Semantic and phonological processing in illiteracy

Illiterate Addenbrooke's Cognitive Examination-III in Three Indian Languages: An Adaptation and Validation Study

BACKGROUND

Literacy is an important factor that predicts cognitive performance. Existing cognitive screening tools are validated only in educated populations and are not appropriate for older adults with little or no education leading to poor performance on these tests and eventually leading to misdiagnosis. This challenge for clinicians necessitates a screening tool suitable for illiterate or low-literate older individuals.

OBJECTIVES

The objective was to adapt and validate Addenbrooke's Cognitive Examination-III (ACE-III) for screening general cognitive functions in illiterate and low-literate older populations in the Indian context in three languages.

METHOD

The Indian illiterate ACE-III was systematically adapted by modifying the original items of the Indian literate ACE-III to assess the cognitive functions of illiterates and low-literates with the consensus of an expert panel of professionals working in the area of dementia and related disorders. A total of 180 illiterate or low-literate participants (84 healthy-controls, 50 with dementia, and 46 with mild cognitive impairment [MCI]) were recruited from three different centers speaking Bengali, Hindi, and Kannada to validate the adapted version.

RESULTS

The optimal cut-off score for illiterate ACE-III to distinguish controls from dementia in all 3 languages was 75. The optimal cut-off scores in distinguishing between controls and MCI ranged from 79 to 82, with a sensitivity ranging from 93% to 99% and a specificity ranging from 72% to 99%.

CONCLUSION

The test is found to have good psychometric properties and is a reliable cognitive screening tool for identifying dementia and MCI in older adults with low educational backgrounds in the Indian context.

Exploring How Sociocultural Factors Affect the Experience of Completing Neuropsychological Assessments Within Older Greek-Australians

OBJECTIVE

The field of cultural neuropsychology has grown exponentially over the last three decades. With a limited culturally informed evidence base to guide neuropsychological practice, the acceptability of existing paradigms has been called into question when applied to culturally diverse and educationally disadvantaged groups. This qualitative study aimed to explore the experiences of Greek Australian older adults who underwent a cognitive assessment to better understand potential barriers and facilitators to engagement and to improve neuropsychological assessment outcomes.

METHOD

Semi-structured interviews were developed to explore cultural attitudes and contextual factors relating to neuropsychological assessment. Interviews were conducted by Greek-speaking neuropsychologists using a sample of 10 healthy elderly Greek Australians following the completion of a comprehensive neuropsychological assessment. Data were analyzed using a phenomenological design within a critical realist framework.

RESULTS

Analysis revealed the emergence of three broad themes: sociocultural factors, experiences within the broader medical system, and the assessment experience. Engagement with cognitive assessment was influenced by several factors, including rapport building, understanding of the assessment, and use of inappropriate tests. Furthermore, level and quality of education, sex differences, language barriers, acculturation, previous experiences of prejudice, anxiety, and a preference for Greek-speaking clinicians were additional factors reported to affect the client experience and validity of assessment outcomes.

CONCLUSION

Neuropsychological assessment is, in part, affected by culturally reinforced attitudes. Failing to adjust the relationship between the clinician and client, test environment, style of communication, and the use of culturally inappropriate tests is likely to affect the validity of assessment outcomes.

Illiteracy, Neuropsychological Assessment, and Cognitive Rehabilitation: A Narrative Review

OBJECT

Νeuropsychological assessment is particularly important for the accurate discrimination of cognitive abilities and weaknesses of patients in order to determine the appropriate therapeutic intervention. However, the reliability and validity of neuropsychological assessment appears to be influenced by a wide range of factors, including literacy and educational level.

AIM

This systematic review evaluates neuropsychological tests appropriate for the valid assessment of illiterate individuals and the effectiveness of cognitive rehabilitation programs for illiterate and/or low-educated individuals according to the results of English language studies that have been published in the PubMed/Medline electronic database until August 2022 (no initiation date).

RESULTS

49 studies were included for neuropsychological assessment and 4 studies for cognitive rehabilitation. In terms of investigating the validity and reliability of neuropsychological tests for the assessment of healthy illiterate individuals, most studies concluded that for the majority of neuropsychological tests there is a significant difference in performance between healthy illiterate and literate individuals. However, there was consensus among studies that the performance of illiterate subjects was equivalent to the performance of literate subjects on tasks depicting colored and real objects. Regarding cognitive rehabilitation programs, all four studies concluded that they are effective in improving the cognitive functions of illiterate and/or low-literate patients with mild cognitive impairment and/or mild dementia.

CONCLUSIONS

For the assessment of illiterate individuals, it is imperative that neuropsychological tests with high ecological validity (i.e., tests related to activities of daily living) be administered so as not to underestimate their cognitive functioning. At the same time, cognitive enhancement/stimulation programs seem to be effective in this population group; however, this area needs further investigation.

Validity of Visuoconstructional Assessment Methods within Healthy Elderly Greek Australians: Quantitative and Error Analysis

Aims

Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer’s disease (ad).

Method

We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of ad on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube.

Results

While healthy participants tended to outperform the ad group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with ad. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube.

Conclusion

Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.

Reading fluency as a measure of educational level

Education exerts a powerful influence on the performance on neuropsychological tests. Recently, the number of years that a person attends school has been the preferred method to operationalize educational level (EL). However, reading fluency (RF) has emerged as an alternative method that can define the quality of education.

Engagement of Language and Domain General Networks during Word Monitoring in a Native and Unknown Language

Functional neuroimaging studies have highlighted the roles of three networks in processing language, all of which are typically left-lateralized: a ventral stream involved in semantics, a dorsal stream involved in phonology and speech production, and a more dorsal "multiple demand" network involved in many effortful tasks. As lateralization in all networks may be affected by life factors such as age, literacy, education, and brain pathology, we sought to develop a task paradigm with which to investigate the engagement of these networks, including manipulations to selectively emphasize semantic and phonological processing within a single task performable by almost anyone regardless of literacy status. In young healthy participants, we administered an auditory word monitoring task, in which participants had to note the occurrence of a target word within a continuous story presented in either their native language, Portuguese, or the unknown language, Japanese. Native language task performance activated ventral stream language networks, left lateralized but bilateral in the anterior temporal lobe. Unfamiliar language performance, being more difficult, activated left hemisphere dorsal stream structures and the multiple demand network bilaterally, but predominantly in the right hemisphere. These findings suggest that increased demands on phonological processing to accomplish word monitoring in the absence of semantic support may result in the bilateral recruitment of networks involved in speech perception under more challenging conditions.

Infant-directed input and literacy effects on phonological processing: Non-word repetition scores among the Tsimane'

Language input in childhood and literacy (and/or schooling) have been described as two key experiences impacting phonological processing. In this study, we assess phonological processing via a non-word repetition (NWR) group game, in adults and children living in two villages of an ethnic group where infants are rarely spoken to, and where literacy is variable. We found lower NWR scores than in previous work for both children (N = 17; aged 1-12 years) and adults (N = 13; aged 18-60 years), which is consistent with the hypothesis that there would be long-term effects on phonological processing of experiencing low levels of directed input in infancy. Additionally, we found some evidence that literacy and/or schooling increases NWR scores, although results should be interpreted with caution given the small sample size. These findings invite further investigations in similar communities, as current results are most compatible with phonological processing being influenced by aspects of language experience that vary greatly between and within populations.

How to Assess Executive Functions in a Low-Educated and Multicultural Population Using a Switching Verbal Fluency Test (the TFA-93) in Neurodegenerative Diseases?

Few neuropsychological tests are available to assess executive dysfunction in low-educated and multicultural populations. To address this issue, the TFA-93, a switching verbal fluency test to assess cognitive flexibility, was administered to 70 healthy controls, 57 patients with a clinical diagnosis of Alzheimer's disease, and 21 with a clinical diagnosis of a neurodegenerative disease associated with frontal disorders. Most of the participants were low-educated and nonnative French speakers. The TFA-93 comprises 2 categorical fluency tasks (animals and fruits) and a fluency task in which participants have to switch between animals and fruits. Correct responses and errors were collected, and a flexibility index expressed the switching cost. Results showed that correct responses were lower, and the switching cost was greater in both patient groups. In low-educated and multicultural populations, the TFA-93 seems to be a good alternative to assess flexibility compared to the standard neuropsychological tools based on academic abilities.

Understanding functional illiteracy from a policy, adult education, and cognition point of view: Towards a joint referent framework

Abstract. The article discusses the emergence of a functional literacy construct and the rediscovery of illiteracy in industrialized countries during the second half of the 20th century. It offers a short explanation of how the construct evolved over time. In addition, it explores how functional (il)literacy is conceived differently by research discourses of cognitive and neural studies, on the one hand, and by prescriptive and normative international policy documents and adult education, on the other hand. Furthermore, it analyses how literacy skills surveys such as the Level One Study (leo.) or the PIAAC may help to bridge the gap between cognitive and more practical and educational approaches to literacy, the goal being to place the functional illiteracy (FI) construct within its existing scale levels. It also sheds more light on the way in which FI can be perceived in terms of different cognitive processes and underlying components of reading. By building on the previous work of other authors and previous definitions, the article brings together different views of FI and offers a perspective for a needed operational definition of the concept, which would be an appropriate reference point for future educational, political, and scientific utilization.

The illiterate brain and the neuropsychological assessment: From the past knowledge to the future new instruments

The lifetime learning of illiterate and low-educated individuals shapes their cognitive skills, which are challenging to grade by the current available neuropsychological tools. Eight hundred million of the global population are illiterate. It is very challenging to interpret the cognitive performance of this population by the available formal neuropsychological tests, mainly developed for higher educated people. From extensive literature investigation, we reviewed the cognitive process and performance of illiterate and low-educated population on various cognitive domains including language, executive function, memory, visual-related function, and motor skills. We also suggested the concept in the development of the appropriate tools for the cognitive assessment among this population. Finally, we provide the available cognitive screening tools validated in the illiterate and low-educated subjects within the last three decades.

A Review about Functional Illiteracy: Definition, Cognitive, Linguistic, and Numerical Aspects

Formally, availability of education for children has increased around the world over the last decades. However, despite having a successful formal education career, adults can become functional illiterates. Functional illiteracy means that a person cannot use reading, writing, and calculation skills for his/her own and the community's development. Functional illiteracy has considerable negative effects not only on personal development, but also in economic and social terms. Although functional illiteracy has been highly publicized in mass media in the recent years, there is limited scientific knowledge about the people termed functional illiterates; definition, assessment, and differential diagnoses with respect to related numerical and linguistic impairments are rarely studied and controversial. The first goal of our review is to give a comprehensive overview of the research on functional illiteracy by describing gaps in knowledge within the field and to outline and address the basic questions concerning who can be considered as functional illiterates: (1) Do they possess basic skills? (2) In which abilities do they have the largest deficits? (3) Are numerical and linguistic deficits related? (4) What is the fundamental reason for their difficulties? (5) Are there main differences between functional illiterates, illiterates, and dyslexics? We will see that despite partial evidence, there is still much research needed to answer these questions. Secondly, we emphasize the timeliness for a new and more precise definition that results in uniform sampling, better diagnosis, conclusion, and intervention. We propose the following working definition as the result of the review: functional illiteracy is the incapability to understand complex texts despite adequate schooling, age, language skills, elementary reading skills, and IQ. These inabilities must also not be fully explained by sensory, domain-general cognitive, neurological or mental disorders. In sum, we suggest that functional illiteracy must be more thoroughly understood and assessed from a theoretical, empirical, and diagnostic perspective.

Verbal Versus Figural Fluency Tests in Currently Ill and Weight Restored Anorexia Nervosa Patients

Fluency tests allow domain-specific assessment of verbal and non-verbal executive functions (EF) comparison and also enable utilizing of both quantitative and qualitative scoring methods. Thirty-five currently ill anorexia nervosa patients (PANs), 33 weight-restored patients (WRAN) and 47 healthy controls (HCs) were administered the word fluency test and the five-point test. Results show that WRANs tended to perseverate more than HCs in the verbal-fluency test. In addition, PANs produced significantly less correct figures and perseverated more than HCs and WRANs; HCs used more strategy methods than PANs and WRANs. Additionally, a positive correlation was found in the HC group between the total number of words in the verbal phonemic test and the number of designs produced and the number of correct designs. No such correlations were found in both anorexia groups. In conclusion, there is a differentiation between verbal and non-verbal EF in PANs and WRANs, showing a deficiency in the non-verbal domain. These findings may contribute to our understanding of the cognitive nature of the disorder.

Normative Study of the Literacy Independent Cognitive Assessment in Illiterate and Literate Elderly Koreans

OBJECTIVE

The aim of this study was to provide normative data on the Literacy Independent Cognitive Assessment (LICA) and to explore the effects of age, education/literacy, and gender on the performance of this test.

METHODS

Eight hundred and eighty-eight healthy elderly subjects, including 164 healthy illiterate subjects, participated in this study. None of the participants had serious medical, psychiatric, or neurological disorders including dementia. Bivariate linear regression analyses were performed to examine the effects of age, education/literacy, and sex on the score in each of the LICA cognitive tests. The normative scores for each age and education/literacy groups are presented.

RESULTS

Bivariate linear regression analyses revealed that total score and all cognitive tests of the LICA were significantly influenced by both age and education/literacy. Younger and more-educated subjects outperformed older and illiterate or less-educated subjects, respectively, in all of the tests. The normative scores of LICA total score and subset score were presented according to age (60-64, 65-69, 70-74, 75-80, and ≥80 years) and educational levels (illiterate, and 0-3, 4-6, and ≥7 years of education).

CONCLUSION

These results on demographic variables suggest that age and education should be taken into account when attempting to accurately interpret the results of the LICA cognitive subtests. These normative data will be useful for clinical interpretations of the LICA neuropsychological battery in illiterate and literate elderly Koreans. Similar normative studies and validations of the LICA involving different ethnic groups will help to enhance the dementia diagnosis of illiterate people of different ethnicities.

Delayed Anticipatory Spoken Language Processing in Adults with Dyslexia—Evidence from Eye-tracking

It is now well established that anticipation of upcoming input is a key characteristic of spoken language comprehension. It has also frequently been observed that literacy influences spoken language processing. Here, we investigated whether anticipatory spoken language processing is related to individuals' word reading abilities. Dutch adults with dyslexia and a control group participated in two eye-tracking experiments. Experiment 1 was conducted to assess whether adults with dyslexia show the typical language-mediated eye gaze patterns. Eye movements of both adults with and without dyslexia closely replicated earlier research: spoken language is used to direct attention to relevant objects in the environment in a closely time-locked manner. In Experiment 2, participants received instructions (e.g., 'Kijk naar de(COM) afgebeelde piano(COM)', look at the displayed piano) while viewing four objects. Articles (Dutch 'het' or 'de') were gender marked such that the article agreed in gender only with the target, and thus, participants could use gender information from the article to predict the target object. The adults with dyslexia anticipated the target objects but much later than the controls. Moreover, participants' word reading scores correlated positively with their anticipatory eye movements. We conclude by discussing the mechanisms by which reading abilities may influence predictive language processing.

Language Development across the Life Span: A Neuropsychological/Neuroimaging Perspective

Language development has been correlated with specific changes in brain development. The aim of this paper is to analyze the linguistic-brain associations that occur from birth through senescence. Findings from the neuropsychological and neuroimaging literature are reviewed, and the relationship of language changes observable in human development and the corresponding brain maturation processes across age groups are examined. Two major dimensions of language development are highlighted: naming (considered a major measure of lexical knowledge) and verbal fluency (regarded as a major measure of language production ability). Developmental changes in the brain lateralization of language are discussed, emphasizing that in early life there is an increase in functional brain asymmetry for language, but that this asymmetry changes over time, and that changes in the volume of gray and white matter are age-sensitive. The effects of certain specific variables, such as gender, level of education, and bilingualism are also analyzed. General conclusions are presented and directions for future research are suggested.

Controlled shifting of attention in schizophrenia and bipolar disorder through a dichotic listening paradigm

The dichotic listening (DL) task was developed originally to examine bottom-up or "automatic" information processing. More recently, however, it has been used as a tool in the study of top-down or "controlled" information processing. This has been done by including forced-choice conditions, wherein the examinee is required to focus attention on one or the other ear. It has been widely utilized with patients with schizophrenia, who exhibit rather severe deficits in managing their attention, but not with other patient groups, such as patients with bipolar disorder. In the present study, we examined potential performance similarities in the DL listening task. In total, the sample consisted of 38 patients with schizophrenia, 20 patients with psychotic bipolar disorder and 35 healthy individuals, who performed a DL task with verbal stimuli once at the beginning of their hospitalization and again on the last day before discharge. Our findings indicated that both patient groups showed similarly diminished performance when compared to healthy participants at both times of administration. Symptom improvement between the two evaluations did not significantly influence performance in the DL task. In conclusion, impaired automated and controlled information processing appears to be a common deficit in both schizophrenia and bipolar disorder.

Word reading skill predicts anticipation of upcoming spoken language input: a study of children developing proficiency in reading

Despite the efficiency with which language users typically process spoken language, a growing body of research finds substantial individual differences in both the speed and accuracy of spoken language processing potentially attributable to participants' literacy skills. Against this background, the current study took a look at the role of word reading skill in listeners' anticipation of upcoming spoken language input in children at the cusp of learning to read; if reading skills affect predictive language processing, then children at this stage of literacy acquisition should be most susceptible to the effects of reading skills on spoken language processing. We tested 8-year-olds on their prediction of upcoming spoken language input in an eye-tracking task. Although children, like in previous studies to date, were successfully able to anticipate upcoming spoken language input, there was a strong positive correlation between children's word reading skills (but not their pseudo-word reading and meta-phonological awareness or their spoken word recognition skills) and their prediction skills. We suggest that these findings are most compatible with the notion that the process of learning orthographic representations during reading acquisition sharpens pre-existing lexical representations, which in turn also supports anticipation of upcoming spoken words.

Working memory and verbal fluency in simultaneous interpreters

We investigated working memory and verbal fluency in simultaneous interpreters, expecting to find enhanced working memory and semantic processing in interpreters relative to others fluent in a second language. The interpreters (n = 15) outperformed the control group (n = 35) on semantic fluency and most measures of working memory; their advantage over teachers of a foreign language (n = 15) approached, but did not reach, statistical significance. Our findings suggest that, while proficiency in a foreign language may enhance fluency and working memory skills, simultaneous interpreters have semantic processing and working memory capacities greater than those expected from mere proficiency in a foreign language.

Language-mediated visual orienting behavior in low and high literates

The influence of formal literacy on spoken language-mediated visual orienting was investigated by using a simple look and listen task which resembles every day behavior. In Experiment 1, high and low literates listened to spoken sentences containing a target word (e.g., "magar," crocodile) while at the same time looking at a visual display of four objects (a phonological competitor of the target word, e.g., "matar," peas; a semantic competitor, e.g., "kachuwa," turtle, and two unrelated distractors). In Experiment 2 the semantic competitor was replaced with another unrelated distractor. Both groups of participants shifted their eye gaze to the semantic competitors (Experiment 1). In both experiments high literates shifted their eye gaze toward phonological competitors as soon as phonological information became available and moved their eyes away as soon as the acoustic information mismatched. Low literates in contrast only used phonological information when semantic matches between spoken word and visual referent were not present (Experiment 2) but in contrast to high literates these phonologically mediated shifts in eye gaze were not closely time-locked to the speech input. These data provide further evidence that in high literates language-mediated shifts in overt attention are co-determined by the type of information in the visual environment, the timing of cascaded processing in the word- and object-recognition systems, and the temporal unfolding of the spoken language. Our findings indicate that low literates exhibit a similar cognitive behavior but instead of participating in a tug-of-war among multiple types of cognitive representations, word-object mapping is achieved primarily at the semantic level. If forced, for instance by a situation in which semantic matches are not present (Experiment 2), low literates may on occasion have to rely on phonological information but do so in a much less proficient manner than their highly literate counterparts.

Literacy versus formal schooling: influence on working memory

Previous work has demonstrated that illiterate individuals exhibit reduced performance on measures of working memory, relative to a literate cohort. Given the relationship of working memory to phonological processing, which is enhanced by literacy, we sought to examine working memory in illiterate individuals and whether differences can be attributed to artifacts of the test typically used. To the extent that differences actually exist, we also examined whether they can be attributed to the effects of literacy per se or whether they reflect the effects of formal schooling. To accomplish this, we explored the performance of four groups of participants (illiterate, functionally illiterate, self-educated literate, school-educated literate), on five tests of working memory. Illiterate groups performed more poorly than the literate groups on all measures except the "Spatial Span" forward condition and "Remembering a New Route." Our results suggest that differences in working memory performance among literate and illiterate individuals can be attributed to literacy per se. Formal schooling, however, appears to enhance working memory skills. Finally, we stress the need to use tools that are not influenced by literacy and schooling effects in the clinical assessment of illiterate individuals.

Effect of schooling in auditory lexical decision

The task of lexical decision demands the functioning of the phonological loop to identify and discriminate strings of sounds and lexical knowledge to identify if this string can be taken as a real word or pseudo-word.

Semantic interference on a phonological task in illiterate subjects

Previous research suggests that learning an alphabetic written language influences aspects of the auditory-verbal language system. In this study, we examined whether literacy influences the notion of words as phonological units independent of lexical semantics in literate and illiterate subjects. Subjects had to decide which item in a word- or pseudoword pair was phonologically longest. By manipulating the relationship between referent size and phonological length in three word conditions (congruent, neutral, and incongruent) we could examine to what extent subjects focused on form rather than meaning of the stimulus material. Moreover, the pseudoword condition allowed us to examine global phonological awareness independent of lexical semantics. The results showed that literate performed significantly better than illiterate subjects in the neutral and incongruent word conditions as well as in the pseudoword condition. The illiterate group performed least well in the incongruent condition and significantly better in the pseudoword condition compared to the neutral and incongruent word conditions and suggest that performance on phonological word length comparisons is dependent on literacy. In addition, the results show that the illiterate participants are able to perceive and process phonological length, albeit less well than the literate subjects, when no semantic interference is present. In conclusion, the present results confirm and extend the finding that illiterate subjects are biased towards semantic-conceptual-pragmatic types of cognitive processing.

Myopia as a latent phenotype of a pleiotropic gene positively selected for facilitating neurocognitive development, and the effects of environmental factors in its expression

Myopia has become an almost pandemic problem in many populations. There are compelling evidence to suggest that myopia is a hereditary condition. However, myopia would constitute a definite selection disadvantage during most stages of human evolution, which is incompatible with its moderate to high prevalence in most modern populations. The rapid upsurge of myopia over just a few decades also implies that its inheritance does not follow any of the usual patterns, and environmental factors may have an important role in precipitating its occurrence in those who are genetically predisposed. Previous studies showed that myopes were, on average, more intelligent than non-myopes, and this association had been attributed to a biological link between eye growth and brain development. We propose a pleiotropic genetic model to explain the atypical epidemiologic and inheritance pattern of myopia and its relationship with neurocognitive development. This pleiotropic gene was positively selected for its facilitation of human intelligence. The myopic component is a latent phenotype; myopia will not be expressed unless some novel external factors are encountered (i.e. a "quirk" phenomenon). Therefore, the myopic component was selectively neutral in our ancestral environment. The net gain in Darwinian fitness enables the pleiotropic gene to attain a high frequency in the human population, as reflected by our current prevalence of myopia.

Lexical Processing in Illiteracy: Effect of Literacy or Education?

Difficulties in phonological processing in illiterates have been attributed to their limited phonological awareness, a consequence of their lack of literacy. We sought to explore the potential influence of education on auditory lexical processing above and beyond literacy per se. In order to achieve this goal, we compared a lexical decision making paradigm with a repetition paradigm using words and pseudo-words. We based this choice of tasks on previous research, which has shown that pseudo-word repetition is dependent on the phonological loop; such studies have thus demonstrated a literacy effect on repetition. Instead, lexical decision making is known to depend on the size of one's vocabulary, which is influenced by the level of education attained. Our sample comprised three groups: illiterate no education, literate/low education and literate/high education, individuals. The pattern of our findings confirmed that literacy has an effect on the capacity of the phonological loop, as our illiterate group alone had difficulty with repetition, as compared with both literate/educated groups. Also, our findings suggested an education effect on lexical decision making, as we found a gradation in the performance of the three groups. Therefore, we succeeded in dissecting the effect of literacy and education on auditory lexical processing through the application and comparison of two simple paradigms.