What is the FAST Scale?

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Dr. Barry Resiberg, an expert in dementia and Alzheimer’s disease, created the Functional Assessment Staging Tool (FAST) to help track the progression of Alzheimer’s dementia. It’s used to help doctors, medical professionals and family members understand, talk about and follow the progression of Alzheimer’s disease. Alzheimer's disease progresses differently in each person, sometimes rapidly in just a few months and often over years or decades. The unpredictable nature of dementia can often be stressful for patients and their families.

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How does the FAST scale determine a person’s level of functioning?

 

Unlike other scales that focus primarily on cognitive decline, such as the GSD, FAST focuses on a person’s day to day functionality and ability perform tasks of daily living (ADLs). This makes it easier to track and decide on a stage.  Alzheimer’s patients do not skip stages, but they do progress through the different stages at different rates. Tracking a patient's FAST stage helps their family and healthcare professionals know what they should expect next and helps them plan for the future. 

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What are the FAST Scale categories?

The FAST Scale divides the dementia into seven stages. These are:​

Stage One (Normal Functioning Adult) – No difficulty either subjectively or objectively.

Stage Two (Normal Functioning Senior Adult) – Complains of forgetting location of objects and subjective word finding difficulties.

Stage Three (Early-Stage Dementia) – Decreased job functioning evident to people around them, difficulty traveling to new locations, and decreased organizational capacity.

Stage Four (Mild Dementia) – Decreased ability to perform complex tasks like handling personal finances or planning dinner for guests.

Stage Five (Moderate Dementia) – Requires help in choosing clothes for the day, for example, patient may wear the same clothes repeatedly unless supervised.

Stage Six (Moderately Severe Dementia) – Needs constant supervision and assistance with multiple tasks.

                6a. Putting on clothes improperly without assistance

                6b. Inability to bathe properly

                6c. Inability to handle mechanics of toileting

                6d. Urinary and fecal incontinence occasionally or more frequently

Stage Seven (Severe Dementia) – The final stage of dementia that includes almost complete loss of ability to communicate and perform any tasks independently.

                7a. Limited speech ability

                7b. Inability to walk without personal assistance

                7c. Cannot sit up without assistance

                7d. Loss of ability to smile

                7e. Loss of ability to hold head up independently

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When is a dementia patient eligible for hospice?

Patients are eligible for hospice when they have severe dementia in the seventh stage or greater on the FAST scale.

 

Dementia is a progressive and terminal disease, but it is also variable in each person. It is nearly impossible to determine how long a person with dementia will live. Hospice services can be incredibly helpful for those with late-stage dementia, but many caregivers aren’t aware that their loved one can qualify for these services. 

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A diagnosis of dementia is life-changing and can be overwhelming for everyone involved. Using the FAST Scale to determine the severity of someone’s Alzheimer's dementia can help both medical professionals and loved ones feel informed and be proactive about planning for the future.

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