Grocery List Research Articles

Associations Between Meal Planning and Food Ordering Features of a Digital Precision Nutrition Platform and Improvements in Diet Quality

ObjectivesFoodsmart is a digital precision nutrition platform that seeks to address barriers to healthy eating with features including (but not limited to) personalized dietary recommendations based on food frequency questionnaire (FFQ) responses, a meal planner, grocery list, and food ordering capabilities. We investigated the association between engagement with these features and changes in diet quality over time. MethodsWe included 9939 obese adults ages 18–80 living in the U.S. who enrolled in Foodsmart. Usual dietary intake, age, weight, height, and sex were reported through a 53-item FFQ, modified from the National Cancer Institue’s Diet History Questionnaire. A healthy diet score was calculated, which contains 7 components: fruits, vegetables, protein ratio (white meat/vegetarian protein: red/processed meat), carbohydrate ratio (fiber: carbohydrate), fat ratio (polyunsaturated: saturated/trans fats), sodium, and hydration (% of daily fluid goal). Change in diet quality was calculated by subtracting users’ first score from their last score. Multivariate logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of improvement in diet quality per engagement with each feature, adjusted for gender, age, baseline BMI, baseline diet score, and enrollment time. ResultsOf the 9,939 adults included in the analysis, 57% were between 40 and 59 years old and 21% were male. In multivariate regression models, each additional engagement with personalized dietary recommendations was associated with a 27% higher likelihood of improving diet (OR: 1.27, 95% CI: 1.16–1.39, P < 0.001). Each additional engagement with the meal planner, grocery list, and food ordering was associated, respectively, with a 12% (OR: 1.12, 95% CI: 1.02–1.22, >P = 0.01), 15% (OR: 1.15, 95% CI: 1.05–1.26, P < 0.001), and 18% (OR: 1.18, 95% CI: 1.00–1.38, P = 0.05) higher likelihood of improving diet quality. ConclusionsIn our prospective study of obese users of a digital precision nutrition platform, we found that more frequent engagement with features related to meal planning and food ordering was associated with diet quality improvement. Funding SourcesThis study was funded by Foodsmart.

Variable objective sleep quality is related to worse spatial learning and memory in young adults

ObjectiveThe majority of research on sleep and cognition has focused on mean markers of sleep across multiple nights; however, variable sleep patterns have become increasingly common in the modern era. The purpose of this study was to examine whether objective intraindividual variability in sleep quantity and quality are related to verbal and visuospatial learning and memory functioning in young adults. MethodsA total of 218 young adult college students were recruited from a university in the Eastern United States, among which 187 participants (70.6% female; mean age = 20.5, SD = 1.5) had complete actigraphy and cognitive performance data. Objective intraindividual means and variabilities of sleep quantity (total sleep time) and sleep quality (percent wake after sleep onset) were measured over a 1- to 2-week timeframe using wrist actigraphy. Verbal and visuospatial learning and memory were assessed using the International Shopping List and Groton Maze Learning tests of the Cogstate computerized test battery. ResultsGreater intraindividual variability in actigraphy-derived sleep quality was associated with poorer visuospatial learning and memory performance after controlling for mean sleep quality and visuomotor attention and processing speed (ps < 0.05). Actigraphic measures of sleep quantity were not related to any learning and memory measures. ConclusionIn young adults, intraindividual variability in objective sleep quality was significantly related to visuospatial learning and memory, over and above mean sleep quality. Given these associations, future studies should aim to identify modifiable lifestyle and environmental factors contributing to variable sleep quality.

How buyer-focused projective techniques can help to gain insights into consumer perceptions about different types of eggs

This study aimed to analyze the consumer perception (n = 840) about different types of eggs using Product Personality Profiling and Shopping List tasks. White egg, brown egg, organic egg, free-range egg, and eggs enriched with omega 3 and vitamins were evaluated. The consumers associated the white egg with unhealthy, sedentary, and overweight individuals in the Product Personality Profiling task and people that are not concerned with health in the Shopping List task. The brown egg was associated with a person who does physical activity and has a healthy diet in the Product Personality Profiling task. The omega 3 egg was associated with a person concerned with health in the Shopping List task, which does physical exercises and follows a healthy diet in the Product Personality Profiling task. The vitamin-enriched egg was associated with people with health disorders in the Shopping List task and following a vegetarian/vegan diet in the Product Personality Profiling task. The free-range egg was associated with a man with a rugged personality, a healthy diet, and animal welfare concern. Finally, the organic egg was associated with a person concerned with animal welfare and a vegetarian/vegan diet. Shopping list and Product Personality Profiling projective techniques proved to be useful tools for understanding consumer perceptions and beliefs about eggs, providing similar or complementary results. The Shopping List was more appropriate in eliciting egg buyers' profile, while the Product Personality Profile shows the “target buyer”.

Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology.

The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as "fast-track" and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.

Who are the multichannel shoppers and how can retailers use them? Evidence from the French apparel industry

PurposeThis study aims to identify, within the context of the French fashion industry, the characteristics of multichannel shoppers, that is, consumers who use more than one channel in a single shopping trip. We especially investigate whether consumers' focus on quality versus price affects their multichannel shopping tendency and their flexibilities in their shopping lists (basket flexibility).Design/methodology/approachWe surveyed a representative sample of 400 French shoppers regarding fashion apparel purchasing. We use a logistic regression framework to measure the probability of a shopper becoming a multichannel shopper based on the key constructs and a battery of control variables.FindingsThe analysis shows that, in fashion buying, shoppers focused on quality and those with high basket flexibility have a higher probability of becoming multichannel shoppers. The probability becomes even greater when a shopper is both quality oriented and has basket flexibility.Research limitations/implicationsWe focus on the fashion apparel market for a deeper understanding of multichannel usage of products with both experience and search features. Future research can investigate other industries for higher generalizability.Practical implicationsOur research provides insights into multichannel fashion companies whose managements aim to effectively manage high-value customers who tend to use more channels when shopping. Specifically, an omnichannel marketing strategy should focus on capturing the quality-oriented and highly basket-flexible segment of consumers.Originality/valueOur study provides evidence that for products having high experiential as well as search features, quality-oriented and highly flexible shoppers engage more in multichannel shopping. Because these characteristics are related to the long-term value of customers, we provide the link between multichannel marketing and firm profitability in the context of the fashion industry.

Microtask Detection

Information systems, such as task management applications and digital assistants, can help people keep track of tasks of different types and different time durations, ranging from a few minutes to days or weeks. Helping people better manage their tasks and their time are core capabilities of assistive technologies, situated within a broader context of supporting more effective information access and use. Throughout the course of a day, there are typically many short time periods of downtime (e.g., five minutes or less) available to individuals. Microtasks are simple tasks that can be tackled in such short amounts of time. Identifying microtasks in task lists could help people utilize these periods of low activity to make progress on their task backlog. We define actionable tasks as self-contained tasks that need to be completed or acted on. However, not all to-do tasks are actionable. Many task lists are collections of miscellaneous items that can be completed at any time (e.g., books to read, movies to watch), notes (e.g., names, addresses), or the individual items are constituents in a list that is itself a task (e.g., a grocery list). In this article, we introduce the novel challenge of microtask detection, and we present machine-learned models for automatically determining which tasks are actionable and which of these actionable tasks are microtasks. Experiments show that our models can accurately identify actionable tasks, accurately detect actionable microtasks, and that we can combine these models to generate a solution that scales microtask detection to all tasks. We discuss our findings in detail, along with their limitations. These findings have implications for the design of systems to help people make the most of their time.

Consumers’ Knowledge and Perception towards Organic Foods: A Cross-Sectional Study

Aims: This study was conducted to investigate the consumer perception towards organic foods in the Saudi market and to scrutinize factors influencing the purchasing decision.&#x0D; Study Design: A cross-sectional study.&#x0D; Place and Duration of Study: Department of Clinical Nutrition, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, between February 2020 and May 2020.&#x0D; Methodology: We included 406 Saudi adults from both genders. A valid and reliable questionnaire was distributed in different regions. Data were statistically analyzed using IBM SPSS Statistics software.&#x0D; Results: Results showed that 71.40% of participants consume organic foods with insignificant differences among regions, genders, education levels or health status. Participants above 50 years old reported significantly higher consumption (p&lt;0.05). Moreover, 87% of the participants who were not purchasing organic foods showed future eagerness to buy these foods and were willing to pay up to 100% price increase. The major drives to buy or consume organic foods were consumers’ health perception (43.86%), nutritive primacy (22.35%), sensory attributes (12.69%) and environmental friendly characteristics (6.66%) of these foods. The major limiting factors, however, were the higher prices (50%) and limited availability (30%).&#x0D; Conclusion: Saudi consumers are knowledgeable about organic foods and are keen to include them in their shopping lists. Organic farming should be encouraged for an adequate availability and reasonable prices of such foods in the local markets.

Motivating Pulse-Centric Eating Patterns to Benefit Human and Environmental Well-Being.

Pulses (e.g., lentil, common bean, chickpea, and dry pea) are linked to a myriad of positive human and environmental health impacts, making them an ideal food for wise and conscientious global citizens. In addition, pulses are affordable and shelf-stable. The combination of these factors, an elevated consumer interest in plant-based diets, and the COVID-19 pandemic resulted in increased purchasing of pulses and even empty grocery store shelves. Although pulses have many associated benefits, some consumers are hesitant to regularly eat pulses, claiming concerns of abdominal discomfort or a lack of knowledge on how to best prepare pulses. To capitalize on increased consumer interest and purchasing of pulses, now is the time for outreach efforts that address these concerns and the positive outcomes associated with pulses, thereby promoting public and environmental health. Consumers must actively decide to add pulses to their grocery lists and incorporate them into their regular eating patterns. Motivation to adopt new eating habits is essential because knowledge alone does not result in behavior change. Thus, to mitigate perceived barriers and drive consumption, we suggest application of the Information-Motivation-Behavioral Skills Model and emphasis of three main benefits of pulses as motivators: (1) culinary versatility, (2) sustainability, and (3) healthfulness.

Associations Between Weight Loss Attempts, Food Planning, and the Home Food Environment

ObjectiveTo evaluate whether food planning behaviors mediate the relationship between a reported weight loss attempt and the home food environment (HFE). DesignSecondary data analysis of 4 home visits, included collecting an objective home food inventory of the HFE and self-reported food planning behaviors. ParticipantsThere were 196 participants (mean age, 44.4 years; 83.7% female). Main Outcome MeasuresThe percentage of obesogenic foods and fruits and vegetables (FV). AnalysisFour regression analyses to test mediation. ResultsMeal planning and grocery list use did not explain the relationship between a weight loss attempt and obesogenic foods or FV in the home (P > 0.05). Post hoc analyses that examined participants with a body mass index of >25, >28, and >30 found that a weight loss attempt was associated with fewer obesogenic foods. In contrast, mediation analyses with planning behaviors and associations with FV in the home were nonsignificant (P > 0.05). Conclusions and ImplicationsObesity was more indicative of the HFE than making a weight loss attempt. A weight loss attempt was not associated with food planning behaviors, which may be used for multiple reasons, including organization and time management. Future studies should evaluate individual differences in strategies to create a healthy HFE in the context of a weight loss attempt.

Cognitive task performance under (combined) conditions of a metabolic and sensory stressor

Effects of stressors on cognitive task performance have primarily been studied in isolation, and little is known about the combined effects of two or more stressors. This study examined how a metabolic stressor (skipping breakfast) and a sensory stressor (noise) affect cognitive task performance in isolation and combined. In addition to performance, we collected physiological and subjective data to get insight in the underlying mechanisms. Twenty participants came to the lab twice, once after skipping breakfast, and once after a standardized breakfast. They performed runs of the 2-back task and the International Shopping List Task, which were alternately presented with and without noise. During the 2-back task, electrocardiography (ECG), electrodermal activity (EDA), and electroencephalography (EEG) were recorded. Subjective ratings on effort and stress were also collected. No interaction effects between the two stressors on cognitive performance were found. Skipping breakfast did not cause hypoglycemia, but resulted in subjective discomfort and a lower state of arousal (as indicated by lower heart rate and EDA). These may underly the trend for more missed responses on the 2-back task after breakfast skipping. Noise appeared to generate arousal and increased attention (reflected in higher EDA and P300) in accordance with higher experienced load and stress. This is consistent with less missed 2-back responses in noise conditions. The results indicate that individuals spent extra effort to maintain task performance in the presence of noise. We propose to use a model that, besides additional effort, takes the effect of stressors on performance into account.

Mother-Child Writing Interactions for Young Children with and without Cerebral Palsy

ABSTRACT Sixty-nine children (20 with cerebral palsy (CP)) and their mothers participated in a joint writing activity. Children (M age = 64.56 months; SD = 7.07 months) wrote a four-item grocery list on a keyboard at home with their mothers. Mothers who had children with CP generally provided a lower level of graphophonemic (i.e., segmenting words into their respective sounds) and print support (i.e., identifying letters to type) when compared to mothers of children with typical development. They were also less likely to be playful and correct their children’s writing errors, although they spent more time on the activity overall and entered into their children’s physical space more frequently. Even when children’s spelling skills were considered, mothers of children with CP provided lower levels of support to their children, suggesting that mothers might be missing opportunities to maximise what children with CP can learn during joint writing activities.

P58 Healthy Eating and Staying Active as We Age Curriculum: Pilot Initial Efficacy

<h3>Objective</h3> To assess changes in nutrition, physical activity, food safety, and food resource management practices as a result of participation in Healthy Eating and Staying Active as We Age (HESA). <h3>Use of Theory or Research</h3> Older adults are at a greater risk for malnutrition, chronic diseases, and falls. By 2034, older adults are projected to outnumber children for the first time in US history. Due to this shift in demographics, nutrition education and health-related resources for older adults has become increasingly critical. <h3>Target Audience</h3> Virginia SNAP-eligible adults (n = 278) ages 45 years and older. <h3>Program Description</h3> HESA is a nutrition education program developed by Virginia SNAP-Ed consisting of nine 60-minute lessons (including nutrition education, food tasting experiences, physical activity, and hands-on learning activities). Lessons were implemented by SNAP-Ed Peer Educators in community settings across Virginia. <h3>Evaluation Methods</h3> Paired t-tests were used to analyze pre- and post-intervention surveys rated on a Likert type scale. Participants' food resource management, nutrition and physical activity, food safety behaviors, and perceptions of food accessibility and affordability were evaluated. <h3>Results</h3> A sample of HESA participants (n = 278) reported statistically significant (<i>P</i> < .003) improvements in frequency of shopping with a grocery list and planning their grocery shopping, consumption of fruits (2.73 ± 1.15 pre to 3.40 ± 1.18 post), vegetables (2.76 ± 1.22 pre to 3.39 ± 1.13 post), dairy (2.64 ± 1.18 pre to 3.14 ± 1.20 post), lean protein (3.15 ± 1.10 pre to 3.61 ± 1.03 post), sugar-sweetened beverages (SSBs, 2.36 ± 1.26 pre to 2.00 ± 1.06 post), and physical activities levels (2.95 ± 1.22 pre to 3.27 ± 1.16 post). There were also statistically significant increases (<i>P</i> < .003) in the perceived affordability and accessibility of healthy foods, and perceived opportunities to be physically active. <h3>Conclusions</h3> SNAP-Ed implementing agencies such as Virginia's FNP are required to use evidence-based curricula. This was the initial step in the process of creating an evidence-based curriculum to address the needs of older adults.

Pilot Study on the Effects of a Plant-Strong Diet on Cardiovascular Risk Factors in Veterans (Part 1)

Abstract Objectives A short-term intervention designed to test the feasibility of Veterans to adopt a whole-food, plant-based (WFPB) diet has not been tested. The specific aims of this study were to (1) determine the feasibility of Veterans adopting a WFPB diet within four weeks, following a plant-strong protocol, (2) determine the effectiveness on participant's cardiovascular risk factors and dietary patterns and (3) compare the results to Veterans following the American Heart Association or Diabetic Diets. Methods Prospective, nonrandomized, pilot study of overweight or obese hyperlipidemic Veterans naive to lipid lowering drugs. The first 4 participants were assigned the control group, the next 6 were assigned the intervention. Participants in the control group who met inclusion/exclusion criteria after completion of control intervention could cross-over into the intervention group. The intervention was a four-week program which included individual education on a WFBP diet, (including menu planning and making grocery lists), a grocery store tour, cooking skills, substitutions and food preparation, and challenges dining out. Participants in the control arm received the standard of care. Anthropometrics, biochemical measures, and dietary intake patterns were obtained at baseline and five weeks. Results Eight male Veterans (mean 57 years old) completed the study, (n = 4 control, n = 6 intervention, 2 crossed over). Ability to adopt a WFBP diet was 83%. Data from diet adopters were compared to the control. Both groups had a significant decrease in LDL from baseline (12% control and 19% in intervention, P = 0.04 each). Veterans in the intervention group had a significant decrease in weight (3%, P = 0.04) and reported: gassiness, better digestion, more energy and better sleep. Conclusions Veterans were able to adopt a WFBP diet and experienced a favorable change in LDL cholesterol. Resources needed to conduct the intervention preclude widespread implementation. Further research is needed to determine if less resource intensive programs are feasible and effective for long-term sustainability and determine which Veterans may benefit most. Funding Sources Carl T Hayden Medical Research Foundation.

‘Shopping List’

Are the unnamed characters who write and respond to these post-it notes flatmates or lovers, friends or acquaintances? Is their relationship as fractious as this prose suggests, or does each note hold something deeper, a series of signs and indicators that gradually reveal affection between the two characters? The medium, somewhat outdated in our digital world, suggests fleeting exchanges, ships that pass in the night, all the while signalling shared space, shared responsibilities and shared lives. The implied story is as complex as the reader wants to make it, as the authors themselves use this brief epistolary form as a prompt for contemplating the mundanity of relationships, the emotional manoeuvring, assumed subtexts and back-stories of each and every moment or event. The authors are a novelist and a poet, writers each involved in their own relationships, colleagues interested in collaboration and new forms. Who is the third voice (or third and fourth voices) this dialogue has created? The story has led Lilwall and Loydell to writing the unexpected, responding to each other’s prose and shopping items in turn, surprising each other and themselves, before refining and editing the work together.

Associations of Apolipoprotein E ε4 Genotype and Ball Heading With Verbal Memory in Amateur Soccer Players

Emerging evidence suggests that long-term exposure to ball heading in soccer, the most popular sport in the world, confers risk for adverse cognitive outcomes. However, the extent to which the apolipoprotein E ε4 (APOE ε4) allele, a common risk factor for neurodegeneration, and ball heading are associated with cognition in soccer players remains unknown. To determine whether the APOE ε4 allele and 12-month ball heading exposure are associated with verbal memory in a cohort of adult amateur soccer players. A total of 379 amateur soccer players were enrolled in the longitudinal Einstein Soccer Study from November 11, 2013, through January 23, 2018. Selection criteria included participation in soccer for more than 5 years and for more than 6 months per year. Of the 379 individuals enrolled in the study, 355 were genotyped. Three players were excluded for reporting extreme levels of heading. Generalized estimating equation linear regression models were employed to combine data across visits for a cross-sectional analysis of the data. At each study visit every 3 to 6 months, players completed the HeadCount 12-Month Questionnaire, a validated, computer-based questionnaire to estimate 12-month heading exposure that was categorized as low (quartiles 1 and 2), moderate (quartile 3), and high (quartile 4). Verbal memory was assessed at each study visit using the International Shopping List Delayed Recall task from CogState. A total of 352 soccer players (256 men and 96 women; median age, 23 years [interquartile range, 21-28 years]) across a total of 1204 visits were analyzed. High levels of heading were associated with worse verbal memory performance (β = -0.59; 95% CI, -0.93 to -0.25; P = .001). There was no main association of APOE ε4 with verbal memory (β = 0.09; 95% CI, -0.24 to 0.42; P = .58). However, there was a significant association of APOE ε4 and heading with performance on the ISRL task (χ2 = 7.22; P = .03 for overall interaction). In APOE ε4-positive players, poorer verbal memory associated with high vs low heading exposure was 4.1-fold greater (APOE ε4 negative, β = -0.36; 95% CI, -0.75 to 0.03; APOE ε4 positive, β = -1.49; 95% CI, -2.05 to -0.93), and poorer verbal memory associated with high vs moderate heading exposure was 8.5-fold greater (APOE ε4 negative, β = -0.13; 95% CI, -0.54 to 0.29; APOE ε4 positive, β = -1.11, 95% CI, -1.70 to -0.53) compared with that in APOE ε4-negative players. This study suggests that the APOE ε4 allele is a risk factor for worse memory performance associated with higher heading exposure in the prior year, which highlights that assessing genetic risks may ultimately play a role in promoting safer soccer play.

CROLIST: A Mobile App for Collaborative Grocery List Management

CROLIST: A Mobile App for Collaborative Grocery List Management

The Flexibility of Episodic Long-Term Memory-Guided Attention and the Impact of Reinstating Context

While it may seem that salient visual events, like the flashing lights on an ambulance, can automatically capture our attention, capture is actually under our control. Depending on our current internal goals, we adopt attentional control settings (ACSs) that specify what stimuli in the environment capture our attention. It has been shown that ACSs can be defined based on long-term episodic memory representations. For example, when searching for the items on your grocery list, an ACS can be specified based on your long-term memory of the list, such that your attention will be drawn to those items, and only those items. Importantly, episodic memories incorporate contextual information that can enhance recall when reinstated (e.g., you will remember your grocery list better if it was memorized at the grocery store rather than at home). Here we asked whether reinstating context can enhance the establishment of long-term memory ACSs. Participants memorized two sets of 15 images of objects in a particular context (i.e., a coloured box in a particular spatial location), that they then searched for, inducing an episodic-based ACS for those objects. During the search task, this encoding context was either reinstated, or not. We found that individuals are able to flexibly switch between ACSs and sources of information. However, we did not find sufficient evidence for the effect of context on the establishment of ACSs or their flexibility. This study extends our understanding of the factors that influence memory-guided attention, and the impact of contextual reinstatement on the formation of ACSs.

A Low Power IoT-Connected Smart Canister System Creating Automatic Shopping List

One of the most common forgotten things of adults is that they go to the shops and completely forget what they went for. The solution to this problem is to carry a shopping list. In this project, a novel Internet of Things (IoT)-connected smart canister system is developed, which automatically senses the item quantity in the canisters using proximity sensor, sends the data to a hub using Bluetooth Low Energy, and then the hub sends a cloud message to the consumer’s smartphone app using the Internet. The hub and the smartphone app display the item quantities and automatically add the items that are about to finish to a digital shopping list. The automatic generation of the shopping list removes the burden of manually checking each item before going to the shops and gives peace of mind to the consumers. A prototype of the proposed system with three canister devices, one hub, and the smartphone app is developed and tested successfully. The canister device consumes ultra-low power and has a battery life of more than a year.

APOE4 STATUS AND AMYLOID BURDEN DIFFERENCES ACROSS REGIONS IN THE ELENBECESTAT MISSIONAD PHASE 3 PROGRAM

Eisai's elenbecestat MissionAD Phase 3 studies in early Alzheimer's disease (EAD) screened a cohort of more than 8,000 subjects for eligibility. Here we investigate the differences in ApoE4 status in this large cohort of subjects. The screening process was performed in 5 tiers, of which ApoE4 status was determined in those subjects that reached tier 3. Cognitive assessment and disease staging were determined in earlier tiers, with amyloid burden determined at tier 5. The subjects were categorized into ApoE4 positive and negative groups and age, gender, disease staging, country, and amyloid burden were evaluated. 4286 subjects screened in MissionAD had a known ApoE4 status. All of these subjects had a MMSE score ≥24, CDR Global score of 0.5, and a cognitive impairment of ≥1 standard deviation from age-adjusted norms in the International Shopping List Task. 1906 (44%) out of the 4286 subjects were ApoE4 positive. The mean age in both the ApoE4 positive and negative groups was 71 years; 50% and 52% of the ApoE4 positive and negative groups, respectively, were female. Frequency of Mild Cognitive Impaired (MCI) and early mild AD dementia subjects was similar in both ApoE4 positive and negative groups. MCI was diagnosed in 81% of ApoE4 positive and 85% of ApoE4 negative subjects. Early mild AD dementia was diagnosed in 15% of ApoE4 positive and 11% of ApoE4 negative subjects. 27 countries spanning the 5 regions of North America, South America, Europe, Japan, and Asia Pacific (APAC) participated in the studies, with a mean ApoE4 positivity of 48%. 2707 of the subjects with a known ApoE4 status progressed through screening to assess their amyloid burden, with a mean amyloid positivity of 63% across the regions. NA had the lowest while APAC the highest ApoE4 and amyloid positivity rates (Fig.1).

A role for metamemory in cognitive offloading

Cognitive offloading refers to our reliance on the external environment in order to reduce cognitive demand. For instance, people write notes on paper or smartphones in order not to forget shopping lists or upcoming appointments. A plausible hypothesis is that such offloading relies on metamemory – our confidence in our future memory performance. However, this hypothesis has not been directly tested, and it remains unclear when and how people use external sources to aid their encoding and retrieval of information. In four experiments, here we asked participants to learn word pairs and decide whether to offload some of the pairs by “saving” them on a computer. In the memory test, they had the opportunity to use this saved information on half of trials. Participants adaptively saved the most difficult items and used this offloaded information to boost their memory performance. Crucially, participants' confidence judgments about their memory predicted their decisions to use the saved information, indicating that cognitive offloading is associated with metacognitive evaluation about memory performance. These findings were accommodated by a Bayesian computational model in which beliefs about the performance boost gained from using offloaded information are negatively coupled to an evaluation of memory ability. Together our findings highlight a close link between metamemory and cognitive offloading.