The Dementia Fast Scale (Functional Assessment Staging Tool)
Submitted by Beth Rush
Founder and Managing Editor
Body+Mind Magazine
Assessing Dementia With the FAST Scale
People who care for individuals living with dementia may have heard of the Functional Assessment Staging Tool (FAST). Professionals train new caregivers and family members to use the FAST Scale. It is a useful tool to track a patient’s progress through each FAST Stage.
Dementia patients live with symptoms that increase in severity over time until death occurs. You might think of cognitive decline and memory loss as the main symptoms of dementia, but there are various mental and physical changes resulting from the condition.
The FAST Scale, often referred to as a global deterioration scale is an easy tool to determine where someone is in their disease progression.
What Is Dementia?
First, a brief background would be in order. Dementia is a debilitating condition that mainly affects adults aged 65 and older. Though commonly paired, Alzheimer’s disease and dementia in general are not the same diagnoses.
Dementia is the general loss of cognition and isn’t a disease on its own. Alzheimer’s is the most common form of dementia. Each type of dementia has independent variables which causes unique challenges for those living with the disease over the course of an average day.
Changes in the brain from various conditions can cause dementia and are rarely genetic. Though some treatments can slow symptoms, a cure doesn’t exist yet.
Millions of adults live with the condition, but dementia is not a normal part of aging and symptoms should be evaluated immediately. A proper diagnosis will allow you or your loved one to get the interventions necessary to live the fullest life possible.
How to Use the FAST Scale for Dementia
The FAST Scale is a seven-stage, 16-item system of tracking the progression of a person living with dementia. These are based on different abilities as defined in the different stages of dementia.
Alzheimer’s leading expert Dr. Barry Reisberg developed the tool as a simple and reliable way for physicians, hospice care professionals, and family members to support patients as their condition deteriorates.
Stage 1 begins during the normal aging process, and Stage 7f completes the cycle with the individual unable to function.
FAST Scale Stages
A person can be in one of the dementia stages at any time. The symptoms are less identifiable at first, and you might not get a dementia diagnosis until you are already several stages into the condition.
Here is how you can determine a dementia stage.
Stage 1: Normal Aging
Stage one may or may not exist in a person living with dementia. It is when aging is completely normal and no symptoms are present. FAST Scale Stage 1 would be generally called a “normal adult.”
Adults in stage one can live normally and have relatively sharp minds.
Stage 2: Possible Mild Cognitive Impairment
A patient in Stage 2 of dementia will notice slight cognitive difficulties. They can still go about their daily life but might feel like something’s off.
Patients won’t remember the locations of objects like their phones, keys, or glasses, more often than usual. They might also struggle finding the right words when carrying a conversation.
Professionals still consider this stage mild, and its symptoms may or may not progress into identifiable dementia.
Stage 3: Mild Cognitive Impairment
You and your doctor are more likely to suspect early dementia in this stage than the previous ones since it is most noticeable to colleagues and loved ones.
Someone with Stage 3 dementia has difficulty performing tasks at work, with co-workers noticing the difference. Patients might also have trouble getting to new locations and can’t stay as organized as they previously were.
The mental state of someone is similar to an adolescent. They can still live independently but might need some assistance with work and traveling.
Stage 4: Mild Dementia
This is the first stage with a dementia diagnosis. Patients at Stage 4 have trouble with mildly complex tasks, such as doing laundry and cooking. Organizational capacity is challenged when managing personal finances like paying bills.
This stage often marks the time to employ services or caregivers to assist with daily tasks. Patients are cognitively between 8 and 11 years old.
Stage 5: Moderate Dementia
Stage 5 dementia patients struggle to choose proper clothing for an event or weather condition.
You will need a caregiver to keep you stay safe if you have stage five. At this stage, patients are cognitively 5-7 years old.
Stages 6 and 7: Moderate to Severe Dementia
There are multiple subcategories for Stages 6 and 7 of the disease. These later stages fall under the same severity, but the symptoms are different enough to categorize them separately.
Stage 6a: Moderately Severe Dementia
The first part of stage six marks the loss of gross motor skills. Cognitively, these patients are only 5 years old.
You cannot get dressed without a caregiver’s assistance if you are at Stage 6. They can help you pull on clothes, fasten buttons, and zip zippers. You will likely also need personal assistance with combing your hair and putting on shoes.
Stage 6b: Moderately Severe Dementia
This stage begins a lapse in hygiene. Patients cannot bathe properly on their own and struggle with adjusting to bath water temperature. At this point, you might have to start using different words or coaxing mechanisms to help patients stay clean. People in this stage are cognitively 4 years old.
Stage 6c: Moderately Severe Dementia
Patients in this stage cannot use the bathroom alone. They are cognitively still 4 years old. They are unlikely to be able to wipe themselves or dispose of toilet tissue. They might forget to flush or wash their hands.
Stage 6d: Moderately Severe Dementia
This stage is when patients begin losing control of their bladder. This urinary incontinence will likely cause the need for specialized products like adult diapers to prevent leaking from accidents. Patients at this stage are cognitively 3-3 ½ years old.
Stage 6e: Moderately Severe Dementia
Patients lose bowel control at this stage and can no longer listen to their bodies. Fecal incontinence will require someone to clean them and take them to the restroom regularly or change their incontinence supplies.
Cognitively, these patients are 2-3 years old.
Stage 7a: Severe Dementia
Stage seven represents the largest mental decline in dementia. In these final stages, Alzheimer’s patients (and other dementias) begin losing their ability to talk.
Cognitively a newborn to 18-month old, patients typically only say around five or six words daily and no longer speak in sentences.
Stage 7b: Severe Dementia
Still at a cognitive age of 18 months or less, patients at this stage will often only say one word over a day. With this substantially reduced speech ability, they may struggle to find the use of a single intelligible word.
They often speak the word when asked a question and will repeat it often.
Stage 7c: Severe Dementia
At this stage, their ambulatory ability is severely diminished and the patient can no longer walk. They will need someone to help them get to different areas in their house via a wheelchair.
Cognitively, they are 18 months or less.
Stage 7d: Severe Dementia
At this stage, patients can’t sit up on their own. They are cognitively 18 months or less.
They need lateral support to help them eat or keep them upright for other activities.
Stage 7e: Severe Dementia
This stage removes the patient’s ability to smile. It isn’t easy to read their emotions and know what they want.
They are still at a cognitive stage between newborn and 18 months.
Stage 7f: Severe Dementia
This is the final stage of dementia before death. In end-stage dementia, the patient can no longer hold their head up. They are at a cognitive age between 4 and 7 weeks old.
By this stage, the patient is often already on hospice care and should not be left alone.
Knowing Each Stage
Though each patient is different, identifying the stages of dementia can help you track the disease’s progression.
Patients who reach stage seven likely have six months to live. This is prudent information for caregivers to know. Knowing the symptoms of the early stages allows you to diagnose dementia sooner than later, allowing for interventions.
Dementia Treatment Options
Though there is no cure for dementia, early interventions can help preserve cognition longer.
Once a physician provides a dementia diagnosis through blood testing, brain scans, and cognitive evaluation, they may prescribe medication. A couple of example are:
- Cholinesterase inhibitors: These medicines block the breakdown of acetylcholine in the brain. Acetylcholine supports memory and cognitive function, and these medications stop its deterioration.
- Memantine: Memantine is often used with cholinesterase inhibitors and regulates glutamine, another neurotransmitter that promotes learning and memory.
Medicines are also available for symptoms that come with a dementia diagnosis, such as depression and sleeping medications.
Common Dementia Symptoms
Many symptoms can be treated. Here are some things dementia patients commonly experience:
Confusion
Dementia patients get confused about dates, times and the people around them.
Paranoia
Patients often develop mistrust for families, doctors and caregivers.
Impulsive actions
The ability to think through actions often fades in dementia patients.
Loss of interest
Depression and cognitive declination can lead patients to lose or avoid situations they previously enjoyed.
Insomnia
Dementia patients often have trouble sleeping or sleep during the day.
Anxiety
Living with dementia is a terrifying experience, which can lead to panic and anxiety disorders.
Depression
Patients often live with major depressive disorder, leading to extreme sadness and isolation.
Loss of Appetite
Dementia patients often lose their appetite and struggle with severe weight loss.
Incontinence
Patients lose bladder and bowel control and cannot listen to bodily cues.
Muscle Aches
Achiness can come with depression but is also directly tied to a dementia diagnosis.
Stiffness
Stiffness is common among dementia patients as their activity levels decrease.
Decreased Muscle Tone
Patients with dementia lose their abilities, and the lack of movement decreases their muscle tone.
Disadvantages of the FAST Scale
The FAST Scale is easy to understand and a great resource for everyone navigating a dementia diagnosis.
However, dementia is a complex illness that may present nonlinearly. Symptoms like sleeplessness, hallucinations and dishonesty aren’t covered in the basic stages.
When using the FAST Scale, it’s sometimes necessary to use the descriptors as guides for identifying disease progression and not exact diagnosing features.
Using the FAST Scale for Someone With Dementia
Dementia is a devastating condition affecting many adults worldwide. The FAST Scale lets caregivers easily identify where their patient or loved one is in their disease progression. It can help you take the right measures to keep them as well as possible.
Beth Rush
Body+Mind Magazine
Beth Rush is a Founder and the Managing Editor at Body+Mind and a lover of all things health and wellness. She is a well-respected writer in the personal wellness space and shares knowledge on a variety of topics related to nutrition, fitness, holistic health and disease prevention.
In her spare time, Beth enjoys cooking healthy recipes and trying out new fitness trends.
