The Reisberg Functional Assessment Screening Tool (FAST) is a scale that doctors use to diagnose and evaluate aspects of Alzheimer’s disease.
Alzheimer’s disease (AD) is a progressive form of dementia, meaning the symptoms gradually worsen over time. The FAST scale evaluates declining physical and thinking abilities in people with AD.
This article provides an overview of the FAST tool, including a breakdown of its individual stages.
It also outlines what to expect from the FAST evaluation, what the scale means for hospice care, and more.
As the National Hospice and Palliative Care Organization (NHPCO) explains, the FAST outlines seven stages of functional decline in AD. It assesses physical and cognitive, or thinking, abilities.
All individuals with AD progress through the seven stages one after the other, without skipping stages. As such, the FAST can offer an accurate assessment of the disease’s progression.
Stages 1 and 2 represent the functional ability of an adult without AD, while stage 7 represents the functional ability of an adult in the final stage of AD.
The journal Hospital and Community Psychiatry first published the Reisberg FAST in 1985.
The Center to Advance Palliative Care and other medical bodies have since provided adapted versions of the FAST.
This section outlines the seven FAST stages of dementia.
Stage 1
Stage 1 is applicable to all adults without AD.
In this stage, the individual does not complain of or demonstrate any difficulties in functioning.
Stage 2
Stage 2 is again applicable to all adults without AD.
In this stage, the individual reports difficulties with the following, but these are not due to AD:
- finding words
- forgetting the location of objects
- work-related tasks
Stage 3
Stage 3 represents the beginnings of AD. Here, a person or those around them may become aware of the following:
- difficulty traveling to new locations
- decreased functioning at work
- decreased organizational capacity, as reported by friends, family, or co-workers
Stage 4
Stage 4 represents mild AD. Here, a person experiences impairments performing complex tasks, such as:
- planning social gatherings or events
- handling personal finances
- shopping
Stage 5
Stage 5 indicates moderate AD. Here, a person needs assistance selecting appropriate clothing to wear for the day, season, or occasion.
Stage 6
Stage 6 represents moderately severe AD. Here, a person makes occasional or increasingly frequent errors in daily functioning. Examples of such errors include:
- putting on the wrong clothing
- being unable to bathe properly
- being unable to use the toilet correctly, which may include:
- forgetting to flush the toilet
- incorrectly disposing of toilet tissue
- not wiping themselves properly after going to the toilet
- experiencing urinary incontinence
- experiencing fecal incontinence
Stage 7
Stage 7 represents the final and most severe stage of AD. Here, a person shows evidence of the following declines in cognitive functioning:
- Their speech is limited to 6 or fewer intelligible words per day or during the course of an intensive interview.
- Their vocabulary is limited to a single intelligible word that they may repeat continually throughout the day or during the course of an intensive interview.
- They are unable to walk without assistance.
- They are unable to sit up without assistance.
- They are no longer able to smile.
- They are no longer able to hold their head up independently.
The FAST evaluation consists of a checklist of criteria for assessing AD-related functional decline.
When conducting the FAST evaluation for suspected early stage AD, a doctor may rely on the person’s own responses.
However, when conducting the evaluation for late-stage AD, the doctor will rely on responses from caregivers.
This is because people in late-stage AD will no longer be aware of their functioning difficulties, or will be unable to communicate them to the doctor.
Doctors may use the FAST to determine whether an individual with AD requires hospice care.
The NHPCO suggests that medical professionals consider hospice care for individuals with a Stage 7 FAST classification.
People who meet this criteria are in the terminal stage of AD and have an average life expectancy of around 6 months or less.
Doctors may deem a person to be terminal if they meet all six of the criteria outlined in stage 7 and have also experienced one or more of the following within the past 12 months:
- aspiration pneumonia
- upper respiratory tract infection
- septicemia
- multiple severe bedsores
- recurrent fever following antibiotic use
- inability to maintain sufficient fluid and calorie intake, combined with either of the following:
- a 10% reduction in body weight within the past 6 months
- a blood serum albumin level of less than 2.5 grams per deciliter (g/dL).
What a FAST score means for hospice care
A FAST score is helpful for determining whether a person needs palliative care. According to the NHPCO, it can also help care teams develop and implement individualized care plans and evaluate their ongoing effectiveness.
Ultimately, the FAST can improve the patient experience and reduce the need for hospital visits.
Alzheimer’s is a progressive disease that begins with mild memory and cognitive impairments and gradually progresses to severe impairments in cognition, communication, and daily functioning.
According to the Alzheimer’s Association, a person with AD typically lives around 4–8 years following their diagnosis, although some people may live as long as 20 years.
As the NHPCO explains, individuals with a Stage 7 FAST score are in the final and most severe stage of AD. These people have an average life expectancy of around 6 months or less.
While there is no cure for AD, treatments are available to help slow the worsening of AD symptoms and prolong the quality of life for individuals with the disease.
As such, these treatments should enable a person with AD to progress through the FAST stages more slowly.
Alzheimer’s disease is a progressive form of dementia, meaning the symptoms gradually worsen over time.
The Reisberg Functional Assessment Screening Tool (FAST) is a scale that doctors use to evaluate declining physical and cognitive functioning in people with AD.
The FAST consists of seven distinct stages. Stages 1 and 2 represent the functioning ability of an adult without AD, whereas stage 3 represents the earliest stage of AD. Stage 7 represents the final and most severe stage of AD, at which the person is usually eligible for hospice care.
The FAST helps doctors to properly evaluate and implement the care needs of people with AD, and decrease their need for hospitalization. A person who would like to know more about the FAST and its implications can talk with a doctor for further information.