The SLUMS is administered by a clinician using the printed form (available free from Saint Louis University). Use this calculator to score a completed administration - it is not a self-test. Record the patient's level of education before scoring, since the interpretation bands differ for high-school and less-than-high-school education.
01
Orientation
"What day of the week is it?"
Item score-
02
Orientation
"What is the year?"
Item score-
03
Orientation
"What state are we in?"
Item score-
04
Maths / money
"You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20." Then ask: "How much did you spend?" (1 point) and "How much do you have left?" (2 points).
Item score-
05
Animal fluency
"Please name as many animals as you can in one minute."
Item score-
06
Delayed recall
Earlier in the administration you said "Please remember these five objects. I will ask you what they are later: apple, pen, tie, house, car." Now ask: "What were the five objects I asked you to remember?" Score one point per object recalled.
Item score-
07
Digit span backward
"I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24." 87 scores no points; 648 scores 1 point; 8537 scores 1 point.
Item score-
08
Clock drawing
"This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock." Hour markers correct scores 2 points; time correct scores 2 points.
Item score-
09
Figures (uses the printed figures on the form)
"Please place an X in the triangle" (1 point) and "Which of the above figures is largest?" (1 point).
Item score-
10
Story recall
Read the Jill story from the printed form, then ask - What was the female's name? (2 points) What work did she do? (2 points) When did she go back to work? (2 points) What state did she live in? (2 points).
Item score-
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0 of 10 answered
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SLUMS0 / 10
The SLUMS is administered by a clinician using the printed form (available free from Saint Louis University). Use this calculator to score a completed administration - it is not a self-test. Record the patient's level of education before scoring, since the interpretation bands differ for high-school and less-than-high-school education.
01
Orientation
"What day of the week is it?"
Item score-
02
Orientation
"What is the year?"
Item score-
03
Orientation
"What state are we in?"
Item score-
04
Maths / money
"You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20." Then ask: "How much did you spend?" (1 point) and "How much do you have left?" (2 points).
Item score-
05
Animal fluency
"Please name as many animals as you can in one minute."
Item score-
06
Delayed recall
Earlier in the administration you said "Please remember these five objects. I will ask you what they are later: apple, pen, tie, house, car." Now ask: "What were the five objects I asked you to remember?" Score one point per object recalled.
Item score-
07
Digit span backward
"I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24." 87 scores no points; 648 scores 1 point; 8537 scores 1 point.
Item score-
08
Clock drawing
"This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock." Hour markers correct scores 2 points; time correct scores 2 points.
Item score-
09
Figures (uses the printed figures on the form)
"Please place an X in the triangle" (1 point) and "Which of the above figures is largest?" (1 point).
Item score-
10
Story recall
Read the Jill story from the printed form, then ask - What was the female's name? (2 points) What work did she do? (2 points) When did she go back to work? (2 points) What state did she live in? (2 points).
The SLUMS is an eleven-task, thirty-point bedside examination of cognition. It samples orientation, immediate and delayed recall, attention and mental control, arithmetic reasoning, semantic verbal fluency (animal naming), visuospatial construction via clock drawing, size and shape differentiation using printed geometric figures, and logical memory through recall of a short spoken story. The breadth is deliberate: the executive and logical-memory tasks were added because the developers judged that briefer screens missed the mild end of the spectrum.
What it produces is a single 0–30 score that is read against education-adjusted bands rather than one universal cutoff. It is a screening instrument, not a diagnostic one. A score below the normal band indicates that a fuller cognitive assessment is warranted; it does not establish a diagnosis of dementia or of mild neurocognitive disorder, and a normal score does not exclude one. The SLUMS is clinician-administered - it requires a printed form, a spoken story and a drawn clock - so it cannot be completed by a patient alone.
02 - Origin & purpose
Where it comes from.
The SLUMS was developed by James Morley and Nina Tumosa at Saint Louis University in partnership with the Geriatric Research, Education and Clinical Center at the St. Louis Veterans Affairs Medical Center, and first circulated in the university's Aging Successfully bulletin in 2002. The stated motivation was dissatisfaction with the Mini-Mental State Examination at the mild end: the MMSE was judged to have too high a ceiling and too little executive content to pick up patients whose deficits were real but early.
The validating study was published by Tariq, Tumosa, Chibnall, Perry and Morley in the American Journal of Geriatric Psychiatry in 2006. Seven hundred and two veterans aged sixty and over attending a VA medical centre were examined with both the SLUMS and the MMSE and classified against DSM-IV criteria as cognitively normal, as having mild neurocognitive disorder, or as having dementia. The two instruments performed comparably for dementia; the SLUMS separated mild neurocognitive disorder from normal ageing considerably better. The instrument remains free, and Saint Louis University provides a training video that the authors recommend clinicians review annually.
03 - Scoring & cutoffs
How scoring works.
Each task carries its own point value, printed on the form beside the item, and the values are summed to a total between 0 and 30. Nothing is reverse-scored and there is no weighting to apply afterwards. Because performance on several tasks - animal naming, the story recall, the arithmetic items - is influenced by schooling, the total is interpreted against one of two sets of bands depending on whether the patient completed high school.
For patients with a high-school education or above, 27–30 is the normal range, 21–26 indicates mild neurocognitive disorder, and 1–20 indicates dementia. For patients with less than a high-school education every threshold drops by two points: 25–30 is normal, 20–24 indicates mild neurocognitive disorder, and 1–19 indicates dementia. Record the education level before scoring, because applying the wrong set of bands will misclassify patients in both directions. The ROC-derived optimum cutpoints reported by Tariq and colleagues sit fractionally below the band edges - 25.5 and 21.5 for high-school-educated patients, 23.5 and 19.5 for those with less schooling - which is simply the statistical restatement of the same thresholds.
Score
Severity
Interpretation
0–20
Dementia
In the dementia range for a patient with high-school education (1-19 for less than high-school education). Requires full diagnostic assessment, not a diagnosis in itself.
21–26
Mild neurocognitive disorder
Suggests mild neurocognitive disorder in a patient with high-school education (20-24 for less than high-school education). Screening guidance only - proceed to fuller cognitive assessment.
27–30
Normal
Normal cognition for a patient with high-school education. For less than high-school education, normal begins at 25.
Screening guidance only, not a diagnosis. A positive screen should feed a fuller cognitive assessment. Interpretation is education-adjusted: for patients with less than high-school education, normal is 25-30, mild neurocognitive disorder 20-24 and dementia 1-19.
04 - Validation evidence
How well it performs.
The evidence base rests on the 2006 Tariq study and on a set of smaller independent replications. In the original sample of 702 veterans (mean age 75.3), mean SLUMS scores in high-school-educated patients were 26.9 for those judged cognitively normal, 22.3 for mild neurocognitive disorder and 14.9 for dementia; in patients with less schooling the corresponding means were 25.7, 20.2 and 11.3. Discrimination for dementia was near-perfect for both the SLUMS and the MMSE. The difference between the two instruments lay in the mild band, where the SLUMS produced an area under the curve of 0.94 against the MMSE's 0.64 in the high-school-educated group, and 0.93 against 0.67 in those with less schooling. 1
Independent work supports convergent validity: correlations of 0.75 with the MMSE in 170 community-dwelling older adults (Feliciano et al.) 3, and 0.83 with the MMSE and 0.91 with the MoCA in a small long-term-care sample (Stewart et al.) 7. The score also carries prognostic weight - in a 7.5-year follow-up of 533 veterans, patients classified as having dementia on the SLUMS had an adjusted mortality hazard ratio of 2.44 and an adjusted institutionalisation hazard ratio of 3.48, although the mild-impairment classification did not significantly predict either outcome. 4 Two caveats matter. The primary validation sample was overwhelmingly white, male and American, and the instrument has been much less studied outside that population. And the score is not a good tracker of change over time: in a one-year follow-up of 304 older adults at risk of cognitive decline, changes in MMSE score correlated with changes in functional measures whereas changes in SLUMS score did not. 5
Sens 98% / Spec 100%
Dementia, high-school education
Cutpoint 21.5. Tariq et al. 2006, n=702 VA outpatients aged 60+.
The best-evidenced screen for mild cognitive impairment, with the largest international and translated evidence base. Requires certification and is licensed.
When time is the binding constraint and you need a fast triage decision rather than a graded score.
SLUMS
11
4–10 min
When you want MoCA-like sensitivity to mild impairment without a licence or certification requirement, and education level is known.
AD8
8
2–3 min
When the patient cannot be tested reliably or you want a collateral history; it asks an informant about change, not the patient about performance.
GPCOG
9
4–6 min
Designed for general practice, with an informant section that reduces the influence of education and language on the result.
06 - When to use it
Right tool, wrong tool.
Reach for it when
-You suspect early cognitive change and want a screen that discriminates at the mild end better than the MMSE.
-You need a free instrument with no licence fee and no certification requirement.
-You know the patient's education level and can apply the correct band set.
-You want executive and logical-memory content, which briefer screens omit.
-You are establishing a baseline before starting a medication with cognitive side effects.
Reach for something else when
-You want to track change across visits - the measurement error is too large and the score does not track functional change well over a year.
-The patient has significant visual, motor or language impairment, or low literacy: clock drawing, figure recognition and animal naming all become unfair.
-The patient is not fluent in the language of administration and no validated translation exists.
-You need a diagnosis rather than a screen, or you need to characterise the profile of deficits - that requires neuropsychological assessment.
-The referral or trial protocol specifies the MMSE or the MoCA; substituting the SLUMS will not satisfy it.
-The patient cannot be examined in person, or you only have an informant available - use the AD8 or GPCOG instead.
07 - Confidence & precision
Reading the score with care.
The SLUMS is reliable enough to classify but not precise enough to monitor. Retested at two weeks in 60 people with dementia, it produced an intraclass correlation of 0.86–0.90 - comparable to the MMSE, MoCA and SPMSQ - but a minimum detectable change at 95% confidence of 6.26 points, roughly a quarter of the full scale. 6 In practice this means that a difference of six points or fewer between two administrations cannot be distinguished from measurement noise in an individual patient, and a patient sitting one or two points either side of a band edge should be treated as sitting on the boundary rather than as firmly classified. No minimal clinically important difference has been published. The one-year follow-up work found that SLUMS change scores did not correlate with change in functional measures, so the instrument should not be used as an outcome measure; repeat it to re-screen after a meaningful interval, not to chart a trajectory.
08 - Limitations
What it cannot tell you.
Validation rests heavily on one sample of 702 US veterans who were predominantly white and male; performance in women, in other ethnic groups and outside the United States is much less well established.
The education adjustment is binary - high school or not - which is a coarse proxy for a variable that strongly affects several tasks, and it does not adjust for literacy, language or numeracy separately.
Clinician-administered by design. It cannot be given as a self-test or a questionnaire, and administration varies unless clinicians are trained; the authors recommend reviewing the training video annually.
Poor sensitivity to change over time, with a minimum detectable change of about six points and no published MCID.
Several tasks depend on intact vision, hearing, hand function and language, any of which can depress the score for reasons unrelated to cognition.
Floor effects appear in moderate to severe dementia, where the score compresses and stops distinguishing severity.
The mild neurocognitive disorder classification did not significantly predict mortality or institutionalisation, so a "mild" result should not be over-interpreted prognostically.
Screening only. A positive result requires a fuller assessment including history, collateral history, physical examination and investigation of reversible causes.
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