Saint Louis University Mental Status (SLUMS) Examination

A New Cognitive Assessment Tool Shows Promise — and It’s Free

Professionals in social services have long used the Mini Mental Status Examination (MMSE) to assess cognitive impairment in older adults. Now, Saint Louis University researchers have developed a new screening tool, the Saint Louis University Mental Status Examination (SLUMS), that appears to work better at assessing mild cognitive impairment than the MMSE and is equally effective as a screen for moderate or severe cognitive impairment.

“This is good news for social workers and other social services practitioners, who are frequently asked to assess the cognitive capacity of older adults and their families,” said ASA member Scott Miyake Geron, who is an expert on assessment and director of the Institute for Geriatric Social Work at Boston University. “Because of their close involvement with clients, these practitioners are often more likely than other health professionals to be in a position to identify early signs of cognitive impairment. Unlike the MMSE, the SLUMS is freely available on the Web, which is another attractive feature.”

The Saint Louis University researchers used both MMSE and SLUMS to test 705 men who were at least 60 years old and who received treatment at the Geriatric Research Education Clinical Center of the Veterans Administration Hospital in St. Louis in 2003. The researchers found that while both tools detected dementia, only the SLUMS screening identified a group of patients as having mild cognitive problems.

“The development of an improved version of a measure long considered the gold standard of assessment is a reminder to all social services practitioners that advances in practice occur regularly,” Geron said. “It illustrates the importance of paying attention to the research and practice literature to stay abreast of new developments.”

The comparative study of SLUMS and MMSE appeared in the November 2006 issue of the American Journal of Geriatric Psychiatry. The researchers cautioned that while both tools are effective for basic screening, neither is a substitute for clinical assessment and neuropsychological testing to diagnose cognitive problems and dementia.

The SLUMS is similar in format, but it supplements the MMSE with enhanced tasks in the attention, calculation, recall, digit span, clock- drawing, and immediate recall areas. The clock-drawing test assesses executive function, one of the earliest forms of cognition affected in MNCD.

  1. What day of the week is it? (1 point for the right answer)

  2. What is the year? (1 point)

  3. What state are we in? (1 point)

  4. Please remember these five objects. I will ask you what they are later: apple, pen, tie, house, car. (No points yet)

  5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20.

    • How much did you spend? (1 point)
    • How much do you have left? (2 points)

  6. Please name as many animals as you can in one minute. (No point for naming 0-5; 1 point for naming 5-10; 2 points for naming 10-15; and 3 points for naming more than 15.)

  7. What were the five objects I asked you to remember? (1 point for each object remembered.)

  8. I am going to say a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24.

    • 87 (0 points)
    • 649 (1 point)
    • 8537 (2 points)

  9. (Draw circle.) This circle represents a clock face. Please put in the hour markers and the time at ten minutes to eleven o’clock.

    • (2 points for hour markers labeled correctly)
    • (2 points for correct time)

  10. (Show a triangle, a square and a rectangle.) Please place an X in the triangle. (1 point)

  11. Which of those objects is the largest? (1 point)

  12. I am going to tell you a story. Please listen carefully because afterward, I’m going to ask you some questions about it.

    Jill was a very successful stockbroker. She made a lot of money in the stock market. She then met Jack, a devastatingly handsome man. She married him and had three children. They lived in Chicago. She then stopped working and stayed at home to bring up her children. When they were teenagers, she went back to work. She and Jack lived happily ever after.

    • What was the female’s name? (2 points)
    • When did she go back to work? (2 points)
    • What work did she do? (2 points)
    • What state did she live in? (2 points)

High school graduate: Normal: 27-30; Needs more evaluation: 20-26; Dementia: 1-19.
Less than high school diploma: Normal: 20-30; Needs more evaluation: 14-19; Dementia: 1-13.