FAST Scale For Dementia: Geriatric Clinician Explains
Written By Kobi Nathan, Pharm.D., M.Ed., CDP, BCGP, AGSF
Sleep Disorders
February 14, 2024

The functional assessment staging tool (FAST) is a crucial tool used to assess the functional status of individuals with Alzheimer’s Disease, a type of dementia.

Developed by Dr. Barry Reisberg in 1982, the FAST scale provides a comprehensive evaluation of functional abilities in patients with all forms of dementia, aiding in the planning of appropriate care.

By measuring physical and language abilities, as well as functional activities, the Fast Score allows for an objective assessment of functional and cognitive decline and the tracking of changes over time.

Its applications extend to various care settings, including hospice and home care, where it assists in tailoring care plans to individual patient needs.

As we explore the significance and implications of the Fast Score for Dementia, we will uncover how this tool empowers caregivers and enhances the quality of life for those living with dementia.

Overview of the FAST Scale for dementia

The FAST scale, developed by Dr. Reisberg in 1982, is a practical and widely utilized tool for assessing functional decline in all forms of dementia.

It serves as a functional assessment staging tool that allows healthcare professionals to monitor the progression of dementia and understand the functional, physical, and language abilities of individuals.

The scale consists of seven stages that represent different levels of cognitive decline and functional impairment.

The FAST scale is particularly useful in hospice care settings, where it can help determine the appropriate level of care for individuals with advanced dementia.

It consists of seven stages that indicate the level of cognitive decline, ranging from normal functioning (stages 1 and 2) to severe dementia (stage 7).

The FAST scale is used by clinicians and caregivers to assess the ability of individuals to perform daily activities and communicate effectively.

By regularly using the FAST scale, healthcare professionals can monitor the progression of dementia and track the effectiveness of treatment over time.

This information is crucial for developing personalized care plans and setting realistic goals for dementia care.

In addition, the FAST scale plays a vital role in determining the need for hospice care.

A person with dementia classified as stage 7 on the FAST scale has lost the ability to speak coherently, saying only a single intelligible word, or has lost the ability to perform simple activities of daily living.

At this juncture, they are in the terminal stage of dementia and may benefit from hospice care.

Hospice care provides tailored support for individuals with a life expectancy of around 6 months or less and helps improve their quality of life.

This is different from acute care or even long term care.

To learn more, read my post Acute Care Vs Long Term Care.

Stages of Functional Decline in Alzheimer’s Disease

The table below details the 7 stages of the FAST scale for dementia:

The 7 FAST Stages Of Dementia

FAST ScoreDementia StageDescription
No Cognitive DeclineCognitive & Functional ability is normal. No observable signs of dementia seen
2Very Mild Cognitive DeclineSlight cognitive changes; Individual starting to forget and has mild word-finding difficulty
3Mild Cognitive DeclineCognitive changes more noticeable; memory impairment is more noticeable by friends and family; starting to struggle in social and work settings
4Moderate Cognitive DeclineMemory loss is significant; problem-solving is negatively impacted; ability to maintain attention is becoming impaired; Cognitive deficits are more pronounced
5Moderately Severe Cognitive DeclineFunctional, cognitive, memory decline is much more pronounced; Starting to get confused about time and place
6Severe Cognitive Decline (Sub stages a-e)Cognitive and functional impairment is profound; Starting to have difficulty recognizing loved ones; personality changes are becoming observable
6aSevere Cognitive Decline (Sub stages a-e)Not dressing appropriaely for weather (walking outside in shorts and T-shirt during winter, etc); difficulty getting dressed (buttoning, zipping, etc); putting shoes on wrong feet
6bSevere Cognitive Decline (Sub stages a-e)Proper bathing is starting to get affected (unable to adjust water temperature, forgetting how to turn on faucet, etc)
6cSevere Cognitive Decline (Sub stages a-e)Difficulty with toileting (forgetting to flush, improper toilet hygiene, wiping, etc)
6dSevere Cognitive Decline (Sub stages a-e)Occassional or frequent urinary incontinence starting to be observed
6eSevere Cognitive Decline (Sub stages a-e)Occassional or frequent fecal incontinence starting to be observed
7Very Severe Cognitive Decline (sub stages a-f)Functional and cognitive decline is much worse
7aVery Severe Cognitive Decline (sub stages a-f)Verbal ability is reduced to uttering just a half-dozen or so intelligible words in a typical day (person may repeat the same word)
7bVery Severe Cognitive Decline (sub stages a-f)Verbal ability is reduced to uttering a single intelligible word in a typical day (person may repeat the same word)
7cVery Severe Cognitive Decline (sub stages a-f)Ability to move without assistance is lost
7dVery Severe Cognitive Decline (sub stages a-f)Ability to sit up unassisted is lost
7eVery Severe Cognitive Decline (sub stages a-f)Ability to smile is lost
7fVery Severe Cognitive Decline (sub stages a-f)Cannot hold their head up

My Clinical Take

During my many years of working with patients and caregivers struggling with dementia, I have come to understand that the progression of dementia is very specific to the individual.

Some people will hold steady at a particular stage for a few years, while others will progress through the stages within a year or two.

There are so many other contributing factors that determine an individual’s progression – medications, other chronic or acute medical problems, access to healthcare, knowledge and education about dementia, access to social interaction, etc.

Overmedication or polypharmacy is the 5th leading cause of death in the U.S. and can cause great harm to people with dementia.

A seemingly benign OTC medication such as Benadryl can cause such a severe effect in a person with dementia that it could send them to the hospital.

Or, paroxetine, a common antidepressant, is quite possibly the worst medication from the SSRI class to give to the older adult.

Because of the possibility of these factors potentially worsening the progression of dementia, it is imperative that a multi-disciplinary approach is adopted when caring for a loved one living with this disease.

Encourage communication between your loved one’s primary doctor, other specialists such as neurologists, psychiatrists, pharmacists, etc.

If one is available near you, I recommend having your loved get established as a patient with a geriatrician.

In my opinion, they are the best-trained doctors to manage complex dementia and geriatric-related issues.


In conclusion, the Fast Score for Dementia is a valuable tool for assessing functional abilities in individuals with dementia.

It provides objective measurements of cognitive decline and is widely used in various settings, including hospice and home care, to tailor care plans based on individual patient needs.

By tracking changes over time, it improves the quality of life for patients and supports well-informed decision-making by caregivers.

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