The SLUMS test — short for Saint Louis University Mental Status Exam — is an 11-question cognitive screening tool that takes roughly seven minutes to administer and is scored out of 30 points. It is used primarily to detect mild cognitive impairment (MCI) and dementia in adults, particularly those 60 years and older who are showing early signs of cognitive decline. Developed in 2006 at Saint Louis University School of Medicine’s Division of Geriatric Medicine in collaboration with a Veterans Affairs medical center, the SLUMS was designed to catch subtle cognitive changes that older screening tools sometimes miss.
If a primary care physician notices that an older patient has been forgetting appointments, struggling to follow conversations, or repeating questions within the same visit, the SLUMS exam might be administered right there in the office. The test covers orientation, memory, attention, executive function, animal naming, digit span, figure recognition, clock drawing, and size differentiation. Scores are then interpreted against education-adjusted thresholds to indicate whether cognition is normal, consistent with mild neurocognitive disorder, or suggestive of dementia. This article explains how the test works, how it is scored, how it compares to other screening tools, and what its results actually mean for patients and families.
Table of Contents
- What Is the SLUMS Test and What Does It Actually Measure?
- How Is the SLUMS Scored and What Do the Results Mean?
- Who Administers the SLUMS and in What Clinical Settings?
- How Does the SLUMS Compare to the MMSE and MoCA?
- Limitations of the SLUMS and When It May Not Be Appropriate
- What Happens After a SLUMS Screen?
- The Role of Brief Cognitive Screens in an Aging Population
- Conclusion
- Frequently Asked Questions
What Is the SLUMS Test and What Does It Actually Measure?
The SLUMS exam is a structured clinical screening questionnaire, not a diagnostic instrument. It is designed to give clinicians a quick, standardized snapshot of a patient’s cognitive functioning across several domains. The 11 questions are organized to probe five core areas: verbal memory (worth 13 points), attention and concentration (5 points), visuospatial and constructional ability (5 points), language (4 points), and orientation (3 points). Together, these domains reflect the range of brain functions that tend to decline earliest and most visibly in conditions like Alzheimer’s disease and other dementias. To illustrate what this looks like in practice: a patient might be asked to remember three words at the start of the exam, then asked to recall them several questions later — this tests delayed verbal memory. They might be asked to name as many animals as they can in one minute, testing language fluency and semantic memory.
A clock-drawing task probes visuospatial reasoning and executive planning simultaneously. Each of these tasks has been chosen because it maps to real-world cognitive demands — the ability to keep track of time, follow a sequence of steps, or retain new information. What distinguishes the SLUMS from a simple memory quiz is its range. By testing multiple domains rather than just orientation or recall, it can detect patterns of impairment that point toward specific types of cognitive decline. Someone with early Alzheimer’s may struggle most on the delayed recall items, while someone with vascular dementia following a stroke might show more pronounced deficits in attention and processing speed. That breadth, packed into a seven-minute format, is a large part of what made the SLUMS attractive to clinicians working in fast-paced settings like primary care or VA facilities.
How Is the SLUMS Scored and What Do the Results Mean?
Scoring the SLUMS is straightforward: each question carries a specific point value, and the total is tallied out of 30. However — and this is a critical nuance — interpreting that score requires accounting for the patient’s educational background. Research has consistently shown that level of education affects performance on cognitive screening tests, so using a single universal cutoff would misclassify many patients, either labeling educated individuals as impaired when they are not, or missing genuine decline in those with less formal schooling. The education-adjusted thresholds work as follows. For patients who completed high school, a score of 27 to 30 is considered normal, 21 to 26 suggests mild neurocognitive disorder, and 1 to 20 is in the range associated with dementia. For patients with less than a high school education, the thresholds shift slightly: normal falls between 25 and 30, mild neurocognitive disorder between 20 and 24, and dementia from 1 to 19.
A patient who scores 22, for example, would be flagged for mild cognitive impairment if they completed high school — but that same score falls within the normal range for someone without a high school diploma. It is important to understand what these scores do and do not tell you. A SLUMS score in the dementia range is not a diagnosis of dementia. It is a signal that warrants further evaluation — additional neuropsychological testing, brain imaging, laboratory workup, and specialist referral. Conversely, a normal score does not rule out very early-stage cognitive decline. The SLUMS is a screen, not a verdict. Clinicians are trained to interpret it in the context of a full clinical picture, including patient history, caregiver reports, and functional changes in daily life.
Who Administers the SLUMS and in What Clinical Settings?
The SLUMS can be administered by a range of qualified healthcare professionals, including physicians, nurses, nurse practitioners, psychologists, and other trained clinicians. Its brief administration time and low equipment requirements — it needs only a pencil, a printed form, and a clock face template — make it practical across a wide variety of settings. It was originally developed and validated in a VA hospital context, which means it has a history with older adult male populations, though it is now used broadly across both sexes and multiple care environments. Primary care offices are one of the most common settings for SLUMS administration, typically when an annual wellness visit includes a cognitive assessment or when a family member or the patient themselves has raised concerns about memory. Memory clinics and geriatric specialty practices use it as part of initial intake assessments.
Hospitals may use it to screen patients admitted with confusion or following neurological events like stroke. It is also used in research settings to characterize study populations or track cognitive change over time. The test is also used with populations beyond general aging. Patients with Parkinson’s disease, those with a history of stroke, individuals with HIV-associated neurocognitive disorder, and others with conditions known to affect cognition may be screened with the SLUMS as part of routine monitoring. In these contexts, the test is often repeated at regular intervals — annually or more frequently — to detect changes from baseline rather than to identify a single cutoff score. A consistent five-point decline over two years, for instance, can be clinically meaningful even if both scores fall within the “normal” range.
How Does the SLUMS Compare to the MMSE and MoCA?
The two most well-known alternatives to the SLUMS are the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), and each has its own strengths and weaknesses. The MMSE has been in use since 1975 and is widely recognized, but it has a significant practical drawback: it is copyrighted and requires a licensing fee for clinical and commercial use. This has increasingly pushed healthcare institutions, particularly those with limited budgets, toward open-access alternatives. The MoCA is widely considered highly sensitive for detecting mild cognitive impairment and has strong evidence supporting its use across many populations. However, it too has faced licensing restrictions, particularly for commercial applications, though basic clinical use has generally remained accessible. The SLUMS, by contrast, is free to use by all healthcare professionals without restriction.
This is not a trivial distinction — in large health systems administering thousands of cognitive screens per year, the cumulative cost of licensing fees is real, and free access to a validated tool matters. In terms of clinical performance, the SLUMS compares favorably with both instruments. Studies have found it to be sensitive to mild cognitive impairment, in some comparisons performing comparably to or better than the MMSE at detecting early-stage decline. The MMSE, in particular, has been criticized for a ceiling effect — meaning that individuals with high premorbid intelligence can score in the normal range even with meaningful cognitive losses because the test is not challenging enough for them. The SLUMS, with its broader range of tasks including more complex executive function items, may be less susceptible to this limitation. That said, no single screening tool is universally superior for every patient population, and the choice of instrument often depends on clinical context, patient characteristics, and local practice norms.
Limitations of the SLUMS and When It May Not Be Appropriate
Like all brief cognitive screens, the SLUMS has meaningful limitations that clinicians and families should understand before placing too much weight on any single score. One important issue is cultural and linguistic bias. The test was developed and validated primarily in English-speaking populations in the United States, and its language-dependent items — particularly the animal-naming task and verbal memory components — may disadvantage patients who are not native English speakers or who come from cultural backgrounds where the testing format itself is unfamiliar. Administering a translated version without validated normative data for that language and population introduces additional uncertainty. Educational adjustment addresses one known confound, but education is a crude proxy for cognitive reserve. Two patients who both completed high school may have had dramatically different educational experiences, and neither set of thresholds can fully account for that variation. Similarly, the test does not adjust for sensory impairments: a patient with significant hearing loss may perform poorly not because of cognitive decline but because they missed or misheard instructions.
Visual impairment can affect performance on the clock-drawing and figure-recognition tasks. Clinicians administering the SLUMS should note any sensory limitations that may have affected performance. There is also the question of anxiety and testing conditions. Older adults in unfamiliar clinical environments, or those who are anxious about being evaluated, may underperform on the day of testing. A single low score is rarely sufficient grounds for a clinical conclusion without contextual information. The SLUMS is most useful as part of an ongoing relationship between a patient and a care team — one data point in a series, not a one-time verdict. Families who receive news that a loved one scored in the mild neurocognitive disorder range should understand that this opens a door to further evaluation, not that a diagnosis has been made.
What Happens After a SLUMS Screen?
A SLUMS score does not stand alone. When results suggest possible mild cognitive impairment or dementia, the standard clinical pathway typically involves referral for more comprehensive neuropsychological evaluation, laboratory tests to rule out reversible causes of cognitive symptoms (thyroid dysfunction, vitamin B12 deficiency, and medication effects are common culprits), and often neuroimaging. A neurologist or geriatric psychiatrist may become involved. The goal at this stage is to determine whether cognitive changes are stable, progressive, or attributable to a treatable underlying cause.
For patients who score in the normal range but whose family members continue to report behavioral or memory concerns, the clinical picture matters more than the number. Caregiver observations — particularly reports of changes from the person’s baseline — carry significant weight. In these cases, a clinician may schedule a repeat screening in six to twelve months or proceed directly to more detailed assessment. The SLUMS result is the beginning of a conversation, not the end of one.
The Role of Brief Cognitive Screens in an Aging Population
As the global population ages and dementia prevalence climbs, the demand for efficient, accessible, and accurate cognitive screening tools is only growing. Brief instruments like the SLUMS serve a public health function: they make it possible to identify patients who need further evaluation without requiring a specialist visit or lengthy neuropsychological battery as a first step. Early identification of cognitive decline — even mild, preclinical changes — matters because it opens the door to intervention, planning, and support before a crisis forces the conversation.
The SLUMS has a particular role in under-resourced settings. Its zero-cost model, brief administration time, and compatibility with non-specialist administration mean it can be deployed in community health centers, rural clinics, and Veterans Affairs facilities where access to specialist care may be limited. As cognitive health becomes an increasingly central concern in preventive medicine, tools like the SLUMS are likely to become more widely integrated into routine care for older adults — not as a final word on brain health, but as a practical first step in identifying who needs closer attention.
Conclusion
The SLUMS test is an 11-question, 30-point cognitive screening tool developed in 2006 at Saint Louis University that takes about seven minutes to administer. It evaluates five cognitive domains — verbal memory, attention, visuospatial ability, language, and orientation — and uses education-adjusted score thresholds to distinguish normal cognition from mild neurocognitive disorder and dementia. It is used primarily in adults 60 and older showing signs of cognitive change, as well as in populations with Parkinson’s disease, stroke history, or other conditions affecting brain function. One of its key practical advantages over tools like the MMSE is that it is completely free for all healthcare professionals to use.
Understanding what the SLUMS can and cannot tell you is essential for anyone navigating cognitive concerns — whether as a patient, a family member, or a caregiver. A score in the impaired range is not a diagnosis; it is a signal that more investigation is warranted. A normal score is not a guarantee. The value of the test lies in its role as a consistent, accessible, well-validated first step in a longer process of evaluation and care. If cognitive changes are a concern for you or someone you love, discussing a brief screening with a primary care provider is a reasonable and low-barrier starting point.
Frequently Asked Questions
Is the SLUMS test the same as a dementia diagnosis?
No. The SLUMS is a screening tool, not a diagnostic instrument. A score suggesting mild cognitive impairment or dementia indicates that further evaluation is needed, not that a diagnosis has been confirmed. Full diagnosis requires comprehensive neuropsychological testing, imaging, and clinical assessment.
How long does it take to complete the SLUMS exam?
The SLUMS typically takes approximately seven minutes to administer. This brief format is one of its main advantages in busy clinical settings like primary care offices or VA facilities.
Who can give the SLUMS test?
The SLUMS can be administered by a range of qualified healthcare professionals, including physicians, nurses, nurse practitioners, and psychologists. It does not require specialist training to administer, though interpreting results should always involve clinical judgment.
Does education level affect the SLUMS score?
Yes. The SLUMS uses education-adjusted scoring thresholds. Patients with a high school diploma are assessed against slightly higher cutoffs than those without one, because educational attainment affects baseline cognitive test performance.
Is the SLUMS test free to use?
Yes. Unlike the MMSE, which is copyrighted and requires licensing fees, the SLUMS is free for all healthcare professionals to use without restriction. This makes it especially practical for community health settings and resource-limited environments.
Can the SLUMS be used for conditions other than Alzheimer’s disease?
Yes. The SLUMS is used in patients with a range of conditions affecting cognition, including Parkinson’s disease, stroke history, and other neurological disorders. It is also used in research settings to track cognitive change over time in various clinical populations.
