Neuropsychology In the public domain

2014, Vol. 28, No. 6, 973983 http://dx.doi.org/10.1037/neu0000112

Repetition Priming of Words and Nonwords in Alzheimers Disease and

Normal Aging
Beth A. Ober and Gregory K. Shenaut
University of California, Davis and Veterans Affairs Northern California Health Care System, Martinez, CA

Objective: This study examines the magnitude and direction of nonword and word lexical decision
repetition priming effects in Alzheimers disease (AD) and normal aging, focusing specifically on the
negative priming effect sometimes observed with repeated nonwords. Method: Probable AD patients
(30), elderly normal controls (34), and young normal controls (49) participated in a repetition priming
experiment using low-frequency words and word-like nonwords with a letter-level orthographic orienting
task at study followed by a lexical decision test phase. Results: Although participants reaction times
(RTs) were longer in AD compared with elderly normal, and elderly normal compared with young
normal, the repetition priming effect and the degree to which the repetition priming effect was reversed
for nonwords compared to words was unaffected by AD or normal aging. Conclusion: AD patients, like
young and elderly normal participants, are able to modify (in the case of words) and create (in the case
of nonwords) long-term memory traces for lexical stimuli, based on a single orthographic processing
trial. The nonword repetition results are discussed from the perspective of new vocabulary learning
commencing with a provisional lexical memory trace created after orthographic encoding of a novel
word-like letter string.

Keywords: memory, implicit memory, lexical decision, reaction time (RT), nonword familiarity

There has been considerable interest in repetition priming
defined as faster or more accurate processing of a repeated stim-
ulus due to its prior processingin elderly normal (EN) and
probable Alzheimers disease (AD) individuals. In repetition prim-
ing paradigms, participants are generally not told about any pos-
sible relationship between the initial and later occurrences of
stimulus items; thus, these paradigms are implicit tests of memory.
This is in contrast to episodic memory paradigms in which specific
mention is usually made of previous experience with the stimulus
items, and participants are asked to recall previously seen items or
This article was published Online First July 7, 2014.
Beth A. Ober and Gregory K. Shenaut, Human Development Unit,
Department of Human Ecology, University of California, Davis and Re-
search Service, Veterans Affairs Northern California Healthcare System,
Martinez, CA.
This research was supported in part by grants to the first author from the
Department of Veterans Affairs Medical Research Service and from the
National Institutes of Health (R29-AG10848) as well as by funding pro-
vided to the University of California Alzheimers Disease Research Center,
including Grants AG10129 and AG10220 from the National Institute on
Aging, and grants from the California State Department of Public Health
Alzheimers disease Program. The contents reported within do not repre-
sent the views of the Department of Veterans Affairs or the United States
Government. We thank the staff of the University of California, Davis,
Alzheimers Disease Clinical Center, Martinez and Sacramento clinics, for
their referrals of research participants to our memory and language studies,
and we are grateful to the participants for their time and effort.
Correspondence concerning this article should be addressed to Beth A.
Ober, Human Development Unit, Department of Human Ecology, One
Shields Avenue, University of California, Davis, CA, 95616. E-mail:
baober@ucdavis.edu
to make yes/no recognition judgments for previously seen and
foil items; these paradigms are explicit tests of memory. Dissoci-
ations between repetition priming and episodic/event memory per-
formance have often been found in AD and normal aging, with
deficits on episodic memory tasks (to a much greater extent for AD
than for EN groups), in the face of normal performance on repe-
tition priming tasks (Craik & Rose, 2012; Zacks & Hasher, 2006).
A particularly interesting aspect of lexical decision repetition is
that nonwords can be repeated; in this case, a performance decre-
ment is sometimes found for word-like nonwords, presumably
because they become more difficult to distinguish from real words
in some way (e.g., McKoon & Ratcliff, 1979, Experiment 2).
Prior to describing the design features and specific rationale for
the current study of repetition priming in AD, we will provide a
brief overview of repetition priming in AD and normal aging,
discuss the advantages of utilizing lexical decision as a repetition
priming task, and review models of lexical decision and repetition
priming.
Brief Overview of the Repetition Priming Literature
Repetition priming has been assessed extensively in AD and
normal aging with riddle-like tasks involving word generation or
retrieval such as word-stem completion or word-fragment comple-
tion, and to a lesser degree with simpler, more passive tasks,
usually involving reaction time (RT) measures and relatively more
shallow access to lexical-semantic memory. Such tasks (e.g., word
identification, word pronunciation, and lexical decision) produce
smaller, less consistent deficits in repetition priming due to AD or
aging, and sometimes no deficit at all. EN individuals showed
repetition priming in RT-based pronunciation or lexical decision
tasks equivalent to that of young normal (YN) individuals in, for

973
974 OBER AND SHENAUT
example, Balota and Duchek (1991), Balota and Ferraro (1996),
Light and Kennison (1996), and Ober, Shenaut, Jagust, and Still-
man (1991). Contrasting studies in which EN participants showed
reduced repetition priming relative to YNs in relatively more
conceptually based tasks are plentiful; for reviews, see Light
(2012), Fleischman and Gabrieli (1998), and Fleischman (2007).
Examples of AD participants showing repetition priming not dif-
fering from that of EN in RT-based pronunciation and/or lexical
decision tasks include Balota and Ferraro (1996), Carlesimo,
Mauri, Fadda, Turriziani, and Caltagirone (2001), and Ober et al.
(1991); however, a study utilizing very long delays between re-
peated stimuli showed significantly less repetition priming of
lexical decision for AD compared with EN (Schnyer, Allen,
Kaszniak, & Forster, 1999). Examples of AD participants showing
reduced repetition priming compared with EN in relatively more
conceptual-level and/or word-retrieval-based tasks, include
Fleischman et al. (2005) and Mitchell and Schmitt (2006); for
reviews, see Fleischman and Gabrieli (1998) and Fleischman
(2007). Several within-subject studies provide evidence for a dis-
sociation such that AD patients show less-than-normal repetition
priming effects when the test task requires word production, but
normal priming when it does not (Fleischman & Gabrieli, 1998;
Fleischman et al., 2001; but see Lazzara, Yonelinas, & Ober,
2001).
Lexical Decision: Advantages as a Repetition
Priming Task
RT-based lexical decision, in contrast to word-stem or word-
fragment completion, is an ideal task for the assessment of lexical
repetition priming in neuropsychological populations with word-
finding problems (such as AD and EN) because no word retrieval
is required. There is ample evidence that AD patients perform at
comparable-to-normal levels of accuracy on two-choice (word
vs. nonword) lexical decision, even though their RTs are rela-
tively long (e.g., Dunabeitia, Marin, & Carreiras, 2009; Perri et al.,
2003). In fact, AD patients produced comparable-to-normal RT
and accuracy in a go/no-go lexical-decision task in which a
button press was made only to real words (Ober, Shenaut, & Reed,
1995). Moreover, the lexical-decision task requires the use of
nonword targets as foils, so priming of both words and nonwords
can be evaluated if desired, with the standard two-choice task.
In spite of these advantages, there have been relatively few
studies of repetition priming of lexical decision in normal aging,
and fewer still that included AD patients. The available evidence
suggests that both AD and EN groups have intact repetition prim-
ing for both nonwords and words, although the evidence is much
more limited for nonwords than for words. This is because the
majority of experiments that have used the lexical-decision task
with AD patients were actually semantic priming experiments
focused on priming due to associative relations between words,
each critical target word being used once in a semantically related
pair and once in a semantically unrelated pair. This systematic
repetition of target words provided the opportunity to assess rep-
etition priming for words but not nonwords, the latter not having
been repeated systematically. When (word) repetition priming has
been assessed within this type of semantic priming paradigm, it has
generally been found to be equivalent for AD, EN, and YN groups
(e.g., Ober & Shenaut, 1988; Ober et al., 1991).
Models of Lexical Decision and Repetition Priming
The most pervasive element in models of lexical decision is
some notion of familiarity. For example, in the two-stage model of
Balota and Chumbley (1984), the initial stage involved rapid
computation of familiarity, with relatively high familiarity biasing
toward a fast yes (word) response and relatively low familiarity
biasing toward a fast no (nonword) response; a second stage
occurred whenever the familiarity fell between the participants
criteria for a word compared with nonword response, and this stage
involved more analytic processing of the lexical/semantic proper-
ties of the stimulus before a (necessarily slower) response was
made. Familiarity has long been thought to be incorporated into the
representation of lexemes in some way that lowers their activation
threshold (Forster, 1978; Morton, 1969), either absolutely as part
of the permanent lexical structure due to the frequency of access
over a long period of time, or perhaps also relatively as the
result of recent access (Coane, Balota, Dolan, & Jacoby, 2011).
Models of lexical decision that are focused more directly on
repetition priming of lexical decision, however, have empha-
sized the levels at which the stimuli are processed during the
study and test phases (Duchek & Neely, 1989), or the degree to
which identical cognitive processes are used for the study and
test tasks (e.g., Franks, Bilbrey, Lien, & McNamara, 2000). For
example, in experiments focusing directly on nonword priming,
Zeelenberg, Wagenmakers, and Shiffrin (2004) demonstrated
that lexical-decision priming for nonwords was inhibitory when
a letter-height task was used at study, but facilitatory when a
lexical-decision task was used at study. Their explanation was
based on a two-process model, with a relatively fast familiarity
assessment followed by a slower episodic retrieval of the mem-
ory of making either a word or nonword response during
the study phase. Their study also included a second experiment
using lexical decision during both study and test, which found
negative nonword priming when participants were asked to
respond very quickly, and positive nonword priming when they
were asked to respond more slowly. The quick-response con-
dition was interpreted as having given preference to the famil-
iarity process, whereas the slow-response condition was said to
allow the retrieval of the prior response (to the stimulus during
the study phase). It is important to note the contrast between the
nonfamiliarity component of Balota and Chumbleys two-stage
model and the nonfamiliarity process of Zeelenberg et al.s
two-process model: In the former, access to permanent lexical/
semantic memory is assumed, and in the latter, it is access to a
recent, episodic memory that is used. In any case, all models of
repetition priming of lexical decision involve the modification
or creation of long-term memory traces representing studied
items that can affect access to those items at the time of test.
Specific Rationale for the Current Study
A study by Balota and Ferraro (1996) assessed repetition prim-
ing of lexical decision in AD and normal aging without embedding
lexical decisions into a semantic priming task. Their studywhich
focused on word-frequency effects employed a rhyme decision
task in the study phase, in which participants indicated whether
pairs of stimuli rhymed or not (e.g., cause/laws vs. cause/raise for
words, spart/cart vs. spart/hurt for nonwords), with both word and
nonword rhyme items being potential targets in a later lexical-
 REPETITION PRIMING IN AD AND AGING
decision task. The repetition priming effect, as assessed by lexical
decision RT, was positive for words and negative for nonwords
(slower lexical decision RTs for repeated nonwords is more likely
when the study task does not involve lexical decision, as will be
discussed later). Most importantly, the study found that the mag-
nitudes of (negative) nonword and (positive) word repetition prim-
ing did not differ across AD, EN, and YN participants, providing
evidence that neither normal aging nor AD impairs the ability to
create the necessary memory traces for nonwords.
Given that episodic memory is significantly impaired in AD,
whereas semantic memory and implicit memory are relatively
preserved, we can assume that the memory processes underlying
preserved repetition priming of lexical decision are unlikely to
depend on episodic memory; on the other hand, the relative pres-
ervation of lexical/semantic knowledge would allow it to be used
normally. The previously published study most similar to ours is
that of Balota and Ferraro (1996). However, our study differed
from theirs in two principal areas: the lexicality of the study task
and the overall similarity of word versus nonword stimuli. Instead
of rhyme decision, which is relatively likely to involve lexical
access, our study task involved matching substrings within word
and nonword strings in order to minimize word-level processing of
the stimuli by focusing the participants on letter-by-letter (ortho-
graphic) processing. Our nonword stimuli were obsolete English
words, and our words were all of low familiarity/low frequency,
our intention being to maximize the similarity of words and
nonwords in form and in familiarity. Moreover, unfamiliar, low-
frequency words show significantly longer lexical decision RTs
and significantly greater repetition priming effectsthan high-
frequency words in YNs (e.g., Balota & Spieler, 1999;
Scarborough, Cortese, & Scarborough, 1977), ENs (Balota &
Ferraro, 1996), and very mild AD patients (but not mild-to-
moderate AD, per Balota & Ferraro, 1996). These experimental
design features were intended to provide a strong test of whether
AD and EN individuals differ from YN individuals in their ability
to modify (in the case of words) or create (in the case of nonwords)
long-term memory traces, on the basis of only relatively shallow
orthographic processing of lexical stimuli, such that these traces
would facilitate later processing of these stimuli.
Study Task
In contrast to the phonological, word-level study task was used
by Balota and Ferraro, we were interested in using a subword level
orthographic study task comparable with the letter-height study
task used by Zeelenberg et al. (2004) with YN participants, in
which the letter string was simply scanned with no requirement of
any processing at the lexical level. Eliminating the requirement for
word-level processing at study would provide a test of whether
participants form new lexical/semantic memory traces for non-
words when there is unlikely to have been any prior conscious
lexical processing of them. Unfortunately, the letter-height task,
which requires participants to ascertain whether a mentally gener-
ated, lower-case version of an upper-case (presented) stimulus has
more ascending letters (e.g., h, t) or descending letters (e.g., j, q),
could be difficult for AD patients due to their deficiencies in
working memory. The study task we decided to use here, substring
matching, had the same orthographic-scanning characteristic as the
975
letter-height task, but did not require participants to hold a differ-
ent version of the presented stimulus in working memory.
Nonword Characteristics
Nonwords that closely resemble words tend to show repetition
priming effects of greater magnitude than those that do not (Stone
& Orden, 1993; Wagenmakers, Zeelenberg, Steyvers, Shiffrin, &
Raaijmakers, 2004), keeping in mind that, depending on experi-
mental parameters, the nonword repetition priming effect may
sometimes manifest as facilitation and sometimes as inhibition
(Zeelenberg et al., 2004). The usual method of generating word-
like nonwords has been to modify real words by replacing one or
two letters, as was done in Balota and Ferraro (1996), but this
approach produces nonwords that may violate standard English
letter-sequence frequencies, and presentation of such nonwords
has been shown to activate, under some circumstances, the source
words from which they were derived (Deacon, Dynowska, Ritter,
& Grose-Fifer, 2004). To avoid these problems in the current
study, we used obsolete English words, that is, words that once
were active in the language, but which have been considered
obsolete for 100 years or more; this results in words that feel
much more like low-frequency words than many nonwords pro-
duced by altering current words. They are generally more likely to
contain familiar morphology and perhaps a few participants may
have seen one or more of them in an historical text or dictionary,
or as a cognate word in a foreign language. In any case, previous
testing has shown that participants have little or no trouble clas-
sifying them correctly as nonwords, at least on first presentation
(Ober et al., 1991).
Word Frequency
Low-frequency words benefit more from repetition than high-
frequency words (Balota & Ferraro, 1996; Duchek & Neely,
1989). This effect has usually been interpreted as indicating that
high-frequency words are already quite familiar, and therefore do
not become more familiar from recent presentation. In order to
maximize the potential amount of word priming in the current
study, we used only low-frequency words, whereas Balota and
Ferraro used half high-frequency and half low-frequency words,
because word frequency was a critical variable in their study. Also,
the use of only unfamiliar, low-frequency words further reduced
the difference in familiarity between words and nonwords in our
study compared with theirs.
Method
Participants
A total of 113 native speakers of English participated in this
study: 30 who had been diagnosed with probable AD, 34 EN, and
49 YN. Demographic and other information about the participant
groups is presented in Table 1. The AD individuals were recruited
from the University of California, Davis, Alzheimers Disease
Clinical Centers (Martinez and Sacramento sites). All met the
NINCDS-ADRDA (McKhann et al., 1984) criteria for probable
AD. None of the AD participants had a history of psychiatric
treatment, drug or alcohol abuse, heart disease, uncontrolled high
976 OBER AND SHENAUT

Table 1 Stimulus Materials

Mean (SD in Parentheses) Age, Education, MMSE, and NAART
for Each Participant Group
N Agea Educ. MMSE NAARTb
YN 49 19.3 (1.6) 13.1 (1.2) 26.41 (8.31)
EN 34 71.5 (6.5) 15.4 (2.4) 29.5 (0.7) 16.41 (8.66)
AD 30 78.4 (6.1) 13.3 (2.4) 22.2 (3.9) 27.31 (10.28)
Note. YN young normal; EN elderly normal; AD Alzheimers
disease; MMSE Mini-Mental Status Exam (number correct out of 30);
NAART North American Adult Reading Test (number of errors, i.e.,
incorrectly pronounced words, out of 61).
a
A smaller sample of EN participants that was more closely age-matched
to the AD group was utilized in a re-analyses of the EN and AD experi-
mental data; details are included in the Results section. b The NAART
was unavailable for one AD participant, due to experimenter error.
blood pressure, stroke, or head injury; none were taking any
medications known to affect cognition (including cholinesterase
inhibitors). The AD participants were mildly-to-moderately de-
mented, with scores on the Mini-Mental State Examination (Fol-
stein, Folstein, & McHugh, 1975) ranging from 1228.
The EN participants were recruited from the community, via
advertisements posted in senior centers and placed in community
newspapers. All of the EN individuals met the same exclusionary
criteria as the AD participants and none had any complaints about
memory or other cognitive functions; they all had scores on the
MMSE in the range of 2730. The YN participants were recruited
from among research subject pools in Psychology and Human
Development at the University of California, Davis. These
younger participants met the same exclusionary criteria as the EN
participants. All participants were given the North American Adult
Reading Test (NAART; Spreen & Strauss, 1991), which involves
the pronunciation of irregularly spelled words, and which is
strongly correlated with verbal IQ. The AD and EN participants
received a nominal fee, whereas the YN participants received
course credit for their participation. The study was approved by the
Institutional Review Boards of the VA Northern California Health
Care System and the University of California, Davis.
A set of 50 low-familiarity, low-frequency word stimuli were
collected from the MRC Psycholinguistics Data Base: Machine
Usable Dictionary, Version 2 (Wilson, 1988). The words ranged
from 217 to 448 (median 411) in the MRC composite familiarity
norm, and ranged from 4 to 15 (median 5) in the MRC Francis and
Kucera (1982) frequency norm. Examples of word stimuli are
ardent, kerosene, sonata, and tweed. In addition, 50 pronounceable
nonwords were collected from a list of obsolete words (Ober et al.,
1991). No nonword appeared either in the familiarity norm or in
the Francis and Kucera norm. They were marked as obsolete in the
Oxford English Dictionary (1971) and were found neither in
Websters Modern (1902) or New Collegiate (1981) dictionaries.
Examples of the nonwords are: chalon, famble, jocant, and san-
glier. Both word and nonword stimuli had from five to eight letters
and from one to four syllables.
Items were divided into two counterbalance sets such that each
stimulus was used equally often as a studied and an unstudied item
(see Table 2). Six words and nonwords were randomly selected to
be used as fillers, two words and two nonwords in each of the three
phases, the same filler items being used in both counterbalancing
sets. The remaining 44 words and 44 nonwords were divided
equally and randomly between the two sets for the study phase,
resulting in 22 words and 22 nonwords for each set. Three-letter
matching substrings of each item were selected randomly (e.g.,
sonata: nat), then modified by random letter substitution to pro-
duce three-letter substrings that did not match the item by only one
letter (e.g., nat: nbt). Of the 22 studied words and 22 studied
nonwords in Set 1, 10 words and 10 nonwords were randomly
assigned to become studied items in the practice phase of Set 1 and
the unstudied items in the practice phase of Set 2; 12 words and 12
nonwords were randomly assigned to become the studied items in
the test phase of Set 1 and the unstudied items in the test phase of
Set 2. The same procedure was used in the opposite direction for
the 22 words and 22 nonwords in the study phase of Set 2. Subjects
were assigned sequentially to Set 1 or Set 2, and items within the
lists were shuffled randomly for each participant, except for filler
items, which always came first.

Table 2
Counterbalancing Scheme for Study, Practice, and Test Phases

Set 1 Set 2

Study phase Fillers for study phase (2 words, 2 nonwords)

P1: Studied items for practice phase, P2: Studied items for practice phase, Set 2
Set 1 (10 words, 10 nonwords) (10 words, 10 nonwords)
T1: Studied items for test phase, Set 1 T2: Studied items for test phase, Set 2
(12 words, 12 nonwords) (12 words, 12 nonwords)

Practice phase Fillers for practice phase (2 words, 2 nonwords)

Studied P1 (10 words, 10 nonwords) P2 (10 words, 10 nonwords)
Unstudied P2 (10 words, 10 nonwords) P1 (10 words, 10 nonwords)

Test phase Fillers for test phase (2 words, 2 nonwords)

Studied T1 (12 words, 12 nonwords) T2 (12 words, 12 nonwords)
Unstudied T2 (12 words, 12 nonwords) T1 (12 words, 12 nonwords)
Note. The same filler items are used in both sets; all other items are used in one set as a studied item and in
the other as an unstudied item, as indicated by the labels P1, P2, T1, and T2. Studied and unstudied items within
a phase were shuffled together before each run.
 REPETITION PRIMING IN AD AND AGING
Design and Procedure
A 3 Group (AD, EN, and YN) 2 Lexicality (word vs.
nonword) 2 Repetition (studied vs. unstudied) design was em-
ployed, with lexicality and repetition being manipulated within
subjects. The experimental procedure involved three phases, with
a brief pause (about 1 min) between them (see above and Table 2
for details on stimulus selection and counterbalancing). In the first
(study) phase the participants performed a substring matching task.
Each of the study phase stimuli was presented on a computer
screen with a three letter string beneath it. Participants were
instructed to press a large green button (yes) if the lower string was
contained in the longer string above it, and to press a large red
button (no) if the lower string was not contained in the longer
string. For half of these trials yes was the correct answer (e.g.,
flyer - yer, brike - rik); for the other half, no was the correct
answer (e.g., mutton - dut, drazel - drx). The second and third
phases consisted of two-choice lexical decision trials, in which
subjects were instructed to respond yes or no depending on
whether a stimulus was a word. The second session was a practice
session for the third, which was the critical test phase. One half of
the studied words and one half of the studied nonwords had been
presented with a matching substring, and the other half had been
presented with a nonmatching substring during the study phase.
None of the test phase stimuli had been utilized in the practice
phase. Participants were not given any information about the
relationship between the substring and lexical decision tasks.
Results
The 113 participants that were included in the data analyses had
all achieved accuracy levels of 75% or more on the critical word
and nonword trials. Additional participants were tested who did
not meet the predetermined accuracy criteria; these included five
YN, one EN, and seven AD participants. In order to reduce RT
variance due to outliers in the data for the final 113 participants, a
data trimming procedure was employed in which the trials with the
highest and the lowest RT in each cell of the experimental design
were eliminated for each participant, as suggested by Bush, Hess,
and Wolford (1993).
The mean RT priming effects (unstudiedstudied) for the three
groups across all experimental conditions are displayed in Figure
1. As can be seen in the figure, the pattern of results for RT
priming is that all three groups showed evidence of a numerically
positive priming effect for words (i.e., shorter RT for studied
words than for unstudied words) and a negative priming effect for
nonwords (i.e., longer RT for studied nonwords compared with
unstudied nonwords). In order to address the primary question as
to whether word and nonword repetition priming of lexical deci-
sion RTs is modulated either by age or by dementia, the AD and
EN groups were included in a first set of ANOVAs (dementia-
related effects), whereas the EN and YN groups were included in
a second set of ANOVAs (age-related effects). Secondary analyses
included: an analysis of lexical decision errors, a test of the effect
of the 7-year mean age difference between our EN and AD groups,
a test of the effect of general slowing due to aging and dementia,
and a test to determine the extent to which individual groups
manifested RT priming effects for words and nonwords. All effect
sizes are expressed in terms of Cohens d statistic; Cohen has
977
100
Priming Effect (Milliseconds)
0
-100
-200
AD EN YN
Word
Nonword
Figure 1. Word and nonword RT priming effect means (SE) for AD
(Alzheimers disease, N 30), EN (elderly normal, N 34), and YN
(young normal, N 49) participants.
suggested that d .20, .50, and .80, be interpreted as small,
medium, and large effects, respectively (Cohen, 1988; pp. 24 27).
Analysis of Differences Due to Age
The RT means are presented in Table 3. A 2 Group (YN, EN)
2 Lexicality (word, nonword) 2 Repetition (studied, unstudied)
ANOVA revealed the expected overall longer RT for the EN
compared with YN groups, F(1, 81) 12.2, p .001, d .78,
and the expected longer RTs for nonwords versus words, F(1,
81) 68.7, p .001, d 1.8. The overall effect of repetition was
negligible, F(1, 81) 1, due to the positive repetition effect for
words canceling out the negative repetition effect for nonwords.
The Lexicality Repetition interaction effect was quite robust,
F(1, 81) 20.1, p .001, d 1.0, and reflects the opposite
effects of repetition on words versus nonwords. All of the remain-
ing interactions were insignificant, including Group Lexicality,
and Group Lexicality Repetition, both with F(1, 81) 1. In
sum, the increase in RT for nonwords versus words was propor-
tionate for the YN and EN groups, and the degree to which the
repetition priming effect was reversed for nonwords (negative
priming) versus words (positive priming) was not modulated by
age group.
Of secondary interest were the error data, which are also pre-
sented in Table 3. The error rate was low, ranging from 3% to 11%
across experimental conditions. A Group Lexicality Repeti-
tion ANOVA showed that EN were more accurate than YNs, F(1,
81) 28.3, p .001, d 1.2; a marginal two-way interaction of
Lexicality Repetition, due to repeated words showing overall
fewer errors than nonrepeated words, in contrast to equivalent
levels of accuracy for repeated versus nonrepeated nonwords, F(1,
81) 3.79, p .052, d .43; and a robust three-way interaction
978 OBER AND SHENAUT
Table 3
Mean RT and Error Rate (SD) Across Groups and
Repetition Conditions
Words Nonwords
Repeated Not repeated Repeated Not repeated
RT (ms)
YN 680 (114) 719 (109) 852 (239) 821 (201)
EN 824 (183) 867 (216) 1,006 (295) 971 (319)
AD 1,140 (363) 1,205 (395) 1,797 (1091) 1,686 (870)
Errors (%)
YN 6 (7) 11 (10) 10 (9) 8 (9)
EN 3 (5) 3 (5) 3 (5) 6 (9)
AD 4 (7) 6 (7) 11 (11) 9 (12)
Note. YN young normal; EN elderly normal; AD Alzheimers
disease.
of Group Lexicality Repetition (absent in the analysis of the
RT data), F(1, 81) 10.3, p .002, d .71. The three-way
interaction was due to YN participants showing the same pattern of
positive repetition priming for words versus negative priming for
nonwords as they showed for the RT data, although EN partici-
pants showed no priming for words and positive priming for
nonwordsa pattern different from that exhibited in the RT data.
There was a marginal indication of a repetition effect, with re-
peated items showing greater accuracy than nonrepeated items,
F(1, 81) 2.80, p .094, d .37; all remaining Fs 1.
Analysis of Differences Due to Dementia
We now turn to the RT data for the EN versus AD groups (see
the relevant rows of Table 3). As expected, the AD group re-
sponded more slowly than the EN group across all experimental
conditions, F(1, 62) 22.0, p .001, d 1.2, and there were
longer RTs for nonwords compared with words, F(1, 62) 26.6,
p .001, d 1.3. The overall effect of repetition was negligible,
F(1, 62) 1, due to the positive effect of repetition for words
canceling out the negative effect of repetition for nonwords. As
was the case for the YN and EN groups combined data, the
analysis on the EN and AD groups combined data showed a
significant Lexicality Repetition effect, F(1, 62) 5.75, p
.018, d .61, due to the opposite effects of repetition on words
versus nonwords. The AD group showed a disproportionate overall
increase in RT for nonwords versus words (563 ms, a 45% in-
crease) as compared with the EN group (142 ms, a 17% increase),
which was reflected in a significant Group Lexicality interaction
effect, F(1, 62) 10.3, p .002, d .81. The remaining
interaction effects, including the important Group Lexicality
Repetition effect, produced Fs 1. In summary, the AD group
exhibited greater slowing for nonwords compared with words than
did the EN group, and most importantly, the degree to which the
repetition priming effect was reversed for nonwords (negative
priming) versus words (positive priming) did not differ for the AD
compared to EN participants.
The error rate ranged from 3% to 11% across experimental
conditions. The Group Lexicality Repetition ANOVA indi-
cated that the AD group showed lower accuracy than the EN
group, F(1, 62) 9.09, p .004, d .77; words showed higher
accuracy than nonwords, F(1, 62) 10.9, p .002, d .84; and
the AD group made disproportionately more errors on nonwords
than words, compared with the EN group, F(1, 62) 3.69, p
.056, d .49, for Group Lexicality. The three-way interaction
was insignificant, F(1, 62) 2.61, p .107, d .41, but at a level
that did not completely exclude the possibility that the EN groups
greater accuracy for studied than for unstudied nonwords differed
from the AD groups pattern in the opposite direction. This would
be parallel to the same interaction found for EN compared with
YN. All remaining main effects and interactions were insignificant
(Fs 1).
Possible Effects of an Age Difference Between the
EN and AD Groups
Given the almost 7-year age difference between our AD and EN
samples (see Table 1), we reanalyzed the RT data with a smaller
sample of EN participants more closely matched on years of age to
the AD group. The youngest of the EN participants were dropped
until we ended up with a group of 21 ENs with a mean age of 75.7
(SD 4.1), which resulted in t(49) 1.73, p .086, for the age
difference (2.7 years) between AD and ENs, in contrast to t(62)
4.34, p .001, for the age difference (6.9 years) between the full
sample of 34 ENs and the AD group. The pattern of results was
nearly identical for this as compared with the full-sample analyses.
The only differences were that the F values were somewhat
decreased (and corresponding p values were somewhat increased),
presumably due to a decrease in power with the smaller sample.
A parallel ANOVA was performed on the error rate date with
the smaller sample of 21 EN participants who were matched more
closely in age with the AD; the results were virtually identical to
those using the full sample of EN participants, including the
direction of the EN groups accuracy difference for studied versus
unstudied nonwords, except for a minor reduction of F values and
slightly increased p values.
Possible Effects of Age- and Dementia-Related
General Slowing
To examine possible effects of general slowing on the between-
group RT priming results, we applied a method suggested by
Madden, Nebes, and Allen (1992). First, in order to get the best
possible estimate of the task-complexity function of the YN and
AD groups relative to the EN group using the data available in this
experiment, we computed the group means of eight different types
of correct trials: For the study phase task (substring matching, not
semantic), we computed the mean RT for word/match, word/no-
match, nonword/match, and nonword/no-match; for lexical deci-
sion (semantic), we included both the practice block and the
experimental block, and computed the means for studied/word,
studied/nonword, unstudied/word, and unstudied/nonword. Then,
using those eight variables, we computed linear regression equa-
tions for EN and AD: AD 69.3 1.68 (EN), r2 .974, and
for EN and YN: YN 287 0.543 (EN), r2 .987. We then
transformed the YN and AD lexical decision data by reversing the
equations (i.e., subtracting the mean and dividing by the coeffi-
cient), and repeated the analyses described earlier on aging and
dementia. For overall RT, neither the AD group nor the YN group
differed from the EN group, Fs 1. For all other factors and
interactions, the pattern of results was identical to that of the
 REPETITION PRIMING IN AD AND AGING
original analysis, suggesting that general slowing had little if any
impact on the results.
Priming in All Groups Combined and Within
Individual Groups
In spite of the pattern of effects reported above, it is still of
interest to determine whether individual groups produced positive
RT priming for words and negative priming for nonwords. As a
preliminary, we looked at word and nonword RT priming for all
three groups combined in a pair of 3 Group (AD, EN, YN) 2
Repetition (studied, unstudied) ANOVAs, using just word or just
nonword data. There was a significant overall positive priming
effect for words, F(1, 110) 15.9, p .001, d 0.76, and also
a significant (but less robust) overall negative priming effect for
nonwords, F(1, 110) 4.75, p .029, d 0.42.
Next, we performed a series of t tests on priming within each
individual group (means and standard errors are displayed in
Figure 1). YN participants showed significant priming for words,
t(48) 2.86, p .006, but insignificant priming for nonwords,
t(48) 1.49, p .138; EN participants showed significant prim-
ing for words, t(33) 3.24, p .003, and marginal priming for
nonwords, t(33) 1.81, p .076; and AD patients showed a
marginal priming effect for words, t(29) 1.83, p .074, and
insignificant priming for nonwords, t(29) 1.33, p .191.
Although all of these results are in the predicted direction, and all
three groups showed priming for words (if only marginally for
AD), only the EN group showed a (marginal) priming effect for
nonwords.
Discussion
Summary of Findings
The RT data from this lexical decision, repetition priming experi-
ment showed that the pattern of priming was not modulated by age
(YN vs. EN) or by dementia (AD vs. EN), and that there was overall
significant positive priming for words as well as overall significant
negative priming for nonwords. A caveat is that although each of the
three individual groups showed at least marginal priming for words,
only the EN group showed marginal priming for nonwords, indicating
that there may have been insufficient power relative to within-group
variability to test for these priming effects in the individual groups.
The accuracy data generally resembled the RT data, with the follow-
ing caveats: The overall accuracy was high, with rather small differ-
ences among conditions; and, unlike the AD and YN groups, the EN
group did not show the expected increase in accuracy with repeated
words, or the expected decrease in accuracy with repeated nonwords.
There did not appear to be any effect of a slight age difference
between the AD and EN groups, nor did there appear to be any effect
of general slowing, due either to age or to dementia.
The current study differed from an earlier one by Balota and
Ferraro (1996) in several ways. Our study task, substring matching,
was intended to maximize the role of orthographic, letter-by-letter
processing, in contrast to the test task (lexical decision), which in-
volved lexical, word-level processing, whereas their study task, rhyme
decision, was at the lexical level. Moreover, the use of low-frequency
word targets and obsolete English nonword targets resulted in the a
priori familiarity of the targets requiring a yes decision being much
979
closer to that of targets requiring a no decision, than was the case for
Balota and Ferraro, who changed one or two letters in real words to
produce their nonwords, and used both high- and low-frequency
words. The combination of the orthography-based study task and the
lexicality-based test task minimized the role of strategies based on
explicit memory for the encoding context, because different levels of
processing as well as different responses were required during the
study versus test phase. In spite of these changes, the results of our
study are quite similar to those of Balota and Ferraro as pertains
specifically to the pattern of word and nonword repetition priming in
aging and dementia; note, however, that Balota and Ferraro did not
report on priming within individual groups nor provide per-group
standard errors. Moreover, it is of interest that the absolute magnitude
of priming in our study was greater than in theirs for every group and
for both words and nonwords (our EN group being compared with
both of theirs, and our AD group to both of theirs). This suggests that
the methodological differences in our studya much shallower study
task and much lower frequency words and more word-like non-
wordsmay have enhanced both positive priming for words and
negative priming for nonwords in every group, at least to some
degree.
Word Repetition Priming
The invariance of the positive word-repetition priming effect with
AD and EN, in spite of the slower overall RTs obtained with these
participant groups on the lexical-decision task relative to YN, and in
spite of the well-documented deficits in explicit memory tests asso-
ciated with AD and normal aging (Fleischman & Gabrieli, 1999; Old
& Naveh-Benjamin, 2008), is another indication of its robustness. The
present findings for words are consistent with findings of preserved
repetition priming in normal aging and AD across several types of
verbal tasks, when the tasks are relatively more perceptual than
conceptual in nature and when word retrieval is not required (as
reviewed by Fleischman, 2007). Nonetheless, the present AD study is
one of very few that have focused on repetition priming of lexical
decision; the majority of experiments on lexically based repetition
priming in AD have utilized tasks such as threshold word-
identification, and word-stem or word-fragment completion (e.g.,
Arroyo-Anllo, Ingrand, Neau, Aireault, & Gil, 2004; Karlsson,
Borjesson, Adolfson, & Nilsson, 2002; La Voie & Faulkner, 2008).
Nonword Repetition Priming
The use of a two-choice lexical decision paradigm to assess repe-
tition priming has the benefit of allowing the researcher to evaluate
nonword repetition priming effects. We were particularly interested in
the nonword priming effect because it provides a test of the intactness
of the memory processes which underlie repetition priming for novel
(i.e., never before encountered) stimuli. The design of the present
experiment, with different study- versus test-phase tasks, very low-
frequency words (i.e., very unfamiliar words), and very word-like
nonwords (i.e., obsolete English words) was meant to ensure a robust
nonword familiarity effect (i.e., negative priming for nonwords),
which we could then compare across participant groups. We did,
indeed, obtain a negative priming effect for nonwords, which was
equivalent between the AD and EN groups, as well as between the EN
and YN groups. Negative priming effects for nonwords have been
obtained with YNs (Bowers, 1994; McKoon & Ratcliff, 1979;
980 OBER AND SHENAUT
Zeelenberg et al., 2004), and with AD and EN participants (Balota &
Ferraro, 1996). We have provided a replication and extension of
equal-to-normal, negative, nonword priming for AD patients, utilizing
a different type of study task (requiring a focus on sublexical orthog-
raphy) and a more challenging lexical-decision task (in terms of the
similarity of the nonwords to the words) than employed in previous
research. Our findings provide increased support for the ability of
mild-to-moderate AD patients (like ENs and YNs) to create long-term
memory traces for novel, word-like letter strings.
There is evidence for two opposing processes in making a lexical
decision to a repeated nonword: a relatively fast, familiarity-based
process, which inhibits the correct response to a repeated nonword
(i.e., it is biased toward a word response) and results in a negative
nonword priming effect; and a relatively slow, instance-based process,
which facilitates the correct response to a repeated nonword (i.e., it is
biased toward a nonword response) and results in a positive non-
word priming effect. This opposing-process evidence was obtained by
the manipulation of speed-stress (Wagenmakers, Zeelenberg, et al.,
2004) and similarity of the study and test tasks (Zeelenberg et al.,
2004), in lexical-decision experiments with YN participants. In their
discussions of the nature of nonword memory representations,
Wagenmakers, Zeelenberg et al. (2004), Zeelenberg et al. (2004), and
Wagenmakers, Steyvers et al. (2004) assume that the initial presen-
tation of a nonword does not result in a lexical-semantic memory trace
for that nonword. Instead, their assumption is that in addition to an
instance (context-based) trace being created, the presentation of a
nonword triggers activation of (actual) words in lexical-semantic
memory that are orthographically and/or phonologically similar to the
presented nonwords. These types of neighborhood activation ef-
fects have, in fact, been demonstrated for nonwords (Siakaluk, Sears,
& Lupker, 2002) as well as for words (Sears, Hino, & Lupker, 1995;
Yates, Locker, & Simpson, 2004). Repeated presentation of a non-
word results in at least some of these neighborhood words being
reactivated, thus increasing the feeling of familiarity to the nonword
stimulus. In any case, it is assumed by Wagenmakers, Zeelenberg, and
colleagues (e.g., Zeelenberg et al., 2004) that the familiarity-based
process underlying negative nonword priming does not entail lexical-
semantic representations for the nonwords per se. In the next section,
we argue that such representations may indeed be involved in the
processing of repeated word-like nonwords.
A Theoretical Conjecture: Nonword Repetition
Priming and Novel Word Learning
It is not unusual to encounter word-like nonwords when reading.
A well-known example is in Chapter 1 of J. K. Rowlings (1997)
Harry Potter and the Philosophers Stone:
Even Muggles like yourself should be celebrating, this happy, happy
day!
And the old man hugged Mr. Dursley around the middle and walked
off.
Mr. Dursley stood rooted to the spot. He had been hugged by a
complete stranger. He also thought he had been called a Muggle,
whatever that was (p. 10).
This word-like nonword is used a few more times later in the
same chapter, but is not defined explicitly until Chapter 4.
There is considerable similarity between encountering an un-
known word while reading a text, and encountering a word-like
nonword in an experimental context. In a textual context, it is
reasonable to assume that the string is processed as a word that was
previously unknown, with fragments of meaning, grammatical
function, and pronunciation stored in a rudimentary, provisional
lexical entry. When the same string is encountered later, additional
meaning is added to the previously created entry from the later
context; this is repeated as part of the normal process of word
acquisition. Obviously, the textual context provides considerable
information that can be stored in the new lexical entry, even if
there is not enough to provide a complete understanding of the
word. In an experimental context, particularly one such as in the
present experiment where the initial encoding of the items was
quite shallow, there is much less information available for storage
in a provisional lexical entry. However, even in such a case there
may be at least some information available, including when and
where the item was encountered, what the readers mental state
was at the time, what the response was, and hypotheses as to
possible morphological, phonological, and semantic attributes
based on the items orthography. If such provisional lexical entries
resulted from single study-phase exposures to word-like nonword
letter strings, then during the test phase of a repetition-priming
experiment the entry would be activated when the previously
viewed letter string was presented again, along with any attributes
stored there, including item familiarity. Incidentally, if such pro-
visional lexical entries are created as the result of an exposure as
shallow as that involved in our experiments study task, it is most
likely that the process is an automatic one, as opposed to one
requiring specific effort or explicit processing of the item.
The concept of a provisional lexical entry is compatible with
both the Tenpenny (1995) weakly episodic and the Bowers
(2000) weakly abstractionist view of repetition priming. Both
views allow for the contribution of episodic and abstract memory
traces to repetition priming, albeit with one type of trace playing a
more important role in each view. Moreover, this type of approach
is compatible either with a multiple-systems view in which lexical
and semantic processing are supported by separate memory sys-
tems (Coltheart, Rastle, Perry, Langdon, & Ziegler, 2001), or with
a single-system view in which lexical and semantic processing are
served by the same memory system (e.g., Dilkina, McClelland, &
Plaut, 2010).
Coane et al. (2011) results, which differentiated a long-lasting
absolute familiarity (resulting from experience with the item
across the life span) from an episode-specific relative familiarity
(a change in familiarity caused by recent access), provides an
interesting nuance to the idea of a provisional lexical entry for
nonwords. Their dual-familiarity model suggests that words with
high absolute familiarity have little potential to accrue relative
familiarity, whereas words with low absolute familiarity have high
potential; this duality can explain certain aspects of the word
frequency effect. Because a newly created nonword lexeme
would have near-zero absolute familiarity, then it would have
maximum potential to attain high relative familiarity, making such
lexemes subjectively more similar to unfamiliar words in terms of
overall familiarity, and perhaps accounting for the negative non-
word repetition effect such as we report here.
In order to account for positive nonword priming based on a
memory of making a previous no response in experiments using
 REPETITION PRIMING IN AD AND AGING
lexical decision at both study and test, Wagenmakers, Zeelenberg
et al. (2004) posited an episodic, instance-based component in
their model of lexical-decision repetition priming, motivated in
part by their explicit assumption that nonwords have no lexical or
semantic memory entries. It is unclear what the participants
decision to classify a word-like letter string as not a word would
have on the formation of provisional lexical entries. The existence
of such entries would presumably facilitate retrieval of memories
of previous responses by acting as a verbal index into episodic
memory; alternatively, one could suppose that the previous lexical
decision is stored in the provisional lexeme itself, being activated
along with its other attributes when the letter string is repeated.
Ironically, in this case part of the information stored in the lexical
entry would be this is not a word. However, this is not unprec-
edented: Consider Lewis Carrolls (1872) slithy toves and other
more or less familiar words whose meaning is essentially that
they are meaningless, plus some bits of source information. The
process whereby an initially sparse provisional lexeme can become
increasingly word-like as it accumulates meaning through subse-
quent experience seems similar to the Wagenmakers, Steyvers et
al. (2004) account of how new information is added to an existing
lexical/semantic trace; the addition of the idea of provisional
lexemes coming into existence upon encoding of word-like letter
strings would provide a theoretical starting point for that process.
Interestingly, there is evidence for implicit learning of novel
words by way of reports of successful acquisition of new words by
amnesics (e.g., Westmacott & Moscovitch, 2001) and partial ac-
quisition (across incidental-learning exposures) and retention of a
novel verb by AD patients (Grossman et al., 2007). Both AD and
amnesic patient groups have significant deficits on explicit mem-
ory tasks; thus, the novel-word learning must be solely or mainly
implicit in nature. In the case of AD, these patients preserved
novel-word learning is consistent with the evidence for preserved
lexical-decision priming, and with a general preservation of im-
plicit learning and memory for lexical stimuli. It should be noted,
however, that there was evidence that the AD patients were defi-
cient compared with controls in the acquisition of the semantic
attributes of newly learned words in Grossman et al. (2007). An
interesting demonstration of novel word learning in YNs is pro-
vided by Tamminen and Gaskell (2013) who were able to obtain
semantic priming by preceding previously known words by newly
learned words (after only a brief period of training); semantic
priming is, of course, indicative of the new words having been
incorporated into the lexical/semantic network.
In sum, our conjecture is that an initial presentation of a non-
word, whether in an experimental task or in a text, may automat-
ically cause a provisional lexical entry to be created, storing
mainly orthographic or phonemic features (but relatively few
semantic features). Consistent with this proposition are research
findings in the domain of novel-word learning that are suggestive
of changes in the lexical/semantic processing for novel words
occurring after just a single exposure (e.g., Nora et al., 2012;
Tamminen & Gaskell, 2013). These and related findings have led
to the complementary systems account of word learning that
distinguishes short- from long-term (after being repeatedly linked
to semantic information) mental representations of novel words,
with the long-term representations becoming less distinguishable
from those of existing words with regard to behavioral and neural
response patterns (Lindsay & Gaskell, 2010).
981
EN Error-Rate Priming
Finally, it was unexpected that the EN groups error data did not
display the pattern seen across all groups for RT priming and in the
YN and AD group for errors, namely positive priming for words and
negative priming for nonwords. Instead, the EN error rate showed
near-zero priming for words and positive priming for nonwords.
Although this could be simply a fluke, there is another possibility: the
well-known cautiousness of elderly participants (e.g., Starns & Rat-
cliff, 2010). EN participants may have noticed during the study phase
that the items seemed to be very infrequent words, and so implicitly
tried to find a meaning for each one (e.g., in case they were asked
about them later) while they performed the substring matching task,
with failure being more salient than success. In this case, I found no
meaning for X memory trace could have facilitated their error
performance for studied nonwords while having little effect on words.
Note that although in our experiment this contrary effect was visible
only in EN error performance, the explanation is somewhat compat-
ible with the finding of Zeelenberg et al. (2004) of positive RT
priming for nonwords when lexical decisions are made at study.
Perhaps if processing time were constrained during the study task,
gratuitous lexical processing could be reduced, parallel to what was
also seen by Zeelenberg et al. for explicit lexical decisions with
constrained study time.
Conclusions and Future Directions
The results of this study extend the stimulus and task parameters
under which repetition priming of lexical decision, based mainly (if
not exclusively) on implicit memory processes, is preserved in AD as
well as normal aging. Specifically, the repetition priming effect and
the degree to which the repetition priming effect was reversed for
nonwords compared with words was unaffected by AD or normal
aging. Thus, AD and EN individuals, like YN individuals, are able to
form new long-term memory traces based on purely orthographic
encoding of novel word-like letter strings.
One obvious question for future research is whether significant
differences in priming effects would be obtained for AD compared
with EN groups or EN compared with YN groups with a lexical
decision test task, if the time between the study and test phases had
been many hours (or several days), as opposed to the approximate 10
min of the current study. A related question for future research is
whether there would be differences in the longevity of the lexical-
decision priming effects based on the nature of the study task (e.g.,
orthographic, phonemic, or semantic) and/or the type of word versus
nonword stimuli (including the similarity between the two types of
stimuli), in addition to differences due to age or disease.
Another direction for future research is toward clarifying the link
between nonword repetition priming and the acquisition of new
vocabulary. To what extent do the abstract structures posited by
Tenpenny (1995) and Bowers (2000) act like lexical entries? Com-
plicating this task is the lack of an accepted way to determine
objectively when a newly encountered nonword such as Muggle
enters the lexicon and what information is stored with it during the
ongoing process of lexicalization. Given the Grossman et al. (2007)
findings regarding novel-word learning abilities in AD (which are
consistent with preserved nonword repetition priming in AD), another
interesting research avenue would be to extend that work via para-
digms that make greater use of implicit memory tasks, on which AD
patients perform relatively well (e.g., tasks that do not require word
982 OBER AND SHENAUT
retrieval). Such implicit tasks could involve pairings of novel words
with pictures, sounds, tactile stimuli, and so forth, in addition to verbal
material such as sentence frames.
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Received December 1, 2013
Revision received March 30, 2014
Accepted May 2, 2014