Cognitive Deficit Reversal as Shown by Changes in the Veterans Affairs Saint Louis University Mental Status (SLUMS) Examination Scores 7.5 Years Later

Objective: The Veterans Affairs Saint Louis University Mental Status (SLUMS) examination is a screening tool that has the sensitivity to detect mild neurocognitive impairment and dementia. This study explores patients' cognitive impairment trajectories based on the SLUMS examination score changes after 7.5 years. Design: Retrospective chart review. Setting: The Geriatric Research, Education, and Clinical Center at the Department of Veterans Affairs Medical Center (VAMC), St Louis, MO. Participants: A review of 533 charts indicated that 357 patients who had participated in the SLUMS examination validation study in 2003 were still alive. Measurement: Charts were screened for indicators of cognitive status in both 2003 and 2010 and interventions after baseline evaluation. Results: The mean age of the 357 individuals in 2003 was 74, all were men, and 73% had a high school education or more. A total of 223 (62%) of the 357 completed the SLUMS examination at baseline and at the 7.5-year follow-up visit; of those, 33 (15%) progressed to mild cognitive deficit, 20 (9%) progressed to severe cognitive deficit, and 53 (24%) improved or reverted back to normal. Further exploration revealed that at least one reversible cause was identified for most (n = 36/53, 68%) of the reversions. The primary interventions that differentiated reversers from nonreversers were correction of visual loss (P = .005) and discontinuation of anticholinergic medications (P = .002). Conclusion: Cognitive improvement (reversion) as indicated by the SLUMS examination after 7.5 years was associated with the correction of some reversible causes. This stresses the importance of early detection and exclusion of reversible causes for persons screened for cognitive dysfunction using the SLUMS examination. (C) 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.