The Saint Louis University Mental Status (SLUMS) examination is a common cognitive assessment tool designed to screen for early signs of mild cognitive impairment in older adults, including various types of dementia, like Alzheimer’s disease. Even with the convenient speed of the SLUMS scoring method—and its free availability—primary care settings still have an issue with underdiagnosis. Providers must work to solve this issue. Patients with delayed dementia or Alzheimer’s diagnosis are often left untreated while their impairment continues to lower their quality of life, straining family and caregivers.
While there are certainly many reasons for this trend, like the stigma around cognitive health, a lack of reliable diagnostic tools may be a contributing factor. While traditional screeners like the SLUMS can be an essential part of determining whether or not a patient is experiencing cognitive impairment, due to their limitations, they are better used as part of a larger diagnostic process (Bruun et al, 2028). Any single test or screener used on its own makes it challenging to effectively diagnose dementia, and the SLUMS test is no different. This is primarily because the SLUMS test can't always distinguish between dementia and other mental illnesses, making it important that providers follow up with further cognitive testing.
In this article, we cover the benefits and limitations of the SLUMS test and how it compares to other cognitive assessments, including digitized cognitive assessment (DCA).
When it comes to the actual process of scoring the SLUMS test, PCPs can expect to ask the patient a set of 11 questions, with the SLUMS score ranging from 0 to 30. These questions are designed to measure the following cognitive domains:
SLUMS scoring is the process of interpreting a patient's responses to the test's 11 questions, with the goal of measuring their cognitive abilities. The test has a maximum score of 30. Scoring the SLUMS test must always be performed by a healthcare professional. The purpose of the SLUMS score is to provide primary care providers (PCPs) with information on a patient's cognitive abilities to support the detection of mild cognitive impairment or dementia.
The test and its scoring method were originally developed at the Saint Louis University School of Medicine in 2006. It is a scientifically validated cognitive screener for dementia and other cognitive impairments in elderly patients aged 60 and above. It's important to note that the test is not validated for patients aged 59 and younger.
For patients who suspect they may have a cognitive impairment, taking the SLUMS test is a quick and convenient process. This may make it a more appealing cognitive assessment compared to hours-long, intensive neuropsychological exams. However, the test is best followed up with further testing to garner the detailed information needed to make a confident diagnosis.
The SLUMS exam is scored by a trained healthcare professional—usually a physician, nurse practitioner, or allied provider. The test’s questions and score are also given cutoffs adjusted for education level. Overall, the entire process takes about seven to 10 minutes.
Scoring the SLUMS has its limitations, making a more comprehensive follow-up testing necessary. There are many reasons why patients may score low on the test. These are just a few of the factors that may impact a patient's score:
Overall, the SLUMS is a brief, validated test for approximating global cognitive functioning among older adults (Noyes et al., 2023). However, it does have some subjective limitations in its scoring method that physicians and patients need to be made aware of to increase the likelihood of accurate results.
SLUMS scoring is broken down into two scales, one for patients who haven't completed a high school education, and another for those who have. It's the healthcare provider's responsibility to score the patient's answer and measure the results appropriately based on their education level.
For patients who have not completed grade 12 or equivalent education:
25–30: Regular cognitive function
20–24: Mild cognitive impairment
1–19: Signs of dementia
For patients who have completed grade 12 or equivalent education:
27–30: Regular cognitive function
21–26: Mild cognitive impairment
1–20: Signs of dementia
However, it should be noted that SLUMS results can be skewed if the patient has:
The test’s use of fixed cutoff scores to categorize cognitive status may oversimplify complex cognitive profiles, especially in borderline cases where a patient may score just above or below a diagnostic line. This demarcation for regular cognitive function vs. mild cognitive impairment becomes even less clear when comorbid disorders, like depression, are introduced, with a cutoff of 25 recommended in one study (Spencer et al., 2022).
In contrast, digitized cognitive assessments like Creyos use large normative datasets to interpret scores dynamically and objectively, placing an individual's performance in the context of thousands of peers. As noted in one study (Sternin et al.,2019), this approach improves precision and reduces reliance on clinical intuition, helping frontline providers detect early cognitive decline with less ambiguity.
Before a primary care physician decides whether the SLUMS test is the right cognitive screener for a patient, they need to gain a complete understanding of its strengths and limitations.
The SLUMS is a valuable tool for initial cognitive screening, but it isn't definitive. If mild cognitive impairment is detected, it may indicate the need for further evaluation to better understand the patient's cognitive health.
Here's a breakdown of what healthcare providers can expect:
The SLUMS test, like all diagnostic tools, has its limitations. These limitations include age range constraints, limited sensitivity, insufficient normative data, limited criterion validation, a lack of detail, and pen and paper administration (Spencer et al., 2022).
When it comes to detecting and monitoring the signs of cognitive decline in older patients, the SLUMS test is just one of many cognitive tests for dementia available for healthcare providers and patients. So, how does it compare to other cognitive assessments?
Here’s a closer look at other cognitive exams as a point of comparison:
The mini-mental state examination (MMSE) is one of the most widely used cognitive screening tools in the world (Gallegos et al., 2022) and is available in a wide variety of languages. The test can be conducted in five to 10 minutes and assigns up to 30 points for task completion, assessing various cognitive domains, including memory, attention, language, and spatial orientation.
While both the SLUMS and MMSE tests take around the same time to conduct and interpret, the SLUMS exam includes different types of questions, like story comprehension. On top of that, the MMSE may be less sensitive than the SLUMS in certain applications (Yoelin et al., 2017).
The MoCA test is another commonly used tool for screening mild cognitive impairment and dementia. Like the SLUMS, it’s designed to identify early cognitive deficits, with a strong focus on executive function, attention, and memory. The test is widely available to many different patient groups, either in-person or online, with options available for people with low or no vision, and those who are experiencing hearing loss.
The MoCA test offers a greater degree of accessibility than the SLUMS. The MoCA has been better studied in academic literature, but the SLUMS test is free to use (Noyes et al., 2022). Depending on a PCP's requirements, both tests have their applications, but both screeners also have certain limitations.
The SAGE test is unique because it can be completed by the patient alone, offering a way for individuals to test their cognitive abilities on their own time. However, the results still need to be interpreted by a healthcare professional. It assesses memory, problem-solving, and verbal reasoning and is available in four variations, allowing patients themselves to retest for consistent results.
The SAGE has similar accuracy to other pen and paper screeners (te Pas et al., 2022); its key difference from physician-administered screeners like the SLUMS is that the SAGE test is a self-assessment tool. That being said, the SAGE still requires manually responding to items on paper and manual scoring, and shares many of the same limitations as other pen and paper screening tools..
While the SLUMS can be a useful tool for screening cognitive impairment in general, some senior-focused primary care organizations recognize its limitations in confirming or ruling out a dementia diagnosis. These organizations opt to use digital cognitive assessments as an alternative.
While the SLUMS test has its uses as a cognitive screener, healthcare providers may want to consider additional or alternative options, like the Creyos digital cognitive assessments. These computerized cognitive assessments offer a more detailed report than the SLUMS test.
Additionally, Creyos cognitive assessments are scored automatically and are accessible to patients of all ages and ability levels. They are also fully capable of retesting without needing multiple variations. Creyos cognitive assessments are able to detect the subtle early signs of cognitive decline (Lupton et al., 2023), allowing for early dementia prevention or intervention before a patient's condition deteriorates.
Creyos has a variety of cognitive assessment solutions and condition-focused protocols that are readily available for PCPs. Physicians can more confidently make a diagnosis with the Creyos dementia screener, assessment, and care plan, expediting treatment before their patients' conditions further deteriorate.
This two-task digital cognitive screener is not only faster—taking less than three minutes to complete—but also more advanced. It uses machine learning to detect the subtle signs of cognitive impairment, confirming whether the patient needs further testing. It is self-administered, so it can be completed without supervision in a clinic or from the comfort of the patient’s own home.
The Creyos screener is a brief, digital cognitive assessment designed to help healthcare providers efficiently identify potential signs of dementia during routine care. It includes two validated tasks that assess working memory and attention, two cognitive skills known to be sensitive to early-stage dementia.
Each task takes just a few minutes to complete, with results scored and compared against Creyos’s large normative database. Results are visualized in a structured report that highlights whether a patient’s performance falls within the expected range or shows patterns consistent with cognitive decline.
The Creyos platform also comes with a cognitive care plan. The care plan is based on guidelines by the Alzheimer's Association, and allows physicians to collect longitudinal data over time, supporting them in making critical clinical decisions with their patients.
It's a structured step-by-step digital template that follows Alzheimer’s Association guidelines, prompting providers to cover: cognitive, functional, behavioral/neuropsychiatric, medication, caregiver needs, safety, advance care planning, including structured patient and caregiver sections help evaluate functional abilities (IADL, DSRS), caregiver stress, education, and support resources. It also meets CPT 99483 billing requirements.
Compared to traditional cognitive screeners like the SLUMS exam, the computerized cognitive testing at Creyos is able to provide healthcare professionals with more detailed insight into a patient's cognition while giving them the convenience of being tested wherever they are most comfortable, without any manual administration or scoring by clinicians.
Additional benefits include:
Support better patient outcomes and learn how you can bring the Creyos dementia screener, assessment, and care plan into your workflows. Speak to our product and reimbursement experts today for more details.
The SLUMS serves as a quick and effective cognitive screener, particularly useful in identifying early signs of cognitive impairment in elderly patients. However, its limitations in the ability to support a complete diagnosis highlight the need for further diagnostic tools. That’s where digital cognitive assessments come in.
More advanced assessments, such as cognitive testing from Creyos, offer greater precision, flexibility, and convenience, providing healthcare providers with detailed, objective data that can improve patient outcomes. While the SLUMS exam remains a valuable tool for initial screening, its role is best complemented by digital cognitive testing for a comprehensive, accurate approach to cognitive healthcare.
Written by Lawrence Stewen
Lawrence Stewen is an SEO copywriter and content marketer based in Vancouver, Canada. Transforming complex, technical concepts into copy that’s simply human is what he does best. In his free time, you can find him hiking, reading at a local café, or working on his many creative writing projects. Learn more about his work at: www.lawrencestewen.com
Reviewed by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.