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RehabMeasures Instrument

Rehabilitation Measure

Saint Louis University Mental Status Exam

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Purpose

The SLUMS Exam is a clinician administered examination used to identify persons who have dementia or Mild Neurocognitive Impairment.

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Instrument Details

Acronym SLUMS

Area of Assessment

Attention & Working Memory
Cognition
Executive Functioning
Language
Mental Health
Reasoning/Problem Solving

Assessment Type

Physiological

Cost

Free

Key Descriptions

  • The SLUMS is a 30-point, 11 question screening questionnaire that tests orientation, memory, attention, and executive function, with items such as animal naming, digit span, figure recognition, clock drawing and size differentiation.
  • The measure is clinician-administered and takes approximately 7 minutes to complete.
  • The maximum score is 30 points, with the point values for correct answers written on the exam for easy scoring.
  • Cut-off scores for dementia or mild neurocognitive impairment are based on the education level of the patient (high school and above or less than high school).

Number of Items

11

Equipment Required

  • Paper copy of the SLUMS and a pen/pencil

Time to Administer

4-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Terry Ellis PT, PhD, NCS; Laura Savella sPT & the PD EDGE Task Force of the Neurology Section of the APTA.

ICF Domain

Body Function

Measurement Domain

Cognition

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations Based on Parkinson Disease Hoehn and Yahr stage: 

 

I

II

III

IV

V

PD EDGE

LS/UR

LS/UR

LS/UR

LS/UR

LS/UR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

No

No

No

Not reported

Considerations

  • This measure is useful in the older adult population and may be more sensitive than the MMSE at detecting Mild Neurocognitive Impairments in that population 
  • Unlike the MoCA and MMSE, the SLUMS contains items assessing logical memory and size differentiation

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Older Adults and Geriatric Care

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Cut-Off Scores

Veterans 60+:

(Tariq et al, 2006; = 702; mean age = 75.3(5.5); VA medical center; Primarily white, male sample). 

Tariq proposes the use of new cut off scores based on ROC curve to improve sensitivity and specificity on the SLUMS, 

High School Education: 

  • 25.5 = Mild Neurocognitive Impairment (SN = 0.95; SP = 0.76) 
  • 21.5 = Dementia (SN = 0.98; SP = 1) 

Less than High School Education: 

  • 23.5 = Mild Neurocognitive Impairment (SN = 0.92; SP = 0.81) 
  • 19.5 = Dementia (SN = 1; SP =0.98)

Normative Data

Community Dwelling Elders:

(Feliciano et al, 2013; = 170; mean age = 23.85 (4.42); mean education = 14.69 (2.50) community dwelling elders) 

  • Mean = 23.85 


 

Veterans 60+:

(Tariq et al, 2006; subjects classified by DSM-IV criteria as Normal, MNI, or dementia and by high school education) 

Mean SLUMS scores; High School Education: 

  • Normal (= 303) = 26.9 (2.0) 
  • Mild Neurocognitive Impairment (= 130) = 22.3 (2.1) 
  • Dementia (= 55) = 14.9 (5.2) 

Mean SLUMS scores; Less than High School Education: 

  • Normal (= 137) = 25.7 (2.8) 
  • Mild Neurocognitive Impairment (= 50) = 20.2 (2.4) 
  • Dementia (n = 27) = 11.3 (5.1)

Criterion Validity (Predictive/Concurrent)

Community Dwelling Elders: 

(Feliciano et al, 2013) 

  • MMSE & SLUMS: Excellent validity (r = 0.75) 

 

Long term care facility:

(Steward et al, 2012; = 40; mean age = 65.08 (8.83); mean education = 10.15 (3.61) )

  • MMSE & SLUMS: Excellent convergent validity (r = 0.83) 

 

Veterans 60+:

(Tariq et al, 2006) 

The results of this study suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. The SLUMS may be better at detecting mild neurocognitive disorder compared to the MMSE.  SLUMS AUCs at cut-offs of maximum specificity/sensitivity 

  • < HS education and MNCD: AUC = 0.927 
  • < HS education and dementia: AUC = 0.998 
  •  ≥ HS education and MNCD: AUC = 0.941 
  •  ≥ HS education and dementia: AUC=0.983 

MMSE AUCs at maximum specificity/sensitivity 

  • < HS education and MNCD: AUC = 0.671 
  • < HS education and dementia: AUC = 0.915 
  • ≥ HS education and MNCD: AUC = 0.643 
  • ≥ HS education and dementia: AUC=0.934 

 

Predictive Validity: 

Veterans 60+:

(Cruz-Oliver et al, 2012; = 533, mean age = 75.1 (5.5). Of these n = 176 had died and = 31 had been institutionalized during 7.5 year follow-up.) 

  • Adjusted SLUMS scores classified as dementia significantly predicted mortality and institutionalization 
    • Classified as Dementia on SLUMS: Adjusted Mortality Hazards Ratio (HR) [95% CI] = 2.44 [1.63, 3.65], p < 0.001 
    • Classified as Dementia on SLUMS: Adjusted Institutionalization Hazards Ratio (HR)[95% CI] = 3.48 [1.34, 9.05], p = 0.01 
  • Adjusted SLUMS scores classified as Mild Cognitive Impairment did not significantly predict mortality and institutionalization 
    • Classified as MCI on SLUMS: Adjusted MortalityHazards Ratio (HR)[95% CI] = 1.33 [0.93, 1.92], p = 0.121 
    • Classified as MCI on SLUMS: Adjusted Institutionalization Hazards Ratio (HR)[95% CI] = 1.48 [0.57, 3.83], p = 0.423
  • Unadjusted SLUMS scores significantly predicted mortality (HR = 1.5 [95% CI 1.1, 2.2], p < 0.019), but not institutionalization

Construct Validity

Long term care facility: 

(Steward et al, 2012) 

  • MoCA & SLUMS: Excellent Convergent validity (r = 0.91) 

 

Male Veterans 60+:

(Cummings-Vaughn et al (no year listed); = 65) 

  • Clinical Dementia Rating & SLUMS: Adequate convergent validity (ROC analysis; AUC = 0.725) 
  • Sensitivity of the SLUMS= 0.742 higher than Sensitivity of MoCA = 0.677 

Floor/Ceiling Effects

Non-Veteran Older Adults: 

(Feliciano et al, 2013) 

  • Distributional analysis suggests that the lower mean values, lower rank scores, less skewness, and more variability in the SLUMS compared to the MMSE suggest the SLUMS may be less impacted by ceiling effects then the MMSE

Alzheimer's Disease and Progressive Dementia

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Cut-Off Scores

Dementia or Mild Neurocognitive Impairment:

(Morley, Tumosa, 2002) 

High School Education: 

  • 27-30 = Normal 
  • 21-26 = Mild Neurocognitive Impairment 
  • 1-20 = Dementia 

Less than High School Education: 

  • 25-30 = Normal 
  • 20-24 = Mild Neurocognitive Impairment 
  • 1-19 = Dementia 

Non-Specific Patient Population

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Normative Data

Pre-surgical sample:

(Brown et al, 2012; n = 30; mean age = 46.14 (11.05)) 

  • Mean = 27.47 (2.41) 

 

Referred for Social Services/Disability Adjudication: 

(Brown et al, 2012; n = 49; mean age = 43 (11.35)) 

Mean scores on the SLUMS: 

  • Below HS education (n = 15) = 22.47 (3.83) 
  • Equal to HS education (n = 23) = 22.61 (4.81) 
  • Beyond HS education (n = 11) = 25.91 (3.02) 

Construct Validity

Referred for Social Services/Disability Adjudication:

(Brown et al, 2012) 

  • Nevada Brief Cognitive Assessment Instrument (NBCAI) & SLUMS: Excellent Convergent validity (Pearson coefficient r = 0.76)

Bibliography

Brown, D. H., Lawson, L. E., et al. (2012). "Relationships Between The Nevada Brief Cognitive Assessment Instrument and the St. Louis University Mental Status Examination in the Assessment of Disability Applicants 1, 2." Psychological Reports 111(3): 939-951.

Cruz-Oliver, D. M., Malmstrom, T. K., et al. (2012). "The Veterans Affairs Saint Louis University mental status exam (SLUMS exam) and the Mini-mental status exam as predictors of mortality and institutionalization." J Nutr Health Aging 16(7): 636-641. Find it on PubMed

Cummings-Vaughn, L., Cruz-Oliver, D., et al. (2012). "The Veterans Affairs Medical Center Saint Louis University Mental Status Examination Comparison Study." Alzheimer's & Dementia 8(4): P485.

Feliciano, L., Horning, S.M., Klebe, K.J., Anderson, S.L., Cornwell, R.E., & Davis, H.P. (2012). "Utility of the SLUMS as a Cognitive Screening Tool Among a Nonveteran Sample of Older Adults." Am J Geriatr PsychiatryFind it on PubMed

Morley, J., & Tumosa, N. (2002). "Saint Louis University Mental Status Examination (SLUMS)." Aging Successfully 12(1): 4.

Stewart, S., O'Riley, A., et al. (2012). "A Preliminary Comparison of Three Cognitive Screening Instruments in Long Term Care: The MMSE, SLUMS, and MoCA." Clinical Gerontologist 35(1): 57-75.

Tariq, S. H., Tumosa, N., et al. (2006). "Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder--a pilot study." Am J Geriatr Psychiatry 14(11): 900-910. Find it on PubMed

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