The topic of this training session is The St. Louis University Mental Status Exam, SLUMS: Administration and Scoring.
The objectives are to learn how to administer the SLUMS, understand the scoring procedures and how to interpret client’s performance on the tool. And also to get some practice scoring Colleen’s SLUMS exam. Before we begin, it would be helpful if you had a copy of the SLUMS form in front of you, as well as the instructions, both of which can be downloaded on the link shown on this slide. It’s also helpful if you have already viewed the SLUMS video with sample patient Colleen and tried to score her performance along the way. This is a screenshot of what the St. Louis University Mental Status Examination looks like.
Before administering the SLUMS, make sure that you have the patient’s full attention, be mindful of speaking clearly and in a reasonably loud enough volume to minimize any confounds from a patient’s hearing loss. It’s also important to remember to record the date, the patient’s age and level of education at the top of the form before you begin, because you’ll be using this information for scoring later.
Read through the instructions very carefully when you are first learning how to administer the tool. You will need to know which items can be repeated and how questions should be phrased because in some places, this is very important. Note that questions one through three, which are about orientation. These questions require exact answers. If the patient is one day off, for example, on the day of the week, that would not be given full credit. That would be scored zero points.
For question number four, this is a word list. There are five words to be presented to patients. Make sure that you say the words approximately one second, apart from each other. Say the words all at once, not one by one, the first time that you are administering the word list. If a patient does not repeat them all back to you, repeat the words that they missed and make sure that they’ve registered each one.
For question number five. This question is in several parts and has to do with mathematic manipulation. Note that you can repeat this question one time, if you need to. Do not offer any prompts or give hints and allow ample time for a response, because in some [inaudible 00:02:35] people will need a little bit more time to do the math in their head. Question number six is animal naming. Make sure that you use a clock or a watch that has a second hand so that by the time you begin and end the task, you’ve allowed exactly 60 seconds. You can use the back of the form to record the person’s answers.
Question number seven is the word recall portion of the SLUMS. Remember don’t offer any hints and the person receives one full point for every word that they remember verbatim. Question number eight is number span. Again, just like with the word list, say each number separately as in eight, seven, not eighty seven. And make sure that you say each number approximately one second apart.
Question number nine is the SLUMS clock drawing. It is okay to draw a bigger circle on the back of the form because you’ll note that the circle on the SLUMS form itself is rather small. Note that if you’re used to administering the Mini-cog, the directions on the clock drawing portion for the SLUMS are different. So do not change the wording for the time. In this example you are asking the patient to set the time for 10 minutes to 11 o’clock. For the clock drawing at a minimum patients must include the four anchor numbers, 12, 6, 3 and 9. If they only use tick numbers, make sure that you prompt them to include the actual numbers. In order to receive credit, the longer hand of the clock must point to the 10 and the shorter hand must point to the 11. Unlike the Mini-cog, hand length is something that is incorporated into scoring on the SLUMS.
Question number 10 involves two items. The first is asking the patient to place an X in the triangle. And the second is asking them to identify which of the three shapes shown is largest. I would recommend that you cover up the circle with your hand so that the patient does not focus on the circle, which of course is technically the largest shape on the form. And instead is focused only on the three shapes directly across from item number 10. Question number 11 is story recall. Make sure that when you’re reading the story you’re doing so at a conversational pace and speak clearly. If when asking the patient questions about the story, they report the state as Chicago, you are able to prompt or repeat that question one time.
Notice also that some items on the SLUMS are worth more points than others. This is designed on purpose to put more weight on so-called higher yield questions. These are often questions that involve mental manipulation or working memory measures of executive functioning. At the end of the test, make sure that you add all of the items very carefully and record the total score at the bottom. You will also see on the bottom of the form, how the slum score is interpreted. This tool breaks down score interpretation according to level of education. If someone has at least a high school education, a passing score is 27 or higher. However, if a patient has less than 12 years of education, extra leeway is given for normal [inaudible 00:06:04] and a passing score is 25 or higher.
Hopefully by now you have already viewed the SLUMS on patient Colleen and tried to score the instrument yourself. What we’ll do next is go through the scoring to get agreement.
The first three questions are about orientation. Colleen correctly answered number two and three, but said Saturday for the day of the week. The day of the week was actually Monday and so she received zero points for that question. Number four was simply giving her the words to remember for later and is not an item that receives a score. For number five, she was able to do both mathematical computations in her head correctly. So she receives a full three over three points. For number six, which is animal naming, she was only able to name seven unique animals in one minute. That corresponds to a score of one out of three. On number seven, when asked to remember the five objects that she was told earlier, she was able to recall banana and apple. Banana is not one of the words on the list, but apple is so she receives one point.
Number eight, she was able to repeat numbers correctly so she receives full credit, two out of two. Question nine is the clock drawing portion of the SLUMS. This shows Colleen’s clock. Note that all of the numbers are represented and in their correct location with no duplicate numbers. However, Colleen set the hands for 10 past 11 instead of 10 to 11. For scoring her clock, she receives two points for the hour markers. However, she did not get the time correct. And so her total score in this section would be two out of four. For question number 10, she was able to place an X in the triangle and could properly identify the square as the largest shape. So she again receives full credit. For questions regarding the story, number 11, she was able to answer several of those correctly. However, when asked when Jill went back to work, Colleen said after her children were born, which is incorrect. When asked what state Jill lived in, Colleen replied, Pennsylvania, which is also incorrect. For the story recall portion. Colleen receives four of the eight points possible.
When you add up all of the points on the SLUMS, Colleen’s total score is 17 out of 30. Colleen has at least a high school education. And so we use the scoring criteria on the left and you can see that this score is not a passing score. And therefore further workup is recommended.
The ACT on Alzheimer’s website has numerous tools that simplify the cognitive screening flow and also instruct providers about what to do when patients fail or pass the screen. For more information and to download these tools, you can visit the ACT on Alzheimer’s website, and there’s also information on the screen, should you wish to email ACT on Alzheimer’s with questions.
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