THE VETERANS AFFAIRS SAINT LOUIS UNIVERSITY MENTAL STATUS EXAM (SLUMS EXAM) AND THE MINI-MENTAL STATUS EXAM AS PREDICTORS OF MORTALITY AND INSTITUTIONALIZATION

Objective: To evaluate predictive validity of cognitive dysfunction of the Saint Louis University Mental Status (SLUMS) exam or Mini-Mental State Exam (MMSE) for institutionalization and mortality after 7.5-years. Design: Longitudinal study. Setting: Geriatric Research, Education and Clinical Center Veterans Affairs Hospital St. Louis, MO. Participants: Patients (N=705) were screened for cognitive dysfunction in 2003 using the SLUMS exam and MMSE, and mortality and institutionalization up to 7.5-years later were evaluated as outcome measures. Measurement: The associations between outcome measures and MMSE and SLUMS exam total scores, and cognitive status were examined using Kaplan-Meier curves and Cox proportional-hazards regression. Results: Five hundred thirty-three charts were reviewed, 176/533(33%) patients had died and 31/526 (6%) were institutionalized during 7.5-year follow-up period. All subjects were male with a mean age of 75 years and most had high school education or greater (71%). MMSE dementia, SLUMS dementia (ps<.001) and MCI (p<.05) groups had significantly lower survival rates than normal cognition group in the Kaplan-Meier curves. Scores classified as dementia on SLUMS (HR=2.4, 95% CI 1.6-3.7; p <.001) or MMSE (HR=2.3, 95% CI 1.5-3.6; p <.001) both predicted mortality and, also, institutionalization (SLUMS: HR=3.5, 95% CI 1.3-9.1; p <.01; MMSE: HR=3.8, 95% CI 1.6-9.0; p <.001) after adjustment for covariates. Unadjusted SLUMS exam MCI predicted morality (HR=1.5, 95% CI 1.1-2.2; p <.019) but not institutionalization. Conclusion: The SLUMS exam and MMSE both predict mortality and institutionalization for male patients screened as positive for dementia.