The St. Louis University Mental Status (SLUMS) Exam

Medical advances mean adults are living longer than before. In an aging population, dementia is more prevalent. And more people with dementia require earlier testing and intervention. Primary care doctors are often the first to use a dementia exam. They may observe changes in thinking (cognitive changes) and suspect dementia.^1,2

Doctors use many tools to evaluate dementia and its progression. To help doctors make a diagnosis, they may use:^1-3

1. Medical history
2. Physical exam
3. Imaging

Doctors may also give a regular dementia exam to track results. Dementia exams help determine a person's ability to use thinking to solve problems (cognitive function). Exam results can show normal function or mild, moderate, or severe impairment.^1-3

What is SLUMS?

One dementia exam is the St. Louis University Mental Status (SLUMS) exam. This tool helps identify mild cognitive impairment. It asks a series of 11 questions. These questions evaluate different aspects of cognitive function. SLUMS translates well into other languages. That means it can more easily evaluate people from diverse backgrounds.^1-6

The highest possible score a person can get with the SLUMS exam is 30 points. It takes around 7 minutes to complete the exam.^1-6

What does SLUMS measure?

The 11 questions on the SLUMS exam measure several types of cognition. Some of the things the questions evaluate are:^3-6

• Orientation in space and time
• Short-term memory
• Basic knowledge and understanding of the world (for example, math and shapes)

Education level

SLUMS has a unique scoring system. The exam takes into account the level of education of the person being tested as part of calculating the score. There is a higher scoring threshold for people with a high school education and above.^1,5,6

A score of 27 to 30 is considered normal for the cognitive function of a person who has graduated high school. A score of 25 to 30 is considered normal for someone with less than a high school education. Similarly adjusted scales identify mild neurocognitive (nerve and thinking) disorder and dementia.^1,5,6

Giving the exam

There are specific guidelines an examiner must follow when giving SLUMS. For example, the examiner is limited to repeating certain questions a specific number of times. People who give the exam must complete an annual training. The kinds of healthcare professionals who can be certified to give the SLUMS exam include:⁵

1. Doctors
2. Licensed nurses and nurse practitioners
3. Occupational therapists
4. Physical therapists

The person taking the exam may have some anxiety. It is helpful when doctors and loved ones reassure them it is not a test. They cannot pass or fail. The tool is a unit of measurement for their memory.⁵

A useful comparison is to a ruler or thermometer. These objects are tools to measure length and temperature. There is no judgment in the numbers that come out of the measurement.⁵

MMSE versus SLUMS

The Mini-Mental Status Exam (MMSE) is one of the most commonly used to measure mental status. It has been in use since 1975. The SLUMS exam is more recent, dating to 2006. The MMSE contains 20 questions and takes about 10 minutes. Like the SLUMS, it gives a score out of 30 points.^1-3,6,7

Each exam has strengths and weaknesses. MMSE is effective for evaluating the stage of dementia. SLUMS is better at identifying signs in a person not yet diagnosed. Physicians who suspect dementia often use SLUMS for early diagnosis.^1-3,6,7

MMSE can classify dementia as mild, moderate, or severe. SLUMS ranks results as normal, mild, or dementia.^1-3,6,7