Clinical Utility of Ocular Assessments in Sport-Related Concussion: A Scoping Review.

Background/objectives: Ocular tools and technologies may be used in the diagnosis of sport-related concussions (SRCs), but their clinical utility can vary. The following study aimed to review the literature pertaining to the reliability and diagnostic accuracy of such assessments. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) extension for scoping reviews was adhered to. Reference standard reliability (RSR ≥ 0.75) and diagnostic accuracy (RSDA ≥ 0.80) were implemented to aid interpretation. Results: In total, 5223 articles were screened using the PCC acronym (Population, Concept, Context) with 74 included in the final analysis. Assessments included the King-Devick (KD) (n = 34), vestibular-ocular motor screening (VOMs) and/or near point of convergence (NPC) (n = 25), and various alternative tools and technologies (n = 20). The KD met RSR, but RSDA beyond amateur sport was limited. NPC met RSR but did not have RSDA to identify SRCs. The VOMs had conflicting RSR for total score and did not meet RSR in its individual tests. The VOMs total score did perform well in RSDA for SRCs. No alternative tool or technology met both RSR and RSDA. Conclusion: Ocular tools are useful, rapid screening tools but should remain within a multi-modal assessment for SRCs at this time.

Mild hunger elicits attentional desensitization to visual food cues in healthy, non-obese individuals.

Introduction: Food is a vital human need, and the human visual system is finely tuned to detect and respond to food cues in the environment. The omnipresence of food cues across various settings has been linked to the prevalence of obesity in susceptible populations. However, the influence of the post-prandial state on visual attention to food stimuli remains poorly understood. This study aimed to elucidate how a 12 hour fast affects visual attention to food and non-food stimuli in healthy, non-obese individuals. Methods: Visual attention was assessed by measuring the total duration of visual fixations on stimuli presented on a computer screen, using a screen-based eye tracker (Tobii X2-60). Participants were divided into two groups: those who had fasted for 12 hours and those tested within two hours after consuming breakfast (satiated state). Additionally, performance on the Food Stroop task and electrodermal activity (EDA) responses were measured to evaluate attentional interference and physiological arousal, respectively. Salivary samples were also collected to assess levels of alpha-amylase and cortisol. Results: Fasted participants exhibited a progressive decline in visual attention toward food stimuli compared to satiated individuals, reflecting a satiated state. This effect was independent of the palatability of the depicted food items and was not observed with stimuli representing non-food items. The Food Stroop task revealed no differences between fasting and satiated participants, indicating that the presence of food-related stimuli does not differentially impact attentional interference under varying hunger states. Moreover, no significant variations were observed in EDA responses across participant groups and stimulus types, suggesting that the modulation of visual attention to food cues by hunger is independent of physiological arousal. Interestingly, satiated subjects exhibited higher levels of salivary alpha-amylase, which was inversely related to their subjective hunger ratings. No differences in salivary cortisol levels were found between groups. Discussion: The findings indicate a novel influence of mild hunger on the processing of visual food cues, independent of physiological arousal. The decline in visual attention to food stimuli in fasted individuals suggests that satiety modulates visual processing. The lack of differences in attentional interference and physiological arousal between fasting and satiated states further supports the notion that visual attention to food cues is primarily driven by hunger-related mechanisms rather than stress. Additionally, the inverse relationship between salivary alpha-amylase levels and hunger ratings implies that alpha-amylase may serve as a marker of satiety rather than stress.

Examining gaze behavior in undergraduate students and educators during the evaluation of tooth preparation: an eye-tracking study.

BACKGROUND: Gaze behavior can serve as an objective tool in undergraduate pre-clinical dental education, helping to identify key areas of interest and common pitfalls in the routine evaluation of tooth preparations. Therefore, this study aimed to investigate the gaze behavior of undergraduate dental students and dental educators while evaluating a single crown tooth preparation. METHODS: Thirty-five participants volunteered to participate in the study and were divided into a novice group (dental students, n = 18) and an expert group (dental educators, n = 17). Each participant wore a binocular eye-tracking device, and the total duration of fixation was evaluated as a metric to study the gaze behavior. Sixty photographs of twenty different tooth preparations in three different views (buccal, lingual, and occlusal) were prepared and displayed during the experimental session. The participants were asked to rate the tooth preparations on a 100 mm visual analog rating scale and were also asked to determine whether each tooth preparation was ready to make an impression. Each view was divided into different areas of interest. Statistical analysis was performed with a three-way analysis of the variance model with repeated measures. RESULTS: Based on the participants' mean rates, the "best" and the "worst" tooth preparations were selected for analysis. The results showed a significantly longer time to decision in the novices compared to the experts (P = 0.003) and a significantly longer time to decision for both the groups in the best tooth preparation compared to the worst tooth preparation (P = 0.002). Statistical analysis also showed a significantly longer total duration of fixations in the margin compared to all other conditions for both the buccal (P < 0.012) and lingual (P < 0.001) views. CONCLUSIONS: The current study showed distinct differences in gaze behavior between the novices and the experts during the evaluation of single crown tooth preparation. Understanding differences in gaze behavior between undergraduate dental students and dental educators could help improve tooth preparation skills and provide constructive customized feedback.

Attention-language interface in Multilingual Assessment instrument for Narratives.

The current study employed the Multilingual Assessment Instrument for Narratives (MAIN) to test comprehension of narrative macrostructure in Russian in a visual world eye-tracking paradigm. The four MAIN visual narratives are structurally similar and question referents' goals and internal states (IS). Previous research revealed that children's MAIN comprehension differed among the four narratives in German, Swedish, Russian, and Turkish, but it is not clear why. We tested whether the difference in comprehension was (a) present, (b) caused by complicated inferences in understanding IS compared with goals, and (c) ameliorated by orienting visual attention to the referents whose IS was critical for accurate comprehension. Our findings confirmed (a) and (b) but found no effect of attentional cues on accuracy for (c). The multidimensional theory of narrative organization of children's knowledge of macrostructure needs to consider the type of inferences necessary for IS that are influenced by subjective interpretation and reasoning.

Pupillary dilation response to the auditory food words in adolescents with obesity without binge eating disorder.

Childhood obesity is a growing global public health problem. Studies suggest that environmental cues contribute to developing and maintaining obesity. We aimed to evaluate pupillary changes to auditory food words vs. nonfood words and to conduct a dynamic temporal analysis of pupil size changes in adolescents with obesity without binge eating disorder by comparing healthy-weight adolescents. In this study, a total of 63 adolescents aged 12-18 years (n = 32, obesity group (OG); n = 31, control group (CG)) were included. In an auditory paradigm, participants were presented with a series of high and low-calorie food and nonfood words. A binocular remote eye-tracking device was used to measure pupil diameter. Generalized additive mixed models (GAMMs) were used for dynamic temporal analysis of pupillometry data. The results of GAMM analysis indicated that CG had larger pupil dilation than the OG while listening to auditory food words. CG had larger pupil dilation in food words than in nonfood words. However, the OG had a similar pupillary response in food and nonfood words. Pupil dilation response to higher-calorie foods was extended over the later stages of the time period (after 2000 ms) in the OG. In summary, our findings indicated that individuals with obesity had lower pupil dilation to auditory food words compared to normal-weight peers. Adolescents with obesity had prolonged pupillary dilation in higher calories of food words. The individual psychological factors affecting the dynamic changes of pupil responses to food cues in adolescents with obesity should be examined in further studies.

Syntactic flexibility and lexical encoding in aging sentence production: an eye tracking study.

Purpose: Successful sentence production requires lexical encoding and ordering them into a correct syntactic structure. It remains unclear how different processes involved in sentence production are affected by healthy aging. We investigated (a) if and how aging affects lexical encoding and syntactic formulation during sentence production, using auditory lexical priming and eye tracking-while-speaking paradigms and (b) if and how verbal working memory contributes to age-related changes in sentence production. Methods: Twenty older and 20 younger adults described transitive and dative action pictures following auditory lexical primes, by which the relative ease of encoding the agent or theme nouns (for transitive pictures) and the theme and goal nouns (for dative pictures) was manipulated. The effects of lexical priming on off-line syntactic production and real-time eye fixations to the primed character were measured. Results: In offline production, older adults showed comparable priming effects to younger adults, using the syntactic structure that allows earlier mention of the primed lexical item in both transitive and dative sentences. However, older adults showed longer lexical priming effects on eye fixations to the primed character during the early stages of sentence planning. Preliminary analysis indicated that reduced verbal working memory may in part account for longer lexical encoding, particularly for older adults. Conclusion: These findings indicate that syntactic flexibility for formulating different grammatical structures remains largely robust with aging. However, lexical encoding processes are more susceptible to age-related changes, possibly due to changes in verbal working memory.

Multimodal insights into granger causality connectivity: Integrating physiological signals and gated eye-tracking data for emotion recognition using convolutional neural network.

This study introduces a groundbreaking method to enhance the accuracy and reliability of emotion recognition systems by combining electrocardiogram (ECG) with electroencephalogram (EEG) data, using an eye-tracking gated strategy. Initially, we propose a technique to filter out irrelevant portions of emotional data by employing pupil diameter metrics from eye-tracking data. Subsequently, we introduce an innovative approach for estimating effective connectivity to capture the dynamic interaction between the brain and the heart during emotional states of happiness and sadness. Granger causality (GC) is estimated and utilized to optimize input for a highly effective pre-trained convolutional neural network (CNN), specifically ResNet-18. To assess this methodology, we employed EEG and ECG data from the publicly available MAHNOB-HCI database, using a 5-fold cross-validation approach. Our method achieved an impressive average accuracy and area under the curve (AUC) of 91.00 % and 0.97, respectively, for GC-EEG-ECG images processed with ResNet-18. Comparative analysis with state-of-the-art studies clearly shows that augmenting ECG with EEG and refining data with an eye-tracking strategy significantly enhances emotion recognition performance across various emotions.

Harnessing technology to measure individual differences in spatial thinking in early childhood from a relational developmental systems perspective.

According to the Relational Developmental Systems perspective, the development of individual differences in spatial thinking (e.g., mental rotation, spatial reorientation, and spatial language) are attributed to various psychological (e.g., children's cognitive strategies), biological (e.g., structure and function of hippocampus), and cultural systems (e.g., caregiver spatial language input). Yet, measuring the development of individual differences in spatial thinking in young children, as well as the psychological, biological, and cultural systems that influence the development of these abilities, presents unique challenges. The current paper outlines ways to harness available technology including eye-tracking, eye-blink conditioning, MRI, Zoom, and LENA technology, to study the development of individual differences in young children's spatial thinking. The technologies discussed offer ways to examine children's spatial thinking development from different levels of analyses (i.e., psychological, biological, cultural), thereby allowing us to advance the study of developmental theory. We conclude with a discussion of the use of artificial intelligence.

Spatiotemporal Eye Movement Dynamics Reveal Altered Face Prioritization in Early Visual Processing Among Autistic Children.

BACKGROUND: Reduced social attention - looking at faces - is one of the most common manifestations of social difficulty in autism central to social development. Although reduced social attention is well-characterized in autism, qualitative differences in how social attention unfolds across time remains unknown. METHODS: We used a computational modeling (i.e., hidden Markov modeling) approach to assess and compare the spatiotemporal dynamics of social attention in a large, well-characterized sample of autistic (n = 280) and neurotypical (n = 120) children (ages 6-11) that completed three social eye-tracking assays across three longitudinal time points (Baseline, 6 weeks, 24 weeks). RESULTS: Our analysis supported the existence of two common eye movement patterns that emerged across three ET assays. A focused pattern was characterized by small face regions of interest, which had high probability of capturing fixations early in visual processing. In contrast, an exploratory pattern was characterized by larger face regions of interest, with lower initial probability of fixation, and more non-social regions of interest. In the context of social perception, autistic children showed significantly more exploratory eye movement patterns than neurotypical children across all social perception assays and all three longitudinal time points. Eye movement patterns were associated with clinical features of autism, including adaptive function, face recognition, and autism symptom severity. CONCLUSIONS: Decreased likelihood of precisely looking to faces early in social visual processing may be an important feature of autism that was associated with autism-related symptomology and may reflect less visual sensitivity to face information.

Predicting Basketball Shot Outcome From Visuomotor Control Data Using Explainable Machine Learning.

Quiet eye (QE), the visual fixation on a target before initiation of a critical action, is associated with improved performance. While QE is trainable, it is unclear whether QE can directly predict performance, which has implications for training interventions. This study predicted basketball shot outcome (make or miss) from visuomotor control variables using a decision tree classification approach. Twelve basketball athletes completed 200 shots from six on-court locations while wearing mobile eye-tracking glasses. Training and testing data sets were used for modeling eight predictors (shot location, arm extension time, and absolute and relative QE onset, offset, and duration) via standard and conditional inference decision trees and random forests. On average, the trees predicted over 66% of makes and over 50% of misses. The main predictor, relative QE duration, indicated success for durations over 18.4% (range: 14.5%-22.0%). Training to prolong QE duration beyond 18% may enhance shot success.

Perspective matters in goal-predictive gaze shifts during action observation: Results from 6-, 9-, and 12-month-olds and adults.

Research on goal-predictive gaze shifts in infancy so far has mostly focused on the effect of infants' experience with observed actions or the effect of agency cues that the observed agent displays. However, the perspective from which an action is presented to the infants (egocentric vs. allocentric) has received only little attention from researchers despite the fact that the natural observation of own actions is always linked to an egocentric perspective, whereas the observation of others' actions is often linked to an allocentric perspective. The current study investigated the timing of 6-, 9-, and 12-month-olds' goal-predictive gaze behavior, as well as that of adults, during the observation of simple human grasping actions that were presented from either an egocentric or allocentric perspective (within-participants design). The results showed that at 6 and 9 months of age, the infants predicted the action goal only when observing the action from the egocentric perspective. The 12-month-olds and adults, in contrast, predicted the action in both perspectives. The results therefore are in line with accounts proposing an advantage of egocentric versus allocentric processing of social stimuli, at least early in development. This study is among the first to show this egocentric bias already during the first year of life.

Differences between overt, covert and natural attention shifts to emotional faces.

In daily life, individuals pay attention to emotional facial expressions and dynamically choose how to shift their attention, i.e. either overtly (with eye-movements) or covertly (without eye-movements). However, research on attention to emotional faces has mostly been conducted in controlled laboratory settings, in which people were instructed where to look. The current preregistered study co-registered EEG and eye-tracking to investigate differences in emotion-driven attention between instructed and uninstructed natural attention shifts in 48 adults. While a central stimulus was presented to the participant, a face appeared in the periphery, showing either a happy, neutral or an angry expression. In three counterbalanced blocks participants were instructed to either move their eyes overtly to the peripheral face, keep fixating the center and therefore covertly shift their attention, or freely look wherever they would like to look. We found that emotional content had stronger effects on the amplitude of the Early Posterior Negativity when participants shifted attention naturally, and that natural shifts of attention differed from instructed shifts in both saccade behavior and neural mechanisms. In summary, our results emphasize the importance of investigating modulation of attention using paradigms that allow participants to allocate their attention naturally.

Eye tracking is more sensitive than skin conductance response in detecting mild environmental stimuli.

The skin conductance (SC) and eye tracking data are two potential arousal-related psychophysiological signals that can serve as the interoceptive unconditioned response to aversive stimuli (e.g. electric shocks). The current research investigates the sensitivity of these signals in detecting mild electric shock by decoding the hidden arousal and interoceptive awareness (IA) states. While well-established frameworks exist to decode the arousal state from the SC signal, there is a lack of a systematic approach that decodes the IA state from pupillometry and eye gaze measurements. We extract the physiological-based features from eye tracking data to recover the IA-related neural activity. Employing a Bayesian filtering framework, we decode the IA state in fear conditioning and extinction experiments where mild electric shock is used. We independently decode the underlying arousal state using binary and marked point process (MPP) observations derived from concurrently collected SC data. Eight of 11 subjects present a significantly (P-value < 0.001 ) higher IA state in trials that were always accompanied by electric shock ( CS + US + ) compared to trials that were never accompanied by electric shock ( CS - ). According to the decoded SC-based arousal state, only five (binary observation) and four (MPP observation) subjects present a significantly higher arousal state in CS + US + trials than CS - trials. In conclusion, the decoded hidden brain state from eye tracking data better agrees with the presented mild stimuli. Tracking IA state from eye tracking data can lead to the development of contactless monitors for neuropsychiatric and neurodegenerative disorders.

A shared robot control system combining augmented reality and motor imagery brain-computer interfaces with eye tracking.

Objective: Brain-computer interface (BCI) control systems monitor neural activity to detect the user's intentions, enabling device control through mental imagery. Despite their potential, decoding neural activity in real-world conditions poses significant challenges, making BCIs currently impractical compared to traditional interaction methods. This study introduces a novel motor imagery (MI) BCI control strategy for operating a physically assistive robotic arm, addressing the difficulties of MI decoding from electroencephalogram (EEG) signals, which are inherently non-stationary and vary across individuals. Approach: A proof-of-concept BCI control system was developed using commercially available hardware, integrating MI with eye tracking in an augmented reality (AR) user interface to facilitate a shared control approach. This system proposes actions based on the user's gaze, enabling selection through imagined movements. A user study was conducted to evaluate the system's usability, focusing on its effectiveness and efficiency. Main results:Participants performed tasks that simulated everyday activities with the robotic arm, demonstrating the shared control system's feasibility and practicality in real-world scenarios. Despite low online decoding performance (mean accuracy: 0.52 9, F1: 0.29, Cohen's Kappa: 0.12), participants achieved a mean success rate of 0.83 in the final phase of the user study when given 15 minutes to complete the evaluation tasks. The success rate dropped below 0.5 when a 5-minute cutoff time was selected. Significance: These results indicate that integrating AR and eye tracking can significantly enhance the usability of BCI systems, despite the complexities of MI-EEG decoding. While efficiency is still low, the effectiveness of our approach was verified. This suggests that BCI systems have the potential to become a viable interaction modality for everyday applications in the future.

Optimal visual gaze pattern of endoscopists for improving adenoma detection during colonoscopy.

BACKGROUND AND AIMS: Visual gaze pattern (VGP) analysis quantifies endoscopists' specific eye movements. VGP during colonoscopy may be associated with polyp detection. However, the optimal VGP to maximize detection performance remains unclear. This study evaluated the optimal endoscopic VGP that enabled the highest colorectal adenoma detection. METHODS: This randomized controlled trial was conducted between July and December 2023. We developed an eye-tracking and feedback (ETF) system that instructed endoscopists to correct their gaze toward the periphery of an endoscope screen with an audible alert. Patients who underwent colonoscopy were randomly assigned to four groups: three intervention groups in which the endoscopist's gaze was instructed to a different level of the peripheral screen area using the ETF system (the periphery of 4×4, 5×5, and 6×6 divisions of the screen) and a control group in which the endoscopist did not receive instructions. The primary outcome was the number of adenomas detected per colonoscopy (APC). RESULTS: In total, 189 patients were enrolled. APC and adenoma detection rate were significantly higher in the 6×6 group than in the control group (1.82±2.41 vs. 0.59±1.17, P=0.002; 68.9% vs. 30.8%, P=0.002). The APC and the number of screen divisions were positively correlated (R=0.985, P=0.0152). The rate at which the endoscopist gazed at the periphery of the screen was positively correlated with the number of divisions (R=0.964, P=0.0363). CONCLUSIONS: Colorectal adenoma detection was improved by correcting the endoscopist's gaze to the periphery of the screen, especially by dividing the screen into 6×6 segments.

Native and non-native vowel discrimination in 6-month-old Norwegian infants.

In the current preregistered study, we tested n = 67 6-month-old Norwegian infants' discrimination of a native vowel contrast /y-i/ and a non-native (British) vowel contrast /ʌ-æ/ in an eye-tracking habituation paradigm. Our results showed that, on a group level, infants did not discriminate either contrast. Yet, exploratory analyses revealed a negative association between infants' performance in each experiment, that is, better discrimination of the native contrast was associated with worse discrimination of the non-native contrast. Potentially, infants in this study might have been on the cusp of perceptual reorganisation towards their native language.

Do health warning labels on alcohol packaging attract visual attention? A systematic review.

OBJECTIVES: To synthesize eye-tracking-based evidence on consumers' visual attention devoted to alcohol warning labels (AWLs) on alcohol packaging. STUDY DESIGN: A systematic review was conducted and reported in accordance with the PRISMA guidelines. METHODS: Two rounds of a literature search were conducted to identify relevant peer-reviewed articles and unpublished grey literature. While the first round (July 3 to August 21, 2023) was based on three electronic databases (PubMed, Web of Science, and PsycINFO), the second round (May 20 to 28, 2024) followed a multiple-step protocol that systematically searched the grey literature. Five criteria were applied to screen eligible articles. Using established quality control tools, the identified articles were assessed for overall quality and then for quality specific to the eye-tracking method. RESULTS: Six published peer-reviewed articles were thus included in the current review along with one unpublished research paper from a doctoral thesis. This review paper summarizes earlier findings in terms of bottom-up (i.e., AWL design-related) factors such as size, color, surrounding border, and pictorial elements, and top-down (i.e., goal-driven) factors such as motivation to change drinking behavior and self-affirmation. The review found that people tend to pay very little attention to AWLs displayed on alcohol packaging, although there is mixed evidence as to the effectiveness of specific factors. CONCLUSIONS: Further investigations using eye-tracking are needed to collect additional evidence on attention devoted to AWLs. Meanwhile, we put forward implications for policymakers and future avenues for research based on our review of the existing literature.

Gaze behavior reveals automaticity and attention allocation during music teaching vs. observing.

In a unique case-study approach in which I served as both the research participant and the experimenter, I wore eye-tracking glasses while teaching a brief music lesson to two university students learning trumpet, then approximately two weeks later, I watched a video of the lesson and tracked my gaze again. To investigate unconscious perceptual processes engaged during music teaching, I compared my attention allocation while teaching to my attention allocation during selfobservation. My gaze behavior while teaching revealed a high level of automaticity regarding lesson sequencing and allocation of attention. Strategic moment-to-moment shifts in attention between the two students occurred entirely below my conscious awareness, yet post hoc analyses revealed precisely timed changes that were related to momentary goals. While watching the video, absent the demands of behavioral interaction and momentary decision-making, I directed more sustained attention to both students than I had while teaching. These results reveal important features of "teacher thinking" that are not directly observable or typically construed as conscious behavior. That this component of teaching practice does not involve volitional control suggests that teachers' descriptions of their thinking may not reveal to novices important elements of pedagogical expertise.

Accounting for Visual Field Abnormalities when Using Eye-tracking to Diagnose Reading Problems in Neurological Degeneration.

State-of-the-art eye trackers provide valuable information for diagnosing reading problems by measuring and interpreting people's gaze paths as they read through text. Abnormal conditions such as visual field defects, however, can seriously confound most of today's existing methods for interpreting reading gaze patterns. Our objective was to research how visual field defects impact reading gaze path patterns, so the effects of such neurological pathologies can be explicitly incorporated into more comprehensive reading diagnosis methodologies. A cross-sectional, non-randomized, pilot clinical study including 45 patients with various neurologic disorders and 30 normal controls was designed. Participants underwent ophthalmologic/neuropsychologic and eye-tracker examinations using two reading tests of words and numbers. The results showed that the use of the eye tracker showed that patients with brain damage and an altered visual field require more time to complete a reading-text test by fixating a greater number of times (p < 0.001); with longer fixations (p = 0.03); and a greater number of saccades in these patients (p = 0.04). Our study showed objective differences in eye movement characteristics in patients with neurological diseases and an altered visual field who complained of reading difficulties. These findings should be considered as a bias factor and deserve further investigation.

Age-related changes in connected speech production: evidence from eye-tracking in the culturally adapted picture description task.

Purpose: Age-related changes in connected speech production remain a subject of debate, yielding inconsistent findings across various tasks and measures. This study aimed to investigate the effects of aging on picture description tasks using two types of pictures: a standardized picture (the Beach picture) and a culturally and linguistically modified picture tailored for Korean speakers (the Han River picture). Method: Twenty-four young adults and 22 older adults participated in two picture description tasks while their eye movements were recorded. Word-level linguistic variables were used to assess informativeness (Correct Information Units per minute) and productivity (noun and verb counts per utterance) of connected speech production. Eye-movement measures were employed to evaluate real-time cognitive processing associated with planning connected speech (pre-speech fixation counts and durations; eye fixations before the speech onset of each utterance). Results and conclusions: The findings revealed age-related declines in linguistic measures, with older adults exhibiting decreased CIUs per minute and smaller counts of nouns and verbs per utterance. Age-related changes in eye movement measures were evident in that older adults displayed longer pre-speech fixation durations. Unlike younger adults, older adults exhibited higher pre-speech fixation counts on the Han River picture compared to the Beach picture, suggesting cognitive challenges in performing the task that requires producing more words and detailed descriptions. These results suggest that aging is associated with reduced informativeness and productivity of connected speech, as well as a decline in cognitive processing efficiency.