If the senior in your life has dementia (or you suspect they do), then you’ll soon become acquainted with the SLUMS test for dementia.
What exactly is the SLUMS test, and how can it inform the treatment plan for a person with dementia in terms of cognitive function, signs of dementia, and its impact on quality of life?
The Saint Louis University Mental Status Examination (SLUMS test) is a tool used by medical professionals to screen for various types of dementia, especially among nursing home residents.
Patients must answer 11 questions that include the identification of figures, drawing, and calculating.
They then receive a score, and based on the score range and cut-off scores, it can be indicative of their cognitive function, stages of dementia, and neurocognitive impairment.
If you’re at the point where you’re considering the SLUMS test for your senior parent or loved one, this is the article for you.
Ahead, we’ll explain what the SLUMS test is, where it came from, and what’s on it.
We’ll also go into the scoring mechanism, the mini-mental state examination, and whether the SLUMS test as a whole is accurate in detecting cognitive decline.
Cognitive assessments like these are crucial tools for healthcare professionals in determining the best care pathways for people with dementia.
What Is A SLUMS Test For Dementia?
First, what is the SLUMS test?
As mentioned in the intro, SLUMS is short for Saint Louis University Mental Status.
Developed by the Division of Geriatric Medicine, Saint Louis University School of Medicine with Veterans Association affiliation, the SLUMS test has been in use since 2006 and is one of the reliable cognitive assessments recommended by many healthcare professionals, especially for nursing home residents.
Before the SLUMS test, the means of identifying Alzheimer’s or other types of dementia via testing in a clinical setting was the widely-used Mini-Mental State Examination or MMSE.
This cognitive screening tool, often utilized by medical professionals, was introduced in 1975 by Folstein, et al.
The MMSE has been a cornerstone in assessing cognitive decline, neurocognitive impairment, and the early signs of dementia.
Why replace a common screening instrument like the MMSE, you ask?
As the decades wore on, concerns grew that, because the MMSE can be affected by demographic factors like education level or age, it may not include the right materials to catch the earliest signs of dementia, such as mild neurocognitive disorder or mild cognitive impairment.
The SLUMS test, recommended by many healthcare professionals, was suited for identifying potential mild cognitive impairment earlier.
Although designed for patients who are at least 60 years old, anyone with possible mild cognitive impairment or showing signs of dementia is eligible to take the SLUMS test.
The test has 11 questions and a clock drawing test in all.
Each question determines a patient’s abilities in areas such as orientation, extrapolation, executive function, visual-spatial, digital span, registration, numerical calculation, immediate and delayed recall, and attention.
It should take about seven minutes to complete the SLUMS test, but that time frame will, of course, vary depending on the mental state of the test taker.
What Questions Are On The SLUMS Test?
Unlike most tests, the questions on the SLUMS test are not multiple choice. Instead, the test taker must identify geometric figures, draw a clock from memory, assign names to animals, do math calculations, and test their short-term memory and orientation.
Here is a full list of the questions found on a traditional SLUMS test.
Question 1 – What Day Of The Week Is It?
The first question is easy enough for someone without dementia to answer. All they have to do is state the day of the week.
Question 2 – What Year Is It?
This is another question that is simple enough, as the test taker only has to fill in the year.
Question 3 – What State Are We In?
The third question on the SLUMS test asks the test taker to identify the state they live in.
Question 4 – Remember These Objects For Later.
On to the fourth question. It’s not really a question at all, so much as it is setting up for a later question. In this part of the SLUMS test, the test taker will review five objects.
There is usually no relationship between these objects. For example, the five objects might be car, house, tie, pen, and apple.
Question 5 – You Have X Dollars And You Go To The Store And Buy Y For Z Dollars and A For B Dollars. 1.) How Much Did You Spend? 2.) How Much Money Do You Have Left?
The fifth question is a two-parter that entails doing math calculations. Let’s say you have $30, and you go to the grocery store.
Then you buy 10 potatoes for $5 and a cake for $15.
The SLUMS test asks the test taker how much money they spent on groceries (which would be $20 in this example) and how much money they have left (which would be $10).
Question 6 – Identify These Animals.
This is the question about naming animals. This question can be presented in several ways.
The test taker might be timed and given a minute or two to name as many animals as they can.
The more animals they correctly name, the higher their score.
As an example, if the test taker only identifies four animals, they’d get a score of 0.
If they name five to nine animals, they’d get a score of 1.
Should the test taker name 10 to 14 animals, they’d receive a score of 2.
For those who name more than 15 animals, they’d be scored 3, which is the highest score they could get on this question.
Other versions of the SLUMS test will present photos of animals that the test taker must then correctly identify.
Question 7 – What Are The Objects I Asked You To Remember?
The random list of objects presented in the fourth question now comes into play on Question 7.
The test taker must remember as many of the objects from memory as they can.
They’d be rewarded a single point for each of the correct objects named, with a potential for 5 points on this question.
Question 8 – Name This Series Of Numbers Backwards.
The next question is also mathematical in nature. The question will include a series of numbers. The test taker should be able to reverse any of those numbers.
For example, if the number in the question was 45, the test taker would write 54.
If the number was 678, then the correct answer is 876.
The numbers will grow from two digits to three and then four digits to make the series of numbers more challenging.
Question 9 – Please Draw A Clock At X Time Using Hour And Minute Markers.
This is the famous clock drawing test, which is a short test of mental status.
The test taker is presented with a blank circle. They’ll be asked to draw a clock face with all 12 numbers and then add the hour and minute markers to denote a specific time, like 6:34.
Question 10 – Identify The Geometric Shape
Next is the question about geometric shape identification. This question will include a series of geometric shapes, each of them different.
The test taker must correctly find the requested geometric shape. In some cases, they’re asked to identify the largest of the shapes.
Question 11 – I’ll Tell You A Story And Then Ask You Questions About It.
The last question on the SLUMS test is all about recall.
The test administrator, who is a doctor or cognitive disorder specialist, will present a short story that includes several characters and life details.
After reading the story, the test taker is then asked questions about it.
The questions are simple, such as what the name is of one of the characters, what someone does for work, or what state the characters live in.
The more questions answered correctly, the higher the score.
What Does A SLUMS Score Mean?
Once the test taker hands in their SLUMS test to the test administrator, the administrator tallies up their responses and the accuracy of each.
Then the test taker is assigned an overall score that’s between 0 and 30.
Here’s more information on what the SLUMS scores mean:
|0 to 20||Considered the lowest score a test taker can receive. More than likely indicates the test taker has dementia.|
|21 to 26||Higher but still not good. Indicates the test taker might have a mild neurocognitive disorder.|
|27 to 30||Highest scores. If the test taker has at least a high school education, they likely have normal cognitive functioning (no dementia or mild neurocognitive disorder).|
No matter how a test taker scores on the SLUMS test, further testing to confirm suspicions of dementia and cognitive decline is never a bad idea.
How Accurate Is The SLUMS Test?
The SLUMS test has been in use for fewer than two decades, which calls into question its veracity.
Recent studies rate the diagnostic accuracy of the SLUMS examination as high.
A 2015 publication of the Polish journal Psychiatria Polska tested 58 participants in a nursing home.
The aim of this study was to verify the utility of the SLUMS for early detection of cognitive impairment.
In the first step, the participants were split up into different groups.
The first group had suspected dementia, the second group had mild cognitive impairment, and the third group had no traces of either.
The participants took the SLUMS test, as well as two other tests that were similar. These were the Test Your Memory (or TYM) test as well as the MMSE (mini-mental status examination).
Allow us to briefly explain the TYM for context. It’s a cognitive screening test that’s self-administered and can identify dementias such as Alzheimer’s.
According to the Polish version, the SLUMS test found the most instances of early dementia compared to the TYM and MMSE tests.
Another study from 2013 came to a similar conclusion. This test had 533 participants ages 60 and over. All participants were male.
The participants were also tested using the SLUMS test and Mini Mental Status Examination (MMSE).
Both tests were able to identify dementia in the participants, but the SLUMS test also detected mild cognitive problems in some participants, while the MMSE test did not.
All that said, this alternative screening test is still considered relatively new.
Compared to the MMSE test, there’s not yet as full of a body of research on SLUMS testing. That will inevitably come with time though.
The SLUMS test is also not administered on the same scale as the MMSE, which also makes tracking its accuracy harder at this point.
Frequently Asked Questions
Is SLUMS the most reliable test for dementia?
Who is qualified to administer and interpret the SLUMS test?
The St. Louis University Mental Status or SLUMS test is an 11-question exam that exercises the test taker’s ability to do mathematical calculations, identify shapes and animals, draw accurately, and remember details.
Since the SLUMS test is newer (introduced in 2006) and still not as widely used as the standard for identifying dementia over the MMSE, we can’t be completely certain of its accuracy.
That said, the studies that do exist indicate that the SLUMS exam serves to catch more early / mild cognitive impairment compared to MMSE.
And early treatment can make a significant difference in holding off the effects of age-related cognitive impairment.
No matter the test taker’s score on the SLUMS test, the test does not constitute a diagnosis of dementia.
When a loved one has symptoms of dementia, family members should always insist that further medical and neuropsychological testing be done.