The Reisberg Functional Assessment Screening Tool (FAST) is a tool for diagnosing and evaluating functional deterioration in individuals with Alzheimer’s disease (AD), a form of dementia.

Dr. Barry Reisberg developed the FAST scale in the 1980s.

This article provides information on the FAST scale, including what it is and how to interpret the different stages. It also explains how medical professionals use the FAST scale to assess a person’s suitability for hospice care.

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The FAST scale enables clinicians and caregivers to accurately assess a person’s decline in cognitive function throughout the disease.

It can also help them monitor how effective the treatment is. If the scale indicates that a treatment is no longer effective, a healthcare professional may refer them to palliative or hospice care.

The National Hospice and Palliative Care Organization (NHPCO) states that the FAST scale is the most validated measure of AD progression in scientific literature and is validated in all medical settings.

However, healthcare professionals use other scales and tools to assess the severity of dementia that may be used more frequently. Examples include the General Practitioner Assessment of Cognition and the Mini-Mental State Examination.

Learn more about other cognitive tests for dementia.

How often will a clinician use the FAST scale?

A clinician may use the FAST scale during each office visit to detect any changes.

According to the NHPCO, the FAST scale outlines seven distinct “stages” of functional decline in AD.

Stages 1 and 2 represent the functional ability of an adult without AD, and stage 7 represents the functional ability of an adult in the final and most severe stage of the disease.

Dr. Reisberg and colleagues presented the FAST scale in a 1985 article published in Hospital and Community Psychiatry. The Center to Advance Palliative Care (CAPC) provides an adapted version of the tool.

The seven FAST stages of AD are outlined below:

1The individual does not complain of or demonstrate any difficulties in functioning.
2The individual complains of some difficulty finding words, forgetting the location of objects, or experiencing some difficulties at work.
3This stage signals the initial development of Alzheimer’s-type dementia (ATD), during which the following problems may become evident:
• decreased functioning at work
• decreased organizational capacity, as reported by friends, family, or co-workers
• difficulty traveling to new locations
4This stage indicates mild ATD. Here, the individual experiences a decreased ability to perform complex tasks, such as:
• planning social gatherings or events
• handling personal finances
• shopping
5This stage indicates moderate ADT. Here, the individual requires assistance in choosing appropriate clothing for the day, season, or occasion.
6This stage indicates moderately severe ADT.
The individual makes the following errors in daily functioning, and these errors may occur occasionally or with increasing frequency over the preceding weeks:
• putting on the wrong clothing without assistance or prompting
• being unable to bathe properly
• being unable to handle the mechanics of going to the toilet, which may include forgetting to flush the toilet, incorrectly disposing of toilet tissue, and not wiping properly after using the toilet
• experiencing urinary or fecal incontinence
7This stage indicates severe ADT, in which the individual shows evidence of the following declines in cognitive functioning:
• Their ability to speak is limited to six or fewer intelligible words over an average day or during an intensive interview.
• Their vocabulary is limited to a single intelligible word that they may repeat continually over an average day or during an intensive interview.
• They are unable to walk without personal assistance.
• They are unable to sit up without assistance.
• They lose the ability to smile.
• They lose the ability to hold their head up independently.

Medical professionals may use the FAST scale to determine whether a person with AD requires hospice care.

The NHPCO suggests that medical professionals consider hospice care for individuals with a stage 7 FAST classification.

Individuals in stage 7 may be in the terminal stage of AD, with a life expectancy of around 6 months or less.

Doctors may deem a person 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 bed sores, affecting tissues beneath the skin
  • a recurrent fever, following antibiotic use
  • inability to maintain sufficient fluid and calorie intake, combined with a 10% loss in body weight within the previous 6 months or a blood serum albumin level of less than 2.5 grams per deciliter (g/dL).

Alzheimer’s disease is progressive, causing a decline in cognitive functioning over time. Medical professionals use the Reisberg Functional Assessment Screening Tool (FAST) to diagnose and stage AD.

The FAST scale consists of seven stages, with the first two representing the functional ability of an adult without AD.

Stage 3 represents the earliest stage of AD, and stage 7 is the final and most severe stage of the disease, during which medical professionals may deem a person suitable for hospice care.

Anyone needing further information about dementia and its progression can ask a doctor for further advice. A doctor will also work to provide an individualized treatment plan to help a person manage dementia symptoms.