SLU Mental Status Exam

Social services professionals, reflections/passages program coordinators, licensed nurses, physicians, nurse practitioners, occupational therapists, physical therapists, residence supervisors and other qualified health care professionals who have been trained (and retrained annually) by viewing the VA-produced video available online.

To screen individuals for the presence of cognitive deficits, and to identify changes in cognition over time.

1. Complete resident demographics at the top of the page. We recommend that you put the date and the name of the evaluator at the bottom of the page as well (see step 19).
2. Administration should be conducted privately and in the examinee’s primary language. Be prepared with the items you need to complete the exam. You will need a watch with a second hand on it.
3. Record the number of years the patient attended school. If the patient obtained an associate, bachelor’s, master’s or doctoral degree, note the degree achieved instead of the actual years of school attended.
4. Determine if the patient is alert. Do not answer “yes” or “no,” but indicate level of alertness. Alert indicates that the individual is fully awake and able to focus. Other descriptors include drowsy, confused, distractable, inattentive and preoccupied.
5. Begin by asking the patient the following: “Do you have any trouble with your memory?”, “May I ask you some questions about your memory?” or “I’d like to see how good your memory is by asking you some questions.” You may need to reassure patients by telling them that this is not a test that they can fail but merely a tool much like a thermometer that takes temperature. What this tool does is check the amount of memory they have. Then proceed with the exam questions.
6. Read the questions aloud clearly and slowly to the examinee. It is not usually necessary to speak loudly but it is necessary to speak slowly.
7. Score the questions as indicated on the examination.
   1. On question No. 4, read the statement as listed on the exam. Ask the patient to repeat each of the five objects (apple, pen, tie, house, car) that you recite to make sure that the patient heard and understood what you said. Repeat them up to three times.
   2. On question No. 5, make sure the patient is focused on you before reciting the information. Obtain an answer for the first part of the question (“How much did you spend”) before moving on to part two (“How much do you have left?”). Do not prompt or give hints, but do give ample time to the patient to answer the questions. If the patient asks you to repeat the question you may do so once.
   3. Redirect the patient’s attention if necessary back to you to answer question No. 6. Give them one minute to complete the question. Be sure to time them.
   4. On question No. 8, state each number by its individual name. For example. 87 is pronounced eight, seven; 648 is pronounced six, four, eight; 8537 is pronounced eight, five, three, seven.
   5. On question No. 9, either draw a large circle on the back of the examination form or provide the patient with a separate piece of paper with a larger circle printed on it and attach it to the original examination form. When scoring, give full credit for either all 12 numbers or all 12 ticks. If the patient puts only four ticks on the circle, prompt them once to put numbers next to those ticks (12, 3, 6 and 9) for full credit. When scoring the correct time, make sure the hour hand is shorter than the minute hand and that the minute hand points at the 10 and the hour hand points at the 11.
   6. You may also provide a separate sheet with larger examples of the forms listed on question No. 10 for those with vision impairment. This sheet should be created by enlarging the figures on the examination form and can also be attached to the original form.
   7. Read question No. 11 as written, and provide ample time to answer each question. Do not repeat the story but do make sure they are paying attention the first time you read it to them. Do not prompt or give hints. The answer of Chicago as the state she lives in gets no credit but you may prompt them once by repeating the question. 
8. Score the examination as listed at the bottom of the page, circling the level based on the score.
9. Upon completion of the form, record the score in the patient’s record and comment on any indicated changes. Depending upon office protocols, either put the sheet in the patient’s record, place it in a separate identified location or destroy the worksheet once the score is recorded in the patient record (specify based on Office Center policy).
10. Form status: (varies by office): Mandatory for (e.g., patients with diagnoses or indicators of cognitive loss)

The answer must be the correct day of the week. For example, if the day is Tuesday when the test is administered, then the patient must respond ‘Tuesday’ to receive 1/1 point for this item.

The answer must be the correct year. For example, if the year is 2023 when the VMAC SLUMS Examination is administered, then the patient must respond ‘2023’ to receive 1/1 point for this item.

The answer must be the correct state. For example, if the state where the SLUMS is administered is Illinois, then the only correct answer is ‘Illinois’.

If patients do not repeat the five words correctly on the first attempt, how many times should I repeat the word list? 

You may repeat the item list of items up to three times. If a patient is unable to repeat the five items correctly after three attempts, then you should stop and move on to the next question. 

If someone gives an incorrect number for "How much money did you spend?" but gives a correct amount for "How much money do you have left?" Do they receive two points for answering the latter question correctly?

Yes, question 5 is a two-part question worth a total of three points. The first part (money spent) is worth one point and the second part (money left) is worth two points. Each part is scored separately. Thus, for question 5 one can score zero points (incorrect answers to money spent and money left), one point (correct answer to money spent and incorrect answer to money left), two points (incorrect answer to money spent and correct answer to money left), or three points (correct answers to money spent and money left).

Should the healthcare professional who administers the VAMC SLUMS exam write down the names of the animals provided by the patient for this question?

You may write down the names or use hash marks when administering this item. We recommend writing down the animal names because it makes it easier to score this item accurately because any repeated animal names should only be counted as one point/one animal name.

For example, if a patient names the following animals in one minute: dog, bird, cow, cat, horse, zebra, giraffe, dog, turtle, penguin, zebra, the total number of animals named for the score is nine because dog was named twice but only counts as one point/animal names. An experienced healthcare professional may use hash marks (e.g., IIII for 4 animals) rather than writing down all the animals named in one minute. If you do this, it is recommended that one does not make a hash mark for any animal names repeated by the patient. 

If a patient names insects (e.g., butterfly, ant, etc.) are they counted as animals named?

Yes, insects are counted as animals named for this item.

How should I say the numbers for this item? If the numbers are 426, should I say ‘four’ – ‘two’ – ‘six’ or ‘four hundred twenty-six’?

The correct way to administer this is for the examiner to say the individual numbers (‘four’ – ‘two’ – ‘six’), and the correct response is for the patient to repeat the sequence in reverse order (‘six’ – ‘two’ – ‘four‘). When administering this item, the examiner also should say each digit/number at a constant rate with a short pause between each (i.e., "four" - [1-second pause] – "two" – [1-second pause] – ‘six’). 

Can patients receive partial credit for ticks or numbers 12, 3, 6, 9 in the correct placement? And can they receive a prompt to add additional numbers or ticks?

When scoring, give full credit for either all 12 numbers or all 12 ticks. If the patient puts only four numbers or ticks on the circle, then prompt one time to request that the patient write down all numbers or ticks.

When scoring, the numbers/ticks should be located approximately in the correct position; if the numbers/ticks are poorly spaced and not close/near to the correct position, then the 'Hour markers okay' score should be 0/2 points (incorrect).

When scoring, both components (hours markers okay; time correct) of the clock test are scored are correct or incorrect with no partial credit, so the possible total scores on the clock test are 0 (both components incorrect), 2 (one component correct, one component incorrect), or 4 (both components correct).

For the question about going back to work, should a response such as ‘After she had children’ count as a correct answer?  

"After she had children" is not a correct answer, because she did not go back to work until the children were teenagers (i.e., at least 13 years after she had her youngest child). If a patient answers, "after she had children", you may use a general prompt to request a more specific answer such as, “Can you provide more information about when she went back to work” or “can you provide more details about when she when back to work”, and score the answer accordingly based on any additional details/information patient provides in response to your prompt. 

The VAMC SLUMS is designed and has been validated for use as a screening measure to detect cognitive dysfunction, i.e., mild cognitive impairment (MCI) and dementia, among older adults ages 60 and above; this is the appropriate patient group for use of the VAMC SLUMS.

The VAMC SLUMS has not been validated for use: in patients ages 59 and below and other patient groups with diseases or conditions that may cause cognitive dysfunction (e.g., traumatic brain injury (TBI), developmental disabilities, schizophrenia/schizoaffective disorder, etc). 

The VAMS SLUMS is a brief screening test for detecting mild cognitive impairment (MCI) and dementia, and it assesses several key cognitive domains commonly affected by these disorders as follows:

• Q1-Q3: Orientation
•  Q4: Short-term memory
• Q5: Calculation
• Q6: Language/verbal fluency
• Q7: Delayed recall/memory
• Q8: Working memory
• Q9: Executive function, visuospatial ability, short-term memory
• Q10: Visual-spatial, executive function
• Q11: Immediate recall/memory, executive function

The VAMC SLUMS Exam is not a measure of global cognitive function. The VAMC SLUMS Exam is a screening test for cognitive dysfunction that is designed and validated to screen for MCI and dementia among older adults ages 60+. As a screening test, the results of the SLUMS Exam (i.e., classification as normal, MCI, or dementia) do not represent a clinical diagnosis. A clinical diagnosis of MCI or dementia requires a full assessment and evaluation based on established criteria, such as DSM-V, by a qualified healthcare professional. Research has shown that the SLUMS Exam has good sensitivity and specificity to detect mild cognitive impairment (MCI) and dementia among older adult patients ages 60+, so it correlates well with clinical diagnoses of MCI and dementia. 

The VAMC SLUMS Examination is free to use for the evaluation/screening of cognitive dysfunction in older adults. We retain the copyright but do not charge for health professionals to use the SLUMS Exam in their clinical work and/or research. The SLUMS is a paper-and-pencil test, but one can scan the results in a health record.

The original VAMC SLUMS was developed and validated for use with patients who are fluent in English. You should not use the VAMC SLUMS Exam with patients who are non-English speakers or who have limited proficiency in English-United States. In these instances, if available, an appropriate translated version of the VAMC SLUMS Examination should be used and administered by a trained professional proficient in the respective translated language version of the VAMC SLUMS Exam (e.g., German, Chinese, Arabic, English-Australia, etc.). There are 23 professionally translated versions of the VAMC SLUMS available on our website.

In most cases, a patient should be tested using the VAMC SLUMS no more than once per year. If the VAMC SLUMS is completed more frequently than one time per year, this increases the likelihood that a patient may remember questions/answers from the test and score differently (higher) because of this.

Confirm that the patient uses corrective eyewear (glasses or contacts) that allows them to see well enough to complete items 9 and 10.

Do not administer the SLUMS if a patient is unable able see/is legally blind or has uncorrected visual impairment (e.g., the patient is not wearing contacts or eyeglasses at the time of appointment).

Confirm that the patient uses corrective hearing aid(s). If hearing deficits are mild, confirm that the patient can hear you okay if you speak in a clear, firm voice.  

Do not administer the SLUMS if the patient is unable to hear you clearly when using a hearing aid and/or when you are speaking in a sufficiently clear and firm voice.

If a patient self-corrects an answer, you can accept the answer as correct, but as the examiner, you should not prompt a patient for a different answer when they provide the incorrect answer.

Example: If a patient answers “Monday” for item 1 (day of the week), but then changes (self-corrects) their answer to “Actually, today is Tuesday, not Monday”, and Tuesday is the correct answer, you can accept the answer as correct.

Example: If a patient answers “Wednesday” for item 1 (day of the week), and the correct answer is Thursday, you should mark the answer as incorrect, and you (the examiner) should not prompt the patient to give a different answer. 

It is not appropriate to allow a patient to use extra aids or resources when taking the test. The VMAC SLUMS questions are designed and are meant to assess if a patient knows the correct answers without using aids. 
Example: A patient is not allowed to:

• Look at their board, calendar, watch, phone, or other resource when answering the orientation questions (day of week, year, state).
• Use a calculator or pencil/pen and paper to respond to the calculation questions (item 5; amount spent and amount left.
• Look at or see a clock or watch to respond to the clock drawing questions (item 9).
• Take notes during the test.

It is not appropriate or possible for a patient to complete the VAMC SLUMS by audio/telephone. Item 10 requires a patient to draw a clock (hour markers and clock hands to indicate time) on a piece of paper, and item 10 requires that a patient views the objects and places a mark in the triangle and identifies the largest object.

No, the VAMCS SLUMS Examination was developed and validated as a screening measure for mild cognitive impairment (MCI) or dementia among older adult patients ages 60+. All items must be administered and scored (0-30 total points) for the classification of normal, MCI, or dementia on this test; these classifications may not be valid if items are excluded and/or modified scores are used).

To further explain the question, Is the VAMC SLUMS Examination conducted/administered in a standardized way? For example, is it acceptable if a health professional changes the words in item 4, the numbers in item 8, or the story in item 11?

This VAMC SLUMS Examination is a standardized screening measure, so the items should not be changed from the original measure. Changes to items may impact performance (e.g., changes to the story may make it more or less difficult than the original version), which could impact the validity of scores/classifications. Of course, there are legitimate reasons why different/modified items may be needed when using the VAMC SLUMS Exam with various older adult patient populations due to language, culture, geographic, and/or other differences. In such cases, you should use a professionally modified/translated version of the SLUMS as appropriate for the patient being tested. 

The VAMC SLUMS Examination was not originally designed to be used as an assessment done virtually for telehealth. It may be possible to make special accommodations to allow for a fully virtual assessment, but before implementation, the changes would require testing for validity in a systematic evaluation study. To our knowledge, this has yet to be done.  

Yes, the scoring criteria for "High School Education" should be used for anyone who has completed grade 12/graduated from high school, or equivalent (e.g, GED / high school equivalency diploma).
The scoring criteria for “Less Than High School Education” should be used for anyone who has a grade 11 or below level of education.