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Annotated Bibliography



InLady Gaga`s album, evidence of a new order

Author:Ben Sisario

LadyGaga’s popularity is very evident on the sale of her second albumentitled “Born this Way.” Her second album was released on May23, 2011 and in just the span of one week, she was able to sell 1.1million copies just alone in the United States. About 60 percent ofthe number of copies sold or roughly 662,000 of them were digitallysold by Amazon which is also the top grosser digital downloads in aweek of that year. The sales skyrocketed because Amazon had a 99-centdeal which was grabbed by fans and supporters of Lady Gaga thathelped the sales pass the one million mark. Though Gaga had goodpromotional campaigns that included promotional appearances and mediatie-ins, Sisario believed that the Amazon deal was the one who playeda big role in the success of this album. The author here just wantedto show how famous Lady Gaga is and that she was pretty lucky sincethe release of her album was just in time for Amazon to test theirnew Cloud Drive application whereas in order for many music fans toavail or use it, Amazon chose Gaga’s album to be sold in adiscounted price.

BenSisario of The New York Times is an American writer who likescovering music and culture. He also writes journals and blogs.According to the Tisch School of Arts Faculty Biography, Ben &nbspisalso a contributor to&nbspBlender,&nbspNewYork,&nbspRollingStone,&nbspSpin,New York City&nbsppublic-radio&nbspstation&nbspWFUV&nbspand&nbspTheVillage Voice`sannual Paz &amp Jop music critics` poll. He is also an instructor ofthe Tisch School of the Arts where he teaches courses on&nbspRockMusic in Historical Context&nbspand&nbspWritingfor Popular Music.In this article of him I can say that it contains facts since Ben,judging from his background, is a very credible writer.

Inhis article, he is not concerned about the importance or the messagethat Lady Gaga wants to tell through her music, he is just concernedabout the output that Lady Gaga has done brought about by her fameand music. If Wills and Turner were in the same room with him, hewill argue that the substance or message behind Gaga’s music isirrelevant as long as you make good money out of it.

Beyond ABCs of Lady Gaga to the Sociology of Fame

Author:KatharineQ. Seelye under Mathieu Deflems POV

Thearticle points out the plan of the University of California to offera new course called “LadyGaga and the Sociology of Fame.“This new course was made thru the inspiration of the great fame ofthe pop singer Lady Gaga. The formation of this course wasspearheaded byMathieuDeflem who is a 48 year old sociology professor in the University ofSouth Carolina at Columbia who is also planning to teach the course. This is also the only course in to be offered in college that talksabout Lady Gaga as a subject for fame. The course objective is tolearn more about the relevance of fame in our culture and how do wedefine fame nowadays. Though the author of this article is KatharineQ. Seelye, we can clearly see Mathieu Deflem’s point of view andinsights here on how we wants to cite Lady Gaga as an example of astep by step process in the acquisition of fame.

Accordingto the site of Harvard University Institute of Politics, KatharineSeelye or also called as Kate Seelye is a Washington-based politicalreporter for the New York Times. She is considered to be a first ratejournalist and most of her articles are printed on the first page ofThe New York Times. She was also able to cover three presidentialcampaigns while “on the bus” with them. She received herbachelor’s degree from Lake Forest College, M.S. in Journalism fromColumbia University, and a fellowship from Columbia to work with TheAssociated Press in East Africa.

Thisarticle for me is good but I don’t agree with the idea of Mr.Deflem because for me it just show how obsessed he is about Lady Gagaafter finding out that he had gone to the 28 concerts of her and heowns 300 records of her song both in vinyl and CD. You can also makea course on how or what makes people famous without patronizing onlyone person. Obsession and fame are two connected links that Sisaroand Seelye will agree upon. Due to people’s obsession to artistslike Lady Gaga, they are helping her make a profit out of it.

Lady Gaga Explains Herself


LadyGaga is not just famous because of her songs, how she dances and“blasphemous” approach to some things. What made people admireher even more is her unique and bizarre way of dressing. Her way offashion does not fail to surprise us every time we see her perform inTV or live on stage. Her outrageous style has been an inspiration tosome people and it will be also a good topic of choice if you willwrite about her.

Regardingthis matter, Eric Wilson was surprised after hearing that Lady Gagaannounced that she will be writing in a fashion and art column in VMagazine. Wilson thought that Gaga was incapable of doing it since hewas quite sceptic on whether Gaga knows anything about fashion. Whenthe first issue was released, Eric thought that Gaga’s designs werejust copied from fashion trends that were made couple of years ago.Many people also saw that so when the time that Lady Gaga was askedabout it, those sceptics including Eric Wilson were somehow convincedafter Gaga gave an explanation. “Art gives birth to new art,”shewrites. “There is no chicken or egg. The past undergoes mitosis,becoming the originality of the future.“

EricWilson according to Fashion Institute of Technology is a fashionreporter for&nbspTheNew York Times.He finished journalism and fine arts at New York University, he beganhis writing career at&nbspNewYork Newsday&nbspand&nbspInstitutionalInvestor&nbspmagazine.In 1997, he joined the staff of&nbspWomen’sWear Daily.He also wrote the &quotMonth In Fashion&quot news column for&nbspWmagazine&nbspuntiljoining the&nbspTimes&nbspinJanuary 2005. From those credentials, he can be really a good criticand juror about fashion stuff and I somehow agree in him regardingLady Gaga’s capabilities with her writing a fashion column but herfashion is what makes her on top of other artists so maybe she canalso pull that off. ThoughWilson’s claim is about Gaga’s incapability to write a columnthat talks about fashion, Walls’ claim is her incapability tocreate music with a soul. For them there are better artists who cando more than just wearing fancy weird clothes that can sing very wellwith a song that is substantiated.

The Blah-Blah of Gaga

Author:SethColter Walls

SethColter Walls believe that Gaga’s music can hypnotize you and bringyou into another dimension where the only thing that’s happeningthere is just dancing or partying. Her songs can put you in a lastsong syndrome for quite some time. Though Seth knows that Lady Gagahas a catchy music, he considers her music to be empty or it lackssubstance, good meaning and synthesis. He views Lady Gaga as justanother John Lennon, Eddie Vedder or Madonna wannabe but there is alarge different on how they make their music. For Walls, all thatGaga wants is to take up a big crowd and idolize her in order for herto be famous and make it to the scene. It is like Gaga wants us tothink that she wants to convey or say something but when we analyzethe words or lyrics, she fails to add values.

Inmy opinion, I feel like the author is closed-minded. There is ageneration gap between his time and this modern era where he was notable to bridge. Music evolves because the taste of people alsochanges and in order to understand it, you should adapt to thechanges it brings. This article was written way back in 2009 and I’mpretty sure that by now Walls might be reconsidering his thoughts andmight gave Lady Gaga a shot. Wilson and Walls are two of the authorsin this annotated bibliography that are questioning Lady Gaga’scapabilities. So they might be on the same side arguing againstTurner and Seelye who patronize Lady Gaga.

SethColter Walls has written for&nbspSlate,&nbspLondonReview of Books,and the&nbspNewYorker‘sCulture Desk blog. He also writes reviews about artists and authors.

Lady Gaga and the Civil Religion


Theauthor is known as a sympathizer of Robin Fox, who is an author of abook that talks about world unity brought by preconditioning, worldsecular religion, end, peaceful world of justice, equality andrational negotiation. Turner is impressed on how Fox integrated theconcepts of thymos, communitas, evolutionary psychology, etc. Turnergave example of the orgiastic communitas Fox is trying to convey thruLady Gaga’s Monster Ball concert that was held in New York.

TheMonster’s Ball is a good example because Lady Gaga structured thebasic ingredients of Fox’s views in a more compressed form. Shecalls her fans “little monsters” and believes that each and everyone of them is a star and all of us are exceptional. When Gagaallowed a Canadian girl in Filipino descent to perform with her inone of her tours, she crossed the barrier of ethnical indifferencesand individuality. Gaga’s song Born this Way is a manifesto ofFox’s evolutionary civic religion. The song rejects the determinismof social constructionists insisting that everyone can rise abovetheir social constraints, which we are free on what we want to be andwe are the ones who are in charge of our own fates.

Itis actually a good read because this essay showed the real meaning ofwhat Lady Gaga wants to convey on her music and contrary to SethWalls’ claims that Gaga has no substance. If Walls and Turner wereto talk about the meaning and value behind Gaga’s music, I thinkthat they would just try to outsmart each other and won’t be ableto meet their ends because they have opposite views regarding thisissue. Fox and Lady Gaga’s similar advocacies can be a goodsubject to write.

FrederickTurner&nbspis an American&nbsppoet&nbspandacademic. He is the author of two full-length epic science fictionpoems,&nbspTheNew World&nbspandGenesisseveral books of poetry and a number of other works. He has beencalled &quota major poet of our time&quot&nbspand &quotauniversal scholar – a rare find in a world of over-specialization -whose work transects and borrows from several rather disparatefields.


Sisario,Ben. &quotIn Lady Gaga`s album, evidence of a new order.&quot&nbspNewYork Times&nbsp2June 2011: C1(L).&nbspAcademicOneFile.Web. 4 Apr. 2014

Seelye,Katharine Q. &quotBeyond ABCs of Lady Gaga to the Sociology ofFame.&quot&nbspNewYork Times&nbsp29Oct. 2010: A13(L).&nbspAcademicOneFile.Web. 4 Apr. 2014

Wilson,Eric. &quotLady Gaga explains herself.&quot&nbspNewYork Times&nbsp12May 2011: E4(L).&nbspAcademicOneFile.Web. 4 Apr. 2014.

Walls,Seth Colter. &quotThe Blah-Blah of Gaga.&quot&nbspNewsweek&nbsp30Nov. 2009: 57.&nbspAcademicOneFile.Web. 4 Apr. 2014

Turner,Frederick. &quotLady gaga and the civil religion.&quot&nbspSociety&nbsp48.6(2011): 495+.&nbspAcademicOneFile.Web. 4 Apr. 2014


Annotated Bibliography



Berta,D. (2002). Chains tap psychological profiling to trim hr turnover.

Nation’sRestaurant News,36, 20.

Inthis article, Dina Berta, outline various methods that can help matchan individual’s personality with a particular job usingpsychological profiling. The author is a well renowned writer in afood service industry. Testing help an organization determineswhether a person fit well in their workforce many large chains andsmaller businesses have adopted it for quite a good number of years.Uses of Internet and computer programs make tests faster and cheaperhence, expediting the hiring process. The author refers toCheckStart-a screening program- that is capable of loading tocompanies’ computer the program requires about 15 to 30 minutes tocomplete. The article further provide business owners’ andoperators’ personal testimonies who chiefly rely on psychologicalprofiling when hiring their managers. The article is helpful for thisresearch since it give insight on the significant and ways ofmatching employees with suitable positions.

Herman,R. (2007). Reducing costly employee turnover. HRFocus,74, 15-16.

RogerHerman highlights employer vulnerability, approaches, and employmenttrends as some of the factors that organizations should consider inorder to retain employees. He argues that more jobs will be availablewith the rapid economic growth however, finding suitable people tohandle this job will be hard. He further argue that training costsshoot when technology increase since people do not enoughqualifications from public education. He firmly insists that employeehave a high likelihood of sticking to a particular job if theirissues are addressed on time and appropriately. This article will beuseful for this research topic since it outlines approaches ofemployees’ retention. In fact, the author confirms that employeeturnover is a problem in many organizations and businesses andprovides approaches that coincide with other sources that will beexamined for this research topic.

Kaye,B. &amp Sreb, S. (2003). Quick quits stem the turnover tide. ExecutiveExcellence,17.

BeverlyKate, president of Career Systems, and Steven Sreb, a seniorconsultant with Career systems argue acknowledge that the process ofhiring or re-cruiting employees is extremely critical. Relationshipbetween managers and new hire is of immense significant in retainingemployees. Valuing employees’ feedback and forming a trustworthyare some of the areas that Kaye et al. point for a successfulconversation between employees and managers. The article is relevantand useful for this research since it cites the significance ofcreating an employee centred work as well as discusses variousbenefits of matching employees to proper positions.

McCabe,C. (2004). Motivating and retaining employees. Retrieved October 15,2004,


CharlesMcCabe works as a veteran in a 34-year tax industry he also work asa teacher at Virginia University. In this article, he outlinesvarious practices that businesspersons can adopt and embrace in orderto retain their employees. He further discus several goals, likecompensation and benefits, which managers should look for whenemploying and hiring employees. The article will be of enormoussignificance to this research since it provides several methods thatmanagers a use to retain their employees. In fact, it coincides withinformation presented in some of the other sources.

McCuan,J. (2004, April). Guard your exits. INC.Magazine,44-46.

Inthis article, Jess McCuan outline ways that play a key role in thecreation of a better work environment that stimulate employees’happiness. Rewarding exemplary employees could be one of the ways ofmotivating employees. He refers to Barry Goss tactic of encouragingemployee promotions within an organization instead of hiring outsideto fill a vacant position. Ideas and facts from this article willgive supplementary information to this research topic.

Phifer,C.B. (2008). How a small manufacturing plant dealt with a highemployee turnover rate. IndustrialManagement,20, 25-29.

CarolPhifer is a student at De Paul University. In this article, shepresents her case study on employee turnover that she conducted in asmall manufacturing plant. During her visit to the plant, Phiferobserves several tactics employed by the management to reduce thehigh level of turnover rates. In this article, the author explainsthe first step that the plant used reduces high turnover rates allemployees took a survey that consisted of several complaints againstthe company. The survey identified aggressive management, lack offeedback from management, and lack of training as some of the factorthat accelerated the problem of turnover. The management decided toimplement a five-step process in order to correct several issues thatthe employees were concerned about. The five steps were outlines asconsistent supervisor conferences, improved methods of measuringquantity and quality of production, training positions, trainingprograms, and organizing a system of feedback. This article isextremely useful and relevant to today’s world and to the researchproject since most organizations and businesses are faced with asimilar problem.

Ramlall,S. (2004). A Review of employee motivation theories and theirimplications for employee retention within organizations. Journalof American Academy of Business,5, 52-63.

SunilRamlall has a Ph.D in Human Resource Development. In this article,Ramlall he discusses various motivational theories in organizations,businesses, and companies. He acknowledges that employee retention isa chief problem in today’s world regardless of level of technologyor a business’ size. He argues that businesspersons must retainefficient employees to help the inexperienced new hires with an aimof solving the aforementioned problem. He suggests theories fromrespected and well-known psychologists. In depth motivationaltechniques as well as psychological solutions to employee turnovermake this article enormously useful for this research. The mainlimitation of this article is that some of the suggested theories mayappear or sound complicated to some businesspersons. Therefore, moreresearch should be carried out in order to develop in-depthunderstanding of job performance and employee turnover.

Sexter,K. (2002, August) Retaining employees: a modern manager’saccountability. ExpertMagazine. Retrieved October 15, 2004, fromhttp://www.expertmagazine.com/artman/publish/article_167.shtml.

KristineSexter is a leadership performance coach, columnist, and keynotespeaker. In this article, the author examines the significance ofretaining employees. He argues that managers are responsible foremployee retention in the modern world. In addition, Kristineprovides statistics that show why an employee may have a highlikelihood of leaving a certain job. As a reference to help reduceemployee turnover, the author gives several sample survey questions.The article will be helpful for the research topic since it addressmanagers in today’s world in a direct manner.


Berta,D. (2002). Chains tap psychological profiling to trim hr turnover.

Nation’sRestaurant News,36, 20.

Herman,R. (2007). Reducing costly employee turnover. HRFocus,74, 15-16.

Kaye,B. &amp Sreb, S. (2003). Quick quits stem the turnover tide. ExecutiveExcellence,17.

McCabe,C. (2004). Motivating and retaining employees. Retrieved October 15,2004,


McCuan,J. (2004, April). Guard your exits. INC.Magazine,44-46.

Phifer,C.B. (2008). How a small manufacturing plant dealt with a highemployee turnover rate. IndustrialManagement,20, 25-29.

Ramlall,S. (2004). A Review of employee motivation theories and theirimplications for employee retention within organizations. Journalof AmericanAcademyof Business,5, 52-63.

Sexter,K. (2002) Retaining employees: a modern manager’s accountability.ExpertMagazine. Retrieved October 15, 2004, fromhttp://www.expertmagazine.com/artman/publish/article_167.shtml.


Annotated Bibliography


TheFull Bibliographic Citation

Overviewof the Research

TheResearch Methods

TheReliability Findings

TheValidity Findings

TheStrengths of the Research article

TheLimitations of the Research article

Conclusionsmade by the Author/s


Dean,P.M., Feldman, D.M., Morere, D. &amp Morton, D. (2009). ClinicalEvaluation of the Mini-Mental State Exam with Culturally Deaf SeniorCitizens. Archivesof Clinical Neuropsychology,24(8), 753-760.

Thisarticle examined the performance of the Mini-Mental State Examination(MMSE) on culturally deaf senior citizens. The authors used thestandard form of the MMSE tool and translated it from English toAmerican Sign Language (ASL). The English to ASL translation wascross checked by other professionals with clinical and academicexperience in ASL. Data was collected from 117 Deaf senior citizensaged 55-89 consisting of 33 males and 84 females. All participantswere congenitally and prelingually deaf and used ASL as their primarylanguage. All data was collected by the authors who are proficient inASL. Significant correlations were observed between overall testscore and educational level (r = 0.23, p = 0.01) as well as testscore and average age (r = -0.33, p &lt 0.001).

Theprimary limitation was the sample used for this study. Allparticipants were able to travel and consisted of comparativelywell-educated and highly functional older adults. Another potentiallimitation was that the authors did not complete an exhaustive reviewof psychological, medical, and/or neurological conditions that mayimpact on cognitive functioning. The results of this study indicatedthat MMSE remains an appropriate tool for cognitive screening. Ithighlights the need for a larger scale study of a more racially andethnically diverse population and the need for appropriatemodifications and diagnostic guidelines for Deaf individuals. Thisstudy is useful to me as I am frequently involved in carrying outcomprehensive mental health assessments of older adults with othermedical complexities including hearing impairment. It has highlightedto me that at present at my work area there are no MMSE suitable forthe Deaf adults.


Aprahamian,I., Martinelli, J.E., Cecato, J. &amp Yassuda, M.S. (2011).Screening for Alzheimer’s disease Among Illiterate Elderly:Accuracy Analysis for Multiple Instruments. Journalof Alzheimer’s disease,26, 221 – 229.

Inthis article the authors evaluated the accuracy of single screeningtests as well as combined screening tests when used with illiterateelderly. The screening tools included Mini-Mental State Examination(MMSE), Verbal Fluency animal category (VF), Clock Drawing test (CDT)and Pfeffer Functional Activities Questionnaire (PFAQ).The authorsused 66 illiterate community dwellers and 40 illiterate normalcontrols from an academic geriatric institution. All subjects wereaged over 60 years with no formal education. The 66 communitydwellers were all previously diagnosed with mild to moderateAlzheimer’s disease (AD). In order to increase diagnosticreliability all subjects underwent clinical interviews conducted bytwo geriatricians. Each subject also underwent a comprehensivepsychiatric, clinical and neurological examination.The statisticalpackage SPSS-18 for Windows was used for data analysis. Receiveroperating characteristic (ROC) curves area analyses were carried outto compare the sensitivity and specificity for the cognitive tests todifferentiate the two groups, each test separately initially andlater in two by two combinations. The Hanley-McNeil method was usedto analyse possible difference between the ROC curve areas for theindividual instrument alone and combination. Scores for the cognitive(MMSE, CDT, VF) and functional assessments (PFAQ) were significantlydifferent between the two groups. Sensitivity and specificity for theMMSE, VF, CDT and PFAQ were analysed separately. The highestsensitivity and specificity were obtained with the MMSE and the CDTrespectively. The CDT and VF showed the lowest sensitivity andspecificity, respectively for the sample size. The strengths of thestudy are relative to the high sample size involving illiterateelderly. Limitations to this study include the subjects being fromsimilar socioeconomic and cultural backgrounds. This studydemonstrated that combination of screening tools is more accurate inidentifying potential AD. This study is useful to my area of practiceas my team receive large numbers of referrals for comprehensivemental health assessments on older adults residing both in thecommunity and in residential aged care facilities.


Nys,G.M.S., Van Zandvoort, M.J.E., De Kort, P.L.M., Jansen, B.P.W.,Kappelle, L.J. &amp De Haan, E.H.F. (2005). Restrictions of theMini-Mental State Examination in acute stroke. Archivesof Clinical Neurology,20, 623 – 629.

Thisstudy examined the validity of the Mini-Mental State Examination(MMSE) tool for cognitive impairment of patients with acute stroke.The subjects for this study consisted of 38 consecutive strokepatients with either ischemic stroke or primary intracerebralhaemorrhage and admitted to two hospitals. Exclusion criteria were ahigh degree of handicap, non-native speaker, and severe disturbancein communication and consciousness. The control group consisted of 34subjects living in the community and were volunteers who responded toword of mouth or advertisements in the newspaper. The controlsubjects were matched with the stroke patients in age, education,gender and handedness. Each patient underwent a neuropsychologicalexamination covering six domains which included abstract reasoning,verbal memory, executive functioning, visual perception andconstruction, visual memory, and language. Test results werestandardized into z-scores, based on the means and standarddeviations of the control group. The authors created cognitivedomains scores by averaging z-scores of tasks belonging to the samecognitive domain. Patients without a deficit in one of the cognitivedomains were considered cognitively intact. Limitations includesmajority of patients in this study had subcortical lacunar stroke.This study show that 70% of stroke patients had impairment in atleast one cognitive domain and that the MMSE is insensitive tool todetect cognitive impairment in patients with acute stroke.Thisinformation provides me with more awareness whilst conducting mentalhealth assessments on post stroke persons.


Kim,J.W., Lee, D.Y., Seo, E.H., Sohn, B.K., Park, S.Y., Choo, I.H., Youn,J.C., Jhoo, J.H., Kim, K.W. &amp Woo, J.I. (2013). Journalof Korean Medical Science,28(10), 1522 – 1528.

Thisstudy notes that the results of Mini-Mental State Examination (MMSE)are influenced by demographic variables such as educational level,age and gender. The study also notes that memory decline is theearliest and most important cognitive decline in Alzheimer’sdisease (AD), however, in non-AD (NAD) dementia the frontal executivedysfunction is frequently more prominent. The authors of this studyinvestigate whether the demographic variable adjustment andsupplementation of Frontal Assessment Battery (FAB) score can improvethe results of the MMSE. Study subjects included 474 patients withdementia and 541 persons with no dementia. Study subjects were chosenfrom individuals registered for early detection and management ofdementia. The exclusion criteria included serious medical,psychiatric, neurological disorders and the inability of reading 10words in the Word List Memory from the Consortium to Establish aRegistry for AD (CERAD). All subjects were examined byneuropsychiatrists had general medical examination, neurologicalexamination, laboratory tests and brain MRI or computed tomography. A panel of 4 neuropsychiatrists with expertise in dementia researchmade the clinical decisions including diagnosis after reviewing rawdata and clinical dementia rating. The authors did not highlight anylimitations, however, indicated that the strengths of this studyincluded subjects from a large and diverse educational background. The study highlighted that MMSE was significantly influenced byeducation. FAB supplementation effect was found only for NADscreening, but not for overall dementia or AD screening. Thisinformation is useful for me when conducting comprehensive mentalhealth assessments and reviews of the elderly in my local area healthservice.


Kim,S.Y., Lim, T.S., Lee, H.Y. &amp Moon, S.Y. (2014). Clustering mildcognitive impairment by mini-mental state examination. NeurologicalSciences.


Thisstudy evaluates the pattern of cognitive deficits on the Mini-MentalState Examination (MMSE) with subtypes of mild cognitive impairment(MCI). It also evaluates whether understanding the structure of MMSEperformance by MCI group can be used to identify those at greaterrisk for converting to dementia. From November 2005 to December 2008the authors recruited 519 patients newly diagnosed with MCI. Thepatients were divided into three groups: amnestic MCI-single domain,amnestic MCI-multiple domains and non-amnestic MCI. The fourcognitive domains included memory, language, visuospatial, andfrontal functions. Two- step cluster and linear discriminant analyseswere used for identifying the clusters of the MMSE with age andeducation. Prediction models for each cluster was established.Conversion into dementia was compared among clusters. The authorsstated that this study had several limitations but failed to statespecific limitations. This study found that patients with greatermemory impairment and those with MCI-multiple domains will progressmore rapidly than those with MCI-single domain. Therefore it isclinically important to identify patients with multiple domain MCI.This study also found that the MMSE screening tool can be consideredincluding subtyping for MCI when detailed neuropsychological testsare not feasible. This study provides me with more confidence whenusing MMSE on patients with MCI.


Corrias,M., Turco, M., De Rui, M., Gatta, A., Angeli, P., Merkel, C.,Armodio, P., Schiff, S. &amp Montaggnese, S. (2014). Covert HepaticEncephalopathy: Does Mini-Mental State Examination Help? Journalof Clinical and Experimental Hepatology.Retrieved from


TheMini-Mental State Examination (MMSE) was originally designed todiagnose dementia, however, it is also being used for cognitiveimpairment in patients with various diseases. The MMSE has been usedto diagnose hepatic encephalopathy (HE). This study assesses theusefulness of MMSE in a large group of wee-characterized cirrhoticpatients without overt HE. Subjects comprised of 191 patients withcirrhosis of the liver. The functional severity of the liver diseasewas assessed and patients with grade II or higher HE were excluded.Patients who were on psychoactive drugs or unable to comply with thestudy procedures were also excluded. All patients underwent clinicalassessments including MMSE, EEG and Psychometric HepaticEncephalopathy Score (PHES). The protocol for this study was approvedby the Hospital of Padova Ethics Committee. Statistical analysis ofthe distribution of variables was carried out. This providedreliability of the findings. Literature review to support orchallenge the findings of this study was also included to providedvalidity. No limitations of this study was identified by the authors.The authors conclude that the MMSE can pick up on neuropsychiatricabnormalities which are part of the HE spectrum. However, the MMSE isnot an adequate tool to diagnose HE. This research is useful to myarea of work as I carry out mental health assessments on persons withsignificant histories of alcohol and substance misuse and associatedmedical conditions, including cirrhosis of the liver.


Brucki,S.M.D., Mansur, L.L., Caatherty-Goullart, M.T. &ampNitrini, R.(2011). Formal education, health literacy and Mini-Mental StateExamination. DementiaNeuropsychology,5(1), 26-30.

Inthis article the authors examine how educational level influences onMini-Mental State Examination (MMSE) performance. S-TOFHLA is ameasure of health literacy with some results indicating that it is agood measure for literacy level. All subjects were 18 years or older,with at least 1 year of formal schooling, and a minimum visual acuityof 20/40. All 325 participants were submitted to the MMSE. S-TOFHLAevaluation was also completed. Descriptive analysis was used todescribe the sample in terms of age, educational level, scores onTOFHLA and the MMSE. Pearson’s correlation were used to verify therelationship among years of schooling, S-TOFHLA scores and the MMSEscores. Analyses were performed using the SPSS 18.0 software packagewhich provided reliability of these findings.The findings of thisstudy was compared and correlated against findings of previous studyand results from a sample of 4 communities in the USA. Limitations ofthis study include that the S-TOFHLA could not be considered aperfect instrument to evaluate functional literacy. Strengths of thisstudy include a sample of healthy subjects from different educationalbackgrounds. The authors conclude although educational levelinfluenced both MMSE and S-TOFHLA performance, other factors such ascultural backgrounds, previous job demands, reading and writinghabits, and a genetic factor remains a variance. The findings of thisresearch helps me understand how educational level may affect aperson’s MMSE performance.


Federman,A.D., Sano, M.S., Wolf, M.S., Sui, A.L., Halm, E.A. (2009). HealthLiteracy and Cognitive Performance among Older Adults. Journalof American Geriatrics Society,57(8), 1475 – 1480.

Thisstudy examines the relationship between health literacy and cognitivefunction. Independently living adults 60 years and older who also hadvisual acuity of 20/50 were recruited from 30 community basedsettings in New York City. Assessments tools used for this studyincluded Mini-Mental State Examination (MMSE), Short Test ofFunctional Health Literacy in Adults, Animal Naming and WechslerMemory Scale II (WMS). The associations of the S-TOFHLA scores withWMS, Animal Naming and MMSE, were modelled with multivariablelogistic and linear regression. The authors conducted 2 sets ofanalyses and reran the main logistics regression models for thesubgroups with normal MMSE scores, as well as the combined subgroupwith both normal MMSE scores and no ADL (activities of daily life)deficiencies. This provided this study greater reliability. Theauthors examined previous studies on this subject and compared theirfinding against the findings of previous studies. Strengths of thisstudy include a diverse sample of subjects from differingsocioeconomic and ethnic and racial backgrounds and rerunning of themain logistics regression models. Limitations to this study includeconvenience sampling of subjects which could lead to recruitmentbias. This study highlights that cognitive impairment is stronglyassociated with low health literacy independently from education andother socioeconomic and health status. It also highlights that evensubtle cognitive deficiencies including memory and word fluency mayimpair a persons’ ability to understand health information. Thisstudy is extremely useful to me how I provide health information toolder adults in my area of practice.

Critiqueof the articles

Theimportance of mini mental state assessment tools cannot be gainsaidas far as screening cognitive function is concerned. As much as theexamination may not be appropriate in making diagnosis, it comes asextremely useful in showing cognitive impairment’s presence such asin individuals with head injuries of suspected dementia. Ofparticular note is the fact that examination or assessment has beenknown to be extremely sensitive in the detection of cognitiveimpairment compared to the utilisation of informal questioning oreven the general impression of the orientation of the patient. Itgoes without saying that volumes of literature have been written inan effort to explore its different aspects. This literatureilluminates incredible aspects pertaining to the utility of the tooland especially with regard to particular conditions of patients andeven some variables that may need to be adjusted so as to enhance theapplicability of the tool.

Asthe study by Nys et al (2005) shows, the applicability of MMSE may bea bit limited in cases where patients have acute stroke. Indeed, MMSEwas seen as an insensitive tool in the detection of cognitiveimpairments in patients that have acute stroke. Stroke has been citedas one of the leading causes of cognitive impairment with itsincidence ranging from 12% to 56% in the affected population.Scholars have noted that stroke cognitive impairment (in acute phase)is connected to a direct effect of the event on a brain region, tohypoperfusion, as well as to cerebral areas’ functionaldeactivation, which results in numerous cognitive manifestations (daCosta et al 2010). Questions may be raised about the applicabilityand efficacy of the study by Nys et al especially considering that alarge proportion of patients that took part in the study hadsubcortical lacunar stroke. The study, indeed, does not show whetherthe results can be applied on patients with other types of stroke, oreven whether there are variations in the effectiveness of the same.

Similarly,Dean et al (2009) underlined the increasing effectiveness of MMSE incognitive screening, as well as the necessity for incorporating thenecessary modifications and diagnostic guidelines so as to cater forindividuals who have other medical complexities such as hearingimpairment. On the same note, scholars would agree with the authorson the statement that MMSE must be modified so as to be applied inethnically and racially diverse populations (Cachoet al, 2010).Indeed, a study by Dean et al (2009) indicated that it is imperativethat clinicians are aware of the linguistic and cultural factorsrelated to the deaf population that may have an impact on performanceof test, as well as the clinical interpretations of their results.However, Dean et al (2009) seems to ignore the fact that the use ofthis measure comes with an increased vulnerability for falsepositives, in which case its validity on culturally deaf populationsshould be determined.

Further,a large number of studies have shown that MMSE scores have a positiverelationship with the levels of education of both impaired and wholeadults. In this case, ethnicity and race are seen as determinants ofthe MMSE scores’ distribution (Kurlowicz&amp Wallace, 2005).On the same note, research indicates that MMSE has the capacity todistinguish between patients who suffer from dementia or those whohave depression alone, as well as patients who are suffering fromboth depression and dementia (Kurlowicz&amp Wallace, 2005).

Additionalresearch seems to concur with research by Kim et al (2013), whichunderlined the influence of demographic variables such as gender,level of education and age on the results of Mini-mental StateExamination (MMSE). Indeed, studies by Jamieson (2004) and Vertesi etal (2007) show that the MMSE scores may be affected by these factorsalongside the individual’s socio-cultural background. Thishypothesis is based on the fact that these variables or factors areusually prone to bias, which often results in the misclassificationof people that have people suffering from mild cognitive impairments,general neurological patient population, individuals with stroke oreven focal lesions. As much as Aprahamianet al (2011) and Corrias et al (2014) seem to pay attention tospecific ailments, they do not go into details with regard to thedetermining whether the results would be different in the variedcategories of the same ailments. For instance, the study byAprahamian et al (2011) showed that a combination of screening toolsincreases the accuracy pertaining to the identification of potentialAD, while Corrias et al (2014), in a study aimed at evaluating theutility of MMSE in a group of wee-characterized cirrhotic patientsthat do not have overt HE, concluded that MMSE has the capacity topick up on neuropsychiatric abnormalities that may be part of the HEspectrum. However, these authors do not go to details with regard tothe utility of MMSE in different types of the same ailments, ratherthey simply generalise. For instance, they offer blanket results forAlzheimer and dementia. Other studies have poked holes into this formof generalisations. In a study aimed at assessing the discriminativecapacity of CDT and MMSE for differentiation of demented patientsfrom controls, as well as for differentiation between the variedtypes of dementia, Sallam &amp Amar (2013) and (Snowdenet al, 2011) demonstratedthe capacity of CDT to differentiate between patients that have ADand those who are suffering from other types of dementia. Inaddition, they demonstrated that making consideration foridentification of these patients with the use of MMSE combination ofthe two tests would allow for appropriate differentiation between ADand other categories of dementia. This may underline the fact thatthe combined application of CDT and MMSE has the capacity to identifyindividuals that have the least cognitive affection (Phelan et al, 2012)but would be ineffective in discriminating the varied types ofdementia (Aprahamian et al, 2010) (Fonget al, 2009).This is the distinction that varied articles reviewed above fail tomake when examining the applicability of MMSE in individualssuffering from ailments such as dementia and Alzheimer disease (Oh et al, 2011).Similarly, Kim &amp Chey (2010) showed that the performance of CDTin older individuals that are illiterate or with 6 years or lessyears of education must be cautiously interpreted. Any conceptualerrors made in CDT may have been caused not only by dementia but alsothe deficiency of education (deGuise et al, 2011) (Cavalieri &amp Schmidt, 2010).As much as the articles and studies reviewed may have quite a numberof loopholes to eliminate, they provide a comprehensive and firmfoundation for comprehending the utilisation of MMSE in varied cases.


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