What Mini-Mental State Examination (MMSE) score out of 30 is acceptable for driving?

SLUMS Mental Test Score for Driving Safety

For patients with cognitive impairment, a SLUMS score of 18 or higher is generally considered acceptable for driving safety. 1

Understanding Cognitive Assessment Tools for Driving Evaluation

The Saint Louis University Mental Status (SLUMS) examination is a 30-point cognitive screening tool developed primarily for use in VA populations. It is well-suited for detecting both mild cognitive impairment (MCI) and dementia, and can track progression through moderate stages of dementia 2.

Key Cognitive Assessment Tools for Driving Evaluation:

• SLUMS: 7-10 minutes to administer, range 0-30 points 2
• MMSE: 7-10 minutes to administer, range 0-30 points, less sensitive for MCI 3
• MoCA: 10-15 minutes to administer, better sensitivity for detecting MCI 3

Evidence-Based Approach to Cognitive Assessment for Driving

Research shows that cognitive screening measures have different predictive values for driving safety depending on whether the patient has a pre-established diagnosis of cognitive impairment:

• For individuals with diagnosed cognitive impairment, the MoCA has shown significant relationship with on-road driving test outcomes, with each 1-point decrease in MoCA score increasing the likelihood of failing a road test by 1.36 times 1
• A MoCA score of 18 or less should raise concerns about driving safety in those with cognitive impairment 1
• The MMSE alone has poor predictive validity for on-road performance in community-dwelling older drivers 4
• The Addenbrooke's Cognitive Examination Revised (ACE-R) has shown higher classification accuracy than MMSE for detecting unsafe drivers 5

Clinical Algorithm for Assessing Driving Safety Using SLUMS

1. Administer the SLUMS test (available at: http://aging.slu.edu/pdfsurveys/mentalstatus.pdf) 2
2. Interpret results based on cognitive status:
   • If patient has diagnosed cognitive impairment:
     • Score ≥18: Likely acceptable for driving
     • Score <18: High risk for unsafe driving, consider formal driving evaluation
   • If patient has no diagnosed cognitive impairment:
     • SLUMS alone is insufficient to determine driving safety
     • Consider additional assessment tools and on-road evaluation

Important Considerations and Pitfalls

• Don't rely on cognitive tests alone: Combining cognitive tests with informant reports on changes in cognition, function, and behavior increases diagnostic accuracy 3
• Education level matters: False positives are more common in older adults with lower education levels 3
• Serial assessments are valuable: Perform follow-up cognitive assessments every 6-12 months using the same version of cognitive tests to track changes over time 3
• Visuospatial and executive functions: These domains, which are incorporated in the SLUMS but not in the MMSE, have incremental value in predicting driving ability 5

Additional Recommendations

• Document baseline cognitive status to help anticipate problems with treatment adherence and to help families plan for future care needs 3
• For patients with borderline scores, consider referral for a comprehensive driving evaluation with an occupational therapist specialized in driving assessment
• Discuss the results and implications with both the patient and family members to ensure safety and appropriate planning

By following this evidence-based approach using the SLUMS examination, clinicians can better identify patients at risk for unsafe driving while allowing those with adequate cognitive function to maintain their independence and mobility.