 (preimplementation) and August–November 2022 (post implementation), large OHFS businesses (250 or more employees) subject to labelling regulations were visited. At two time points, a researcher visited the same 117 food outlets (belonging to 90 unique businesses) across four local authorities in England. Outlets were rated for compliance with government regulations for whether kcal labelling was provided at any or all point of choice, provided for all eligible food and drink items, provided per portion for sharing items, if labelling was clear and legible and if kcal reference information was displayed. Results There was a significant increase (21% preimplementation vs 80% post implementation, OR=40.98 (95% CI 8.08 to 207.74), p<0.001) in the proportion of outlets providing any kcal labelling at point-of-choice post implementation. Only 15% of outlets met all labelling compliance criteria post implementation, with a minority of outlets not presenting labelling in a clear (33%) or legible (29%) way. Conclusion The number of large businesses in the OHFS providing kcal labelling increased following the implementation of mandatory labelling regulations. However, around one-fifth of eligible outlets sampled were not providing kcal labelling 4–8 months after the regulations came into force, and the majority of businesses only partially complied with government guidance. More effective enforcement may be required to further improve kcal labelling practices in the OHFS in England. Preregistration Study protocol and analysis strategy preregistered on Open Science Framework (https://osf.io/pfnm6/).

Background: Regulations mandating kilocalorie (kcal) labelling for large businesses in the out-of-home food sector (OHFS) came into force on 6th April 2022 as a policy to reduce obesity in England. To provide indicators of potential reach and impact, kcal labelling practices were studied in the OHFS, and customer purchasing and consumption behaviours prior to implementation of the mandatory kcal labelling policy in England. Methods: From August-December 2021, large OHFS businesses subject to the kcal labelling regulations were visited prior to regulations coming into force on 6th April 2022. 3308 customers were recruited from 330 outlets and collected survey information on the number of kcal purchased and consumed by customers, customers’ knowledge of the kcal content of their purchases, and customers noticing and use of kcal labelling. In a subset of 117 outlets, data was collected on nine recommended kcal labelling practices. Results: The average number of kcals purchased (1013 kcal, SD = 632 kcal) was high with 69% of purchases exceeding the recommendation of a maximum of 600 kcal per meal. Participants underestimated the energy content of their purchased meals by on average 253 kcal (SD = 644 kcals). In outlets providing kcal labelling in which customer survey data was collected, a minority of customers reported noticing (21%) or using (20%) kcal labelling. Out of the 117 outlets assessed for kcal labelling practices, 24 (21%) provided any in-store kcal labelling. None of the outlets met all nine aspects of recommended labelling practices. Conclusions: Prior to implementation of 2022 kcal labelling policy, the majority of sampled OHFS large business outlets in England did not provide kcal labelling. Few customers noticed or used the labels and on average customers purchased and consumed substantially more energy than recommended in public health guidelines. The findings suggest that reliance on voluntary action for kcal labelling implementation failed to produce widespread, consistent, and adequate kcal labelling practices.