Understanding the Functional Assessment Staging Tool (FAST) Scale for Alzheimer's Disease

The Reisberg FAST (Functional Assessment Staging Tool) Scale provides crucial insights into the stages of cognitive decline caused by Alzheimer's disease, aiding patients, families, and healthcare professionals. As the family member or caregiver of a patient with Alzheimer's disease, understanding the patient's FAST score can help you track their disease progression, anticipate the next stages, and communicate with their doctors.

Let’s explore the different stages of the FAST Scale, its practical use, and its implications for hospice admission eligibility.

What Is the FAST Scale for Alzheimer's Disease?

The FAST Scale is a widely recognized tool developed to track the progression of Alzheimer's disease, the most common form of dementia. It provides a structured framework to understand how an Alzheimer's patient's daily activities and abilities decline over time, and physicians use FAST scores to help determine whether a patient is eligible for hospice care.

A higher FAST score indicates a more advanced stage of cognitive decline, warranting additional support and specialized care.

Are you a healthcare provider? Here’s an eligibility guide for your Alzheimer’s or dementia patient.

FAST Scale Stages

Below, you'll find the stages of the FAST Scale for Alzheimer’s disease, which range from normal functioning to severe cognitive decline.

Stage Name Description
1 No Functional Decline No cognitive impairment or decline is present.
2 Very Mild Decline Slight forgetfulness and subtle cognitive changes.
3 Mild Cognitive Decline Noticeable memory and cognitive deficits become evident.
4 Moderate Cognitive Decline Individuals struggle with more complex tasks, requiring assistance.
5 Moderately Severe Decline Patients require assistance with basic activities and may exhibit behavioral changes.
6 Severe Cognitive Decline

Significant cognitive decline, necessitating constant supervision and help with daily activities. Patients progress through the following substages in order: 

  6a Inability to dress without help.
  6b Inability to bathe without help.
  6c Inability to use the restroom without help.
  6d Urinary incontinence
  6e Fecal incontinence
7 Very Severe Decline

lndividuals lose the ability to communicate, requiring extensive care and support in all aspects of life. Patients progress through the following substages in order: 

  7a Very limited speech; the patient speaks only a few words a day.
  7b Patient speaks only one word clearly.
  7c Inability to walk.
  7d Inability to sit up.
  7e Inability to smile.
  7f Inability to hold up head.

How Do You Use the FAST Score?

A patient’s FAST score corresponds directly to the stage of cognitive decline they have reached. Understanding the score and the corresponding stage will help guide healthcare professionals toward the most appropriate care and support.

Individuals diagnosed with pure Alzheimer's dementia tend to advance through the FAST scale stages in order; disordered advancement through the FAST scale can indicate the presence of mixed dementia.  

Is the FAST Scale Only Used for Alzheimer’s Disease?

The FAST Scale was designed to assess the progression of Alzheimer's disease, and physicians use it for this purpose.

However, the scale's framework for measuring functional decline can provide insights into a variety of cognitive impairments. It remains useful in assessing a patient’s ability to perform daily activities across a range of neurodegenerative disorders.

What FAST Score Is Needed for Hospice Admission?

Assessing a patient’s FAST score, alongside other clinical evaluations, helps identify when that patient may benefit from transitioning to hospice care, where comprehensive and compassionate support is tailored to their unique needs.

Only patients with Alzheimer's disease can be admitted to hospice on the basis of a FAST score alone. Patients with other dementias require other forms of assessment.

In the United States, the FAST score that qualifies an Alzheimer's patient for hospice varies geographically. Different regions of the country fall under the jurisdiction of separate Medicare Administrative Contractors (MACs), private insurers that process Medicare claims. Each MAC may determine its own FAST threshold.

An Alzheimer's patient who does not yet meet the FAST threshold for their region may still be eligible for hospice if they have additional health problems or complications that contribute to a prognosis of six months or less. 

Find out if hospice care could help your loved one.


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