If you don’t have much knowledge about the decline in cognitive function that leads to dementia, it’s very difficult to watch what’s happening to your family member. Fortunately, there are ways to track what’s happening with your loved one. There are assessment tools that may be used to determine whether or not there’s a fast decline occurring.
What is the FAST Scale for Dementia?
The FAST Scale for Dementia, also known as the Reisberg Functional Assessment Staging (FAST) Scale, is a scale designed to be used to see how patients with Alzheimer’s disease are progressing deeper into the disease. It was authored by Dr. Barry Reisberg, a leading expert in Alzheimer’s disease.
The scale has been in use for many years and is most beneficial for patients who have Alzheimer’s disease and a prognosis of six months or less. It’s specifically for those who will be accepted for hospice if they have a score of 7 or more.
Although there are other scales that focus primarily on cognitive decline, FAST places its emphasis on the patient’s ability to function and perform regular everyday tasks of living. When tested against other assessment tools for Alzheimer’s disease, FAST has been found to be a reliable and valid assessment technique for evaluating functional deterioration of patients throughout the entire course of the illness.
FAST is also a strong diagnostic and differential diagnostic aid for clinicians because the elements of functional capacity used in FAST are pretty universal and readily ascertainable. Plus they are also characteristic of the course of Alzheimer’s disease.
7 Stages of Dementia
There are generally accepted to be 7 different stages of dementia. Stage 1 is a normal adult and it moves up to severe dementia at stage 7. Each of the stages is associated with a label of function or the disease:
|Stage 1||Normally functioning adult|
|Stage 2||Normally functioning senior adult|
|Stage 3||Early dementia|
|Stage 4||Mild dementia|
|Stage 5||Mid-stage dementia|
|Stage 6||Moderately severe dementia|
|Stage 7||Severe (end stages) of dementia|
FAST Scoring Explained
The FAST scale mirrors the 7 stages of dementia. The scoring is detailed in the chart below. If you want to download or print a copy, click the following PDF link:
At Stage 1, there is no real difficulty with Alzheimer’s. But at Stage 2, the patient is starting to forget where objects are and has difficulty at work. However, this stage is still considered “normal” if you’re a senior citizen.
The work issues progress to a higher level in Stage 3, and with this stage, it’s also difficult to travel to new locations. This is when patients are telling a story over and over and complicated tasks become difficult.
The patient may not be able to handle their finances or do things around the house. Stage 4 is an introduction to the problems with dependency on others. Meal planning is hard at this point in time.
At stage 5 and then 6, all the issues about dressing, bathing and handling the toilet and one’s body after the toilet arise. 24/7 supervision is required and it’s at this point where mobility may become a problem. It’s the time when family members and caregivers are recommending a specialized memory care facility.
At Stage 6 d and e, there is both urinary and fecal incontinence. During Stage 7, speech and intelligible vocabulary are lost in the early parts and by the later parts of this stage, the patient cannot walk, sit up on their own, smile or hold their head up.
Secondary health conditions set in during the latter stages. These may include bedsores, UTI, inability to swallow, aspiration pneumonia and more. This is when eligibility for hospice care is usually granted.
|Functional Assessment Scale (FAST)|
|1)||No difficulty either subjectively or objectively.|
|2)||Complains of forgetting location of objects. Subjective work difficulties.|
|3)||Decreased job functioning evident to co-workers. Difficulty in traveling to new locations. Decreased organizational capacity. *|
|4)||Decreased ability to perform complex task, (e.g., planning dinner for guests, handling personal finances, such as forgetting to pay bills, etc.)|
|5)||Requires assistance in choosing proper clothing to wear for the day, season or occasion, (e.g. pt may wear the same clothing repeatedly, unless super-vised. *|
|6)||Occasionally or more frequently over the past weeks. * for the following|
A) Improperly putting on clothes without assistance or cueing .
B) Unable to bathe properly ( not able to choose proper water temp)
C) Inability to handle mechanics of toileting (e.g., forget to flush the toilet, does not wipe properly or properly dispose of toilet tissue)
D) Urinary incontinence
E) Fecal incontinence
|7)||A) Ability to speak limited to approximately < 6 intelligible different words in the course of an average day or in the course of an intensive interview.|
B) Speech ability is limited to the use of a single intelligible word in an average day or in the course of an intensive interview
C) Ambulatory ability is lost (cannot walk without personal assistance.)
D) Cannot sit up without assistance (e.g., the individual will fall over if there are not lateral rests [arms] on the chair.)
E) Loss of ability to smile.
F) Loss of ability to hold up head independently.
|*Scored primarily on information obtained from a knowledgeable informant.|
Psychopharmacology Bulletin, 1988 24:653-659.
Can Dementia Suddenly Get Worse?
Unfortunately, dementia can suddenly get worse – particularly for those with delirium. Those who have delirium tend to decline mentally more quickly than those that don’t have delirium. In one study, thinking abilities declined twice as fast in the year after a hospitalization in those with delirium than those without it.
Delirium is mental confusion that is worse than usual. It’s brought on by some type of stress on the body or mind. It develops over hours to days, not months or years like what occurs in Alzheimer’s disease. Caregivers have to recognize that delirium affects memory, language, disorientation and may cause vivid hallucinations. Symptoms can be better or worse at different times of the day. A surgery can trigger delirium, as can medications.
Delirium affects 32% of patients with dementia during hospitalization, say researchers of one study, while another study states that rates of delirium are anywhere from 18% to 89% in hospitalized and community dwelling older adults.
The following medications that can trigger delirium:
- sleep medications
- asthma medications
- Parkinson’s drugs
- pain drugs
- medications for anxiety and depression
The FAST scale for dementia is a good tool for caregivers, family members, and health practitioners. It is but one tool, however. If you want to look at other tests and tools, I suggest reading our article on Memory Tests for Dementia.
Do you have experience with the FAST scale for dementia? Let us know in the comments section below.
Sclan, S.G. and Reisberg, B. Functional assessment staging (FAST) in Alzheimer’s disease: reliability, validity, and ordinality. Int Psychogeriatr 1992;4 Suppl 1:55-69. https://pubmed.ncbi.nlm.nih.gov/1504288/
Fick, Donna M., et al. Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med 2013 Sep;8(9):500-5. https://pubmed.ncbi.nlm.nih.gov/23955965/