SLUMS Score: Assessing Alzheimer's and Cognitive Function

SLUMS, the Saint Louis University Mental Status Examination, is a screening test for Alzheimer's disease and other kinds of dementia. It is an alternative to the widely used Mini-Mental State Examination (MMSE). Based on their responses, participants receive a SLUMS score that can be used to help healthcare providers screen for dementia.

SLUMS was designed to be more effective at identifying people with very early Alzheimer's symptoms, also called mild cognitive impairment (MCI) or mild neurocognitive disorder (MNCD). These symptoms occur as people progress from normal aging to early Alzheimer's disease.

What Does SLUMS Assess?

SLUMS measures aspects of cognition. It consists of 11 questions that help a healthcare provider evaluate:

• Orientation to time and place
• Short-term memory
• Calculations
• Naming of animals
• Clock drawing test
• Recognition of geometric figures

For example, the administrator will ask the test taker to:

• Tell them what year and day of the week it is
• Memorize a list of five objects and repeat them back a few minutes later
• Name as many animals as they can in a minute
• Draw the numbers on a blank clock face and mark a specific time
• Indicate which shape in a set of three is the largest

You can view the full SLUMS assessment on St. Louis University's website. The SLUMS test takes approximately seven minutes to administer.

SLUMS Scoring and Results

Depending on the question, answers count for between 0 and 5 points. Final SLUMS scores range from 0 to 30.

SLUMS scores are interpreted as follows:

• 27 to 30: Normal in a person with a high school education
• 21 to 26: Suggest a mild neurocognitive disorder
• 0 to 20: Indicates dementia

How Accurate Is SLUMS?

SLUMS is thought to be more sensitive than the MMSE, another assessment of cognitive function. That means it can more reliably determine who is in various levels of cognitive decline.

A study involving 58 nursing home residents compared the SLUMS' ability to detect early stages of dementia to that of the MMSE, as well as the Short Test of Mental State (STMS) and the Test Your Memory (TYM) screen—other cognition assessments.

They found that the SLUMS test was significantly better at being able to identify dementia in its early stages as compared to the other tests.

Research also found that although both the SLUMS and the MMSE have a total of 30 points, the average score of the SLUMS is approximately five points lower than that of the MMSE. This supports the idea that the SLUMS is a more demanding test and, thus, likely to be more sensitive to mild cognitive impairment.

Next Steps After Testing

After someone receives their SLUMS score, their healthcare provider will determine if further testing should be performed. Some further tests might include:

Neuropsychiatric Testing: Neuropsychiatric testing might include a variety of tests that the neuropsychiatric evaluator will determine based on the patient's symptoms.

ADAS-Cog Test: Short for the Alzheimer's Disease Assessment Scale-Cognitive Subscale, the ADAS-Cog test may measure cognition. It is an 11-part test that includes word recall, visuospatial abilities, and more.

Montreal Cognitive Assessment (MoCA): The MoCA test can help identify if a person has dementia, although it cannot determine the cause of dementia. Like the SLUMS test, it can help detect mild cognitive impairment.

Brain Imaging: Some healthcare providers might order imaging tests like a CT scan or MRI to help rule out other factors that might lead to cognitive decline, like brain tumors, multiple sclerosis, or stroke.

Advantages and Disadvantages of SLUMS

Though it has notable pluses, the SLUMS test also has some cons that need to be considered.

Summary

The SLUMS test is an important part of the diagnosis of Alzheimer's disease or related dementia. It is more sensitive than prior tests like the MMSE, so it can pick up milder cognitive decline.

The test involves assessing the person's orientation to time and place, short-term memory, ability to perform straightforward calculations, naming of animals, ability to draw a specific time on a clock face, and recognition of geometric figures.

A score of 27 to 30 reflects normal cognitive function for someone with a high school education; 20-26 indicates mild cognitive disorder; and under 20 indicates dementia. After the SLUMS test, healthcare providers may do additional testing.

It is important that a healthcare provider administers and assesses the results of the SLUMS test, even though people can access it themselves. A healthcare provider can put the results in the appropriate context for each person.