The SLUMS test is a 30-point cognitive screening tool used to detect early signs of memory loss and thinking problems. Short for the Saint Louis University Mental Status examination, it was developed by the geriatric medicine division at Saint Louis University to catch mild cognitive impairment that other common screening tools often miss. The test takes about 7 to 10 minutes to complete and is free for clinical use.
What the Test Measures
The SLUMS exam contains 11 items that test a range of mental abilities. It starts with simple orientation questions: what day of the week it is, what year it is, and what state you’re in. These check whether a person is grounded in basic time and place awareness.
From there, the tasks get progressively more complex. You’ll be asked to remember and repeat five words, then recall them later in the test. This split between immediate and delayed recall is one of the exam’s strengths, since difficulty retrieving information after a short delay is one of the earliest signs of cognitive decline. A math problem involving money spent and change received tests calculation ability, while naming as many animals as possible in one minute measures verbal fluency.
The exam also includes a backward digit span task, where you repeat a string of numbers in reverse order. This targets working memory, the mental workspace you use to hold and manipulate information in real time. Two visual tasks round out the test: drawing a clock with the hands set to a specific time, and copying geometric figures. These require spatial reasoning, planning, and the ability to translate a mental image onto paper. Finally, a short story is read aloud, and you answer questions about it, testing both comprehension and recall.
How Scoring Works
Each item earns a set number of points, with a maximum total score of 30. The scoring thresholds are adjusted based on education level, which matters because years of formal education can influence performance on tasks like calculation and verbal fluency.
For people with a high school education or more, a score of 27 to 30 is considered normal. Scores between 21 and 26 suggest mild neurocognitive disorder, and scores of 20 or below point toward dementia. For those without a high school education, the cutoffs shift downward: 25 to 30 is normal, 20 to 24 suggests mild neurocognitive disorder, and 19 or below indicates dementia.
These are screening thresholds, not diagnoses. A low score signals the need for further evaluation, which typically involves more detailed neuropsychological testing, imaging, or lab work to rule out reversible causes of cognitive decline like thyroid problems, vitamin deficiencies, or medication side effects.
How It Compares to the MMSE
For decades, the Mini-Mental State Examination (MMSE) was the go-to cognitive screening tool. The SLUMS was designed in part to address a key gap: the MMSE is reasonably good at detecting dementia but tends to miss mild cognitive impairment, the gray zone between normal aging and dementia where early intervention can make the most difference.
Research published in The American Journal of Geriatric Psychiatry found that both tests produce comparable results for detecting dementia, but the SLUMS performs better at identifying mild neurocognitive disorder. The MMSE failed to flag cases that the SLUMS caught, regardless of the patient’s education level. This advantage likely comes from the SLUMS including more complex tasks like delayed recall, clock drawing, and story comprehension, which stress higher-order thinking in ways the MMSE’s simpler questions do not.
There’s also a practical advantage. The MMSE is copyrighted and requires a paid license to use, which limits its availability. The SLUMS exam can be downloaded directly from Saint Louis University’s website at no cost, making it accessible to any clinic, hospital, or research group.
What to Expect During the Test
The test is administered one-on-one by a healthcare provider, nurse, or trained clinician. It’s done with paper and pencil, and you won’t need to prepare for it in advance. The whole process typically wraps up in under 10 minutes.
Some of the tasks feel straightforward, like stating today’s date. Others may feel harder, and that’s by design. The clock-drawing task, for example, requires you to place all 12 hour markers correctly and then set the hands to a specific time. Even people with very early cognitive changes sometimes struggle with the spacing of the numbers or the distinction between the hour and minute hands. The animal-naming task can also feel pressured because it’s timed, but there’s no penalty for naming fewer animals. Every response simply adds to your point total.
If you’re taking the test for a loved one’s appointment, know that nervousness, fatigue, or feeling unwell on the day of the test can all affect performance. A single low score doesn’t confirm a diagnosis. Clinicians look at SLUMS results alongside medical history, daily functioning, and sometimes repeat testing over time to see whether scores are stable or declining.
Why Mild Cognitive Impairment Matters
The main reason the SLUMS test exists is to catch problems early. Mild cognitive impairment (MCI) affects roughly 15 to 20 percent of adults over 65. People with MCI typically notice that their memory or thinking isn’t as sharp as it used to be, and others around them may notice too, but they can still manage daily tasks independently.
Not everyone with MCI progresses to dementia. Some people remain stable for years, and in cases where the cognitive changes are driven by treatable conditions like depression, sleep apnea, or certain medications, the decline can actually be reversed. Early detection opens the door to lifestyle changes, medication adjustments, and monitoring that can slow progression or address the underlying cause. That early window is exactly what the SLUMS test is designed to identify.