FAST Scale

## **Symptoms of dementia** Dementia symptoms vary, but patterns emerge in the early stages of many neurodegenerative disorders. Recognizing these early signs and their risk factors causes better referrals and faster workups with core screening tools and the global deterioration scale. - Memory loss that disrupts daily life - Word-finding trouble and repeating questions - Getting lost or mismanaging finances - Poor judgment or problem-solving - Personality or behavior changes - Difficulty with complex tasks and work - Disorientation to time or place If you see persistent dementia symptoms especially with functional decline, use core screening tools (e.g., MoCA, MMSE), the global deterioration scale, and informants’ reports, then escalate to diagnostic testing when red flags appear or progression continues. (Kayhan Koçak & Kumral, 2025; Brown et al., 2013)

## **What is the FAST Scale?** The Reisberg Functional Assessment Staging Tool (FAST) Scale, also known as the Functional Assessment Staging Scale, is an easy-to-use tool designed by Dr. Barry Reisberg to help healthcare professionals assess patients with dementia, particularly those with Alzheimer's disease. It tracks the disease progression of dementia patients by categorizing their functional abilities across seven stages, ranging from normal aging to severe dementia. The scale showed good inter-rater reliability and clear ordinal staging across the disease course (Sclan & Reisberg, 1992), so it is primarily used in hospice care and clinical settings to monitor the functional decline resulting from dementia. Here are the designations and descriptions of each stage: **Stage 1: Normal aging** The patient shows no noticeable cognitive or functional decline. Functional abilities remain intact without any impairments in daily life. **Stage 2: Possible mild cognitive impairment** The patient starts experiencing subjective word-finding difficulties and may report misplacing objects more frequently. No severe cognitive decline is evident in this stage. **Stage 3: Mild cognitive impairment** The patient's cognitive function deteriorates, impacting organizational capacity and job performance. Tasks like navigating new locations become challenging, signaling an early decline in the ability to perform complex tasks. **Stage 4: Mild dementia** At this stage, patients exhibit difficulties managing Instrumental Activities of Daily Living (IADLs), such as paying bills, preparing meals, and handling personal finances. There is a noticeable decline in cognitive function that impacts everyday activities, and patient need personal assistance. **Stage 5: Moderate dementia** Patients may require assistance in selecting the proper clothing and may struggle with seasonal or situational appropriateness, reflecting a moderate level of severe cognitive impairment. **Stage 6: Moderately severe dementia** This stage is broken into several subsets, highlighting the patient's loss of functional abilities, including dressing up, bathing, or even using and disposing of toilet tissue. Urinary incontinence and fecal incontinence become evident in the later subsets of this stage. **Stage 7: Severe dementia** Patients experience very severe cognitive decline, losing basic motor functions such as walking, sitting up, smiling, and holding their head up. Severe cognitive impairment profoundly impacts their functional ability, and their speech is limited to using a single intelligible word on an average day, leaving them fully dependent on caregivers. For each stage, there are functional assessment designations, which outline specific abilities that may be impaired due to dementia. While the FAST Scale provides a structured overview of a patient's functional decline, it is not a standalone diagnostic tool. Instead, it should be used alongside other assessments for a comprehensive diagnosis and the development of a care plan. The FAST Scale is normally used when healthcare professionals are assigned to treat a person diagnosed with dementia, or if they have a patient exhibiting functional impairments that were not present before. It is used to set a baseline so that the professional, their teammates, the patient, and the patient's loved ones/companions know where the patient is currently at in terms of functional decline due to (the signs of) dementia. Our FAST scale template streamlines staging and documentation so you can move quickly from observation to action. It supports tailored care plans as disease progresses, helps teams anticipate severe stages, and informs discussions about safety, services, and hospice eligibility when appropriate. By capturing changes in ambulatory ability and daily function over time, it clarifies trends, improves handoffs, and guides families through the dementia journey.

## **How to use our FAST Scale template** Here is how to use our FAST Scale for dementia template in your practice: ### **Step 1: Access the template** Press the "Use template" button to open the FAST Scale template in the Carepatron app. The customizable template allows you to fill in, print, and share the form as needed. Keep the template handy as you may need to reassess the patient multiple times as their dementia progresses. ### **Step 2: Assess the patient's functional status** Conduct a functional assessment staging test by observing the patient's abilities in day-to-day tasks and noting impairments related to the progression of dementia. This may include evaluating their capacity to dress, bathe, or communicate effectively. ### **Step 3: Record the patient's stage** Once the assessment is complete, indicate the patient's stage of dementia on the FAST Scale based on the observed functional abilities and cognitive decline. ### **Step 4: Determine what goes into the patient care plan** Use the FAST Scale findings to inform the development or adjustment of a patient care plan. The care plan should address both current and anticipated challenges, including symptom management and interventions to improve the patient's quality of life. ### **Step 5: Monitor and review** Periodically reassess the patient using the FAST Scale to track the progression of dementia and evaluate the effectiveness of interventions. The scale helps ensure the care plan is adapted to meet the evolving needs of the patient. It's also recommended that you combine this with other assessments that you may have to get a more well-rounded view of your patient. By considering other aspects of the patient's life and other ailments they might be dealing with, you will be able to create a more comprehensive care plan for them. For more resources on taking care of elderly patients and clients, check these out: - [Elderly Care Plan](https://www.carepatron.com/templates/elderly-care-plan/) - [Daily Care Plan For Elderly](https://www.carepatron.com/nb-NO/templates/daily-care-plan-for-elderly/) - [Elderly Home Safety Checklist](https://www.carepatron.com/templates/elderly-home-safety-checklist/)

## **References** Brown, M. A., Sampson, E. L., Jones, L., & Barron, A. M. (2012). Prognostic indicators of 6-month mortality in elderly people with advanced dementia: A systematic review. Palliative Medicine, 27(5), 389–400. https://doi.org/10.1177/0269216312465649 Kayhan Koçak, F. O., & Kumral, E. (2025). The relationship between dementia staging scales, cognitive-behavioral scales and functionality in patients with cognitive impairment. PLOS One, 20(5), e0322572. https://doi.org/10.1371/journal.pone.0322572 Sclan, S. G., & Reisberg, B. (1992). Functional Assessment Staging (FAST) in Alzheimer’s disease: Reliability, validity, and ordinality. International Psychogeriatrics, 4(3), 55–69. https://doi.org/10.1017/s1041610292001157