SLUMS Score Interpretation
A "positive" SLUMS score indicates cognitive impairment, with specific thresholds adjusted for education level: scores ≤24 suggest mild cognitive impairment (MCI) and scores ≤17-20 indicate dementia. 1, 2
Understanding SLUMS Scoring
The SLUMS (Saint Louis University Mental Status) examination is scored from 0 to 30 points, where higher scores indicate better cognitive performance. 1 The test takes 7-10 minutes to administer and assesses multiple cognitive domains including memory, orientation, attention, executive functions, language, and visuospatial abilities. 1, 3
Education-Adjusted Cutoff Scores
For individuals with high school education or higher:
- Normal cognition: ≥27 points 4
- MCI (positive screen): 21-26 points 4
- Dementia (positive screen): ≤20 points 4
For individuals with less than high school education:
- Normal cognition: ≥25 points 4
- MCI (positive screen): 20-24 points 4
- Dementia (positive screen): ≤19 points 4
Revised Cutoffs Based on Recent Research
A 2024 study using comprehensive neuropsychological assessment as the gold standard proposed modified cutoff scores that improved diagnostic accuracy: scores ≤24 for MCI and ≤17 for dementia, correctly classifying 65.4% of examinees compared to 55.1% with original cutoffs. 2 These revised thresholds showed strong discriminability between cognitive status groups (AUCs ranged from 0.834 to 0.986). 2
Clinical Performance Characteristics
The SLUMS demonstrates acceptable diagnostic accuracy for dementia detection across multiple validation studies:
- For dementia: AUC 0.96-0.98, with sensitivity of 83.8% and specificity of 87.3% at a cutoff of ≤20 5, 6
- For MCI: AUC 0.74-0.77, with sensitivity of 66.6% and specificity of 72.3% at a cutoff of ≤23-24 5, 6
The SLUMS performs comparably to the MoCA and STMS for detecting both MCI and dementia, with equivalent AUCs across all three instruments. 6 Importantly, the SLUMS is superior to the MMSE for detecting MCI, which the MMSE frequently fails to identify. 4
Critical Interpretation Caveats
A positive SLUMS score is not a diagnosis—it indicates the need for comprehensive evaluation. 7 Following an abnormal or borderline SLUMS result, you must obtain:
- Collateral history from family/caregivers regarding functional decline in activities of daily living 7
- Neurologic examination 7
- Screening for dementia mimics: depression (PHQ-2/PHQ-9) and delirium (Confusion Assessment Method) 7
- Appropriate laboratory studies and brain imaging 7
- Consider comprehensive neuropsychological testing for definitive diagnosis 7, 2
Education level, language barriers, and cultural factors significantly affect test performance and must be factored into interpretation. 7 In Chinese populations, the SLUMS showed acceptable AUCs only for dementia detection (0.78-0.81), not for MCI screening (0.32-0.54), highlighting the importance of cultural validation. 8
Practical Advantages
The SLUMS is freely available without copyright restrictions, unlike the MMSE, making it accessible for routine clinical use. 3 It was originally developed in Veterans Affairs populations but has been validated across diverse settings and cultures. 1, 3