Eye movement and reading behavior in older adults with dementia

TL;DR

This study explores how eye movements differ when older adults with dementia read documents of varying difficulty, aiming to improve readability and comprehension.

Contribution

The study identifies specific eye movement patterns and the effectiveness of revised documents and caregiver support in enhancing reading for dementia patients.

Findings

Revised documents significantly reduced skipping and misreading in older adults with dementia.

Aloud reading with revised documents decreased reading time, fixation count, and regression.

Caregiver support and individualized strategies were crucial for effective reading comprehension.

Abstract

With the rising number of patients with dementia, it is essential to develop support strategies that incorporate visual information. This study aimed to clarify differences in eye movement patterns when older adults with dementia read documents of varying difficulty, in order to identify strategies for enhancing readability and supporting comprehension.

Eye movements were measured using an eye tracker while nine older adults with dementia read documents. Each document had an original version and a revised version, designed to improve readability. Data were compared across document types, original versus revised versions, and aloud versus silent reading. Video recordings were qualitatively analyzed.

In the comparison of document types, “skipping over” (p = 0.046) and “misreading” (p = 0.050) significantly decreased in documents of lower difficulty. No significant difference was observed between aloud and silent reading. However, among participants who read aloud, the revised version showed significant reductions in reading time (p = 0.028), fixation count (p = 0.046), and regression (p = 0.046). Qualitative analysis yielded three major categories: Response to caregiver support, Reading strategies, and Challenges in using support.

The revised documents improved eye movement patterns, suggesting enhanced readability. In addition to text modifications, individualized caregiver support was critical for comprehension. These findings can inform the design of written information for older patients with dementia.

The online version contains supplementary material available at 10.1186/s12877-026-07030-8.