Key Takeaways
- The FAST scale assists clinicians in diagnosing and tracking Alzheimer’s by evaluating an individual’s capacity to carry out everyday tasks.
- The tool comprises seven stages, from normal functioning to severe dementia, allowing monitoring of disease progression and treatment impact.
- The FAST scale can help determine hospice eligibility for advanced Alzheimer’s, commonly when a person reaches stage 7C and requires help with walking.
The Reisberg Functional Assessment Staging (FAST) scale is an instrument clinicians use to stage and diagnose Alzheimer’s disease, the most prevalent form of dementia.
Dr. Barry Reisberg, a prominent figure in Alzheimer’s research, created the FAST scale in the 1980s.
The scale evaluates changes in a person’s ability to perform daily living activities, such as working, managing finances, dressing, or walking.
What is the purpose of the FAST scale?
The FAST scale aids clinicians in diagnosing and gauging the progressive phases of Alzheimer’s disease.
Alzheimer’s is a degenerative disorder, meaning dementia symptoms worsen over time. In early stages, memory difficulties are mild. In later stages, individuals may struggle greatly to interact with their surroundings or to carry on a conversation.
By applying the FAST scale during routine assessments, clinicians can:
- evaluate whether a person’s dementia aligns with Alzheimer’s
- track the disease’s progression over time
- identify different complications related to Alzheimer’s
- assess how well treatments are working
- inform new treatment strategies based on the stage of disease
For individuals who reach advanced dementia, clinicians can use the FAST scale to assess eligibility for hospice services.
The FAST scale is tailored specifically for staging Alzheimer’s disease and may not be appropriate for other dementia types.
What are the stages of the FAST scale?
The FAST scale includes 16 items grouped into seven dementia stages, spanning normal activity to severe impairment.
The table below outlines each stage of the FAST scale, including functional changes and the typical duration.
| Stage | Stage name | Functional changes | Average duration |
|---|---|---|---|
| 1 | Typical adult | There is no noticeable increase in difficulty carrying out various activities and functions. | N/A |
| 2 | Typical older adult | The individual has slightly more trouble with certain tasks and functions, such as misplacing items or having work-related difficulties. | unknown |
| 3 | Early dementia | The person shows greater difficulty performing job-related duties visible to colleagues and has trouble navigating to unfamiliar places. | 2 to 7 years |
| 4 | Mild dementia | There is increased difficulty with complex tasks, like managing bills or preparing meals. | 2 years |
| 5 | Midstage dementia | The individual needs help selecting appropriate clothing. | 4 years |
| 6 | Moderately severe dementia | The person has substantially greater difficulty dressing, bathing, and toileting independently.• 6A: Requires help getting dressed.• 6B: Needs assistance bathing correctly.• 6C: Needs support with toileting mechanics (e.g., flushing or wiping).• 6D: Experiences urinary incontinence.• 6E: Experiences fecal incontinence. | 4 years |
| 7 | Severe dementia | The person shows marked reductions in speech, mobility, and awareness.• 7A: Has trouble speaking (1 to 5 words per day).• 7B: Struggles to use intelligible vocabulary.• 7C: Requires help walking.• 7D: Needs assistance sitting up.• 7E: Has difficulty smiling. • 7F: Needs support to hold their head upright. | 2 1/2 years |
How accurate is the FAST scale?
The FAST scale is among the most researched and well-validated instruments for following Alzheimer’s progression. Validity refers to how closely a staging score reflects the true disease stage. Experts report that the FAST scale yields dependable and consistent findings over time.
That said, the scale has limitations.
It may not be appropriate for individuals with other dementia types. The scale also presumes dementia advances sequentially through numbered stages without skipping; however, some patients may bypass stages due to additional illnesses.
How does the FAST scale apply to hospice care?
Hospice care focuses on comfort and quality of life for people with serious illnesses who are nearing the end of life.
Clinicians use the FAST scale to decide whether someone with Alzheimer’s is eligible for hospice services. When dementia severity exceeds stage 7C (needing help to walk independently), a person with Alzheimer’s may qualify for hospice. At this point, clinicians estimate survival to be six months or less, though many individuals with advanced Alzheimer’s live beyond that timeframe.
A 2021 review indicated that hospice or palliative care may provide a better quality of life for people with advanced Alzheimer’s than continued aggressive medical interventions.
Other advantages of hospice care for individuals with advanced Alzheimer’s include:
- a lower likelihood of hospital admission during the final 30 days of life
- a greater chance of receiving consistent pain management
- higher overall satisfaction with care for both the person with Alzheimer’s and their caregiver
Takeaway
The FAST scale is a clinical tool used to assess the severity and course of Alzheimer’s disease. It is widely used, well-validated, and reliable for diagnosing and staging Alzheimer’s.
Clinicians also rely on the scale to determine hospice eligibility for those with advanced Alzheimer’s.
If you’d like more information about the FAST scale and dementia, consult a physician or other healthcare professional.
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