These Scores Do NOT Rule Out Dementia
A Mini-Cog score of 4/5 suggests normal cognition, but a SLUMS score of 25/30 indicates mild cognitive impairment (MCI) in most patients, and these screening tools alone cannot definitively rule out dementia—further comprehensive evaluation is required. 1
Understanding the Mini-Cog Score
- A Mini-Cog score of 4 out of 5 is above the threshold for concern, as scores less than 3 are considered concerning for possible dementia 1
- The Mini-Cog has 76% sensitivity and 89% specificity for identifying dementia, meaning it can miss approximately 24% of dementia cases 1
- This score suggests normal cognition on this brief screening tool, but does not exclude all cognitive impairment 1
Interpreting the SLUMS Score of 25/30
- The interpretation of SLUMS scores depends critically on education level 2, 3
- Recent 2024 research proposes revised cutoff scores: a score of ≤24 suggests mild cognitive impairment, and ≤17 suggests dementia 2
- A score of 25/30 falls in the borderline zone, just above the MCI threshold using these revised criteria 2
- Original SLUMS cutoffs vary by education, but the test was designed to detect both MCI and dementia, not just dementia alone 3, 4
Critical Clinical Considerations
The discordance between these two screening tests is clinically significant and warrants further evaluation. 1
- Screening tools provide probability estimates, not diagnoses—they cannot definitively rule out or rule in dementia 5
- When screening tests show conflicting results or borderline scores, comprehensive neuropsychological assessment is indicated 1
- An abnormal or borderline score on any screening test must be followed by: neurologic examination, multidomain mental status testing, appropriate laboratory studies, and imaging studies 1
Essential Next Steps
- Obtain collateral history from family members or caregivers regarding functional decline in activities of daily living, behavioral changes, and medication adherence 1, 5
- Screen for dementia mimics: depression (using PHQ-2/PHQ-9) and delirium (using Confusion Assessment Method) 1
- Consider administering a more comprehensive multidomain test such as the Montreal Cognitive Assessment (MoCA), which takes 10-15 minutes and may provide additional diagnostic clarity 1, 5
- Evaluate for reversible causes of cognitive impairment: thyroid dysfunction, vitamin B12 deficiency, medication effects, sleep disorders 5
Common Pitfalls to Avoid
- Do not assume normal cognition based on a single screening test, especially when another test suggests impairment 5
- Education level, language barriers, and cultural factors significantly affect test performance and must be considered in interpretation 1
- High-functioning individuals may score in the "normal" range on brief screening tests despite having meaningful cognitive decline from their baseline 5
- Failing to obtain collateral information when cognitive impairment is suspected is a critical error 5