What Is the Fast Scale for Dementia?

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What Is the Fast Scale for Dementia?

The Functional Assessment Staging Tool (FAST) is a dependable method often used to assess the current state of dementia in patients. It offers a thorough and effective evaluation of functional abilities and the potential for decline over time. This makes it an essential resource for healthcare professionals, caregivers, and family members to monitor the capabilities of dementia patients.

What is the FAST Dementia Rating Scale?

The Functional Assessment Staging Scale is a way to determine if your loved one has dementia. Dr. Reisberg developed FAST in 1982 as a tool to define and rate all types of dementia. The FAST scale has seven stages:

  • No cognitive or functional impairment
  • Early functional changes
  • Mild functional decline
  • Moderate functional losses
  • Moderately severe loss of function
  • Severely reduced functional capacity
  • Total dependence

mobility, and feeding. Families worried about Alzheimer’s and other dementias can use the FAST scale to gauge the extent of cognitive decline in their loved ones. Knowing the person’s functional level helps determine their specific care needs. It also allows caregivers to track changes in a patient’s functional status as early as possible with accurate results.

Understanding the Fast Score for Dementia

The FAST Scale categorizes the progression of dementia based on the person’s ability to perform daily tasks and activities. The scale consists of seven stages, with higher stages, indicating more significant impairment.
Here is a further breakdown of the stages:

Stages of the FAST Dementia Scale

Here is a breakdown of the stages of the FAST Dementia Scale:

1- No subjective or objective difficulty
2- Complains of forgetting where things are; has trouble finding words
3- Decreased job performance noticed by coworkers; traveling to new places is hard; reduced organizational skills
4- Difficulty with complex tasks (e.g., planning a dinner, managing finances, shopping)
Needs help choosing proper clothing for the day, season, or occasion
6a. Trouble dressing properly without help (e.g., mismatched clothes, difficulty with buttons)
6b. Needs help with bathing (e.g., adjusting bath water)
6c. Problems with toileting (e.g., forgetting to flush, improper wiping)
6d. Occasional or frequent urinary incontinence
6e. Occasional or frequent fecal incontinence
7a. Can only speak six or fewer words on an average day or during an interview
7b. Speech limited to one word, repeated often
7c. Cannot walk without assistance
7d. Cannot sit up independently
7e. Cannot smile
7f. Cannot hold up head independently

Duration of Each Stage

Alzheimer’s disease progresses clearly through the FAST scale, with all stages typically occurring in order, though there may be some overlap. This progression is not always seen in other dementias, where patients might skip stages. According to the Alzheimer’s Association, a person with Alzheimer’s lives an average of four to eight years after diagnosis but can live up to 20 years. Before showing symptoms, the brain can undergo years of subtle changes known as preclinical Alzheimer’s disease.
The below table provides an overview of the stages of dementia, detailing the diagnosis, the stage of cognitive decline, the signs and symptoms associated with each stage, and the expected duration of each stage.

Diagnosis Stage Signs and Symptoms Expected Duration of Stage
No Dementia Stage 1: No Cognitive Decline
  • Normal Abilities
  • No memory problems
  • Individuals without dementia fall into this stage
No Dementia Stage 2: Very Mild Cognitive Decline
  • Occasional forgetfulness of names
  • Misplacing familiar items
  • Symptoms not noticeable to family or doctors
No Dementia Stage 3: Mild Cognitive Decline
  • Noticeable increase in forgetfulness
  • Slight trouble focusing
  • Decline in work performance
  • Getting lost more often
  • Struggling to find the right words
  • Observed by close ones
Typically lasts between 2 and 7 years
Early-stage Stage 4: Moderate Cognitive Decline
  • Concentration issues
  • Forgetting recent events
  • Inability to manage finances
  • Inability to travel alone to unfamiliar places
  • Struggles with task completion
  • Denial of symptoms
  • Withdrawal from social interactions
  • Cognitive issues detectable by doctors
Generally lasts about 2 years
Mid-Stage Stage 5: Moderately Severe Cognitive Decline
  • Significant memory gaps
  • Requires help with daily activities like dressing and bathing
  • Forgets personal details such as address or phone number
  • Disorientation regarding time and place
Typically lasts around 1.5 years
Mid-Stage Stage 6: Severe Cognitive Decline (Middle Dementia)
  • Needs assistance with daily activities
  • Forgets names of close family members
  • Unable to recall recent events
  • Cannot remember significant past events
  • Difficulty counting down from 10
  • Bladder control issues
  • Trouble speaking
  • Changes in personality and emotions
  • Experiences delusions, compulsions, and anxiety
Generally lasts about 2.5 years
Late-Stage Stage 7: Very Severe Cognitive Decline (Late Dementia)
  • Unable to speak or communicate
  • Requires assistance with most activities
  • Loss of motor skills
  • Unable to walk
Typically lasts between 1.5 and 2.5 years

The FAST Scale: Hospice Care Criteria

Alzheimer’s patients receiving palliative care are usually in stage seven. At this stage, they have significant difficulties with communication and independent movement. Many Alzheimer’s patients also have other illnesses, such as coronary heart disease. Doctors consider all these factors when deciding if a patient qualifies for hospice care. Alzheimer’s patients typically enter hospice care during the final stages of the disease. At this point, they usually:

  • Need help with daily activities and personal care around the clock
  • Are unaware of recent events and surroundings
  • Have changes in physical abilities, including trouble walking, sitting, and swallowing
  • Have more difficulty communicating
  • Are prone to infections, especially pneumonia

In the final stages, patients struggle to respond to their environment, talk, and control their movements. They might still say words or phrases, but it can be hard for them to express their pain or needs. As their memory and thinking abilities decline, they might experience significant personality changes and need more help with daily activities.

Utilization of the FAST Score in Hospice Care

In hospice care settings, the FAST Score can help in several ways:

Patient Evaluation: It helps hospice teams assess the current functional status of patients with advanced Alzheimer’s disease. This evaluation guides the creation of personalized care plans to address specific needs and symptoms.

Prognosis: For advanced Alzheimer’s patients, the FAST Score predicts survival. It is crucial in determining if hospice care is appropriate for a patient.

Care Planning: The FAST Score helps tailor care interventions to the needs of patients and their families. The score can help predict the need for specialized care and assistance as the disease progresses.

Communication with Families: The FAST Score helps in discussions with families about the disease progression, treatment options, and prognosis. It helps manage expectations and ensures the patient’s wishes and care goals are respected.

Measuring Outcomes: In hospice care, the FAST Score is used to evaluate the effectiveness of interventions and track changes in functional status over time.

It is important to note that the FAST Score may be used differently in hospice care depending on institution-specific policies, regional practices, and individual patient needs.

Contact Melodia Hospice Care

If a loved one is progressing along the FAST scale, our hospice care team can help you make decisions about their care while they can still provide input. We aim to ensure that these desires are carried out when the time comes. Contact us at 1-888-635-6347 to learn how we can help you and your family navigate and understand the FAST scale as it relates to your loved one’s hospice journey.

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What is the FAST Scale, and how it is used in assessing dementia?

The Functional Assessment Staging Test (FAST) Scale is a tool used to evaluate the functional progression of Alzheimer’s disease and other dementias. It provides a detailed staging system, ranging from normal aging to severe dementia, based on observed abilities and disabilities. Healthcare professionals use the FAST Scale to determine the stage of dementia, monitor changes over time, and tailor care plans accordingly.

What are the different stages of the FAST Scale, and what do they imply?

The FAST Scale has 7 primary stages, each with sub-stages, that describe the progressive decline in functional abilities:
Stage 1: No difficulty, either subjectively or objectively.
Stage 2: Subjective complaints of memory deficit, such as forgetting the location of objects.
Stage 3: Early deficits in job performance and organizational skills.
Stage 4: Decreased ability to manage complex tasks, like handling finances.
Stage 5: Assistance needed in choosing proper clothing and some aspects of daily living.
Stage 6: Assistance needed with dressing, bathing, and toileting.
Stage 7: Severe dementia, characterized by loss of verbal abilities and motor skills.

How is the FAST Scale different from other scales used to assess dementia, like the MMSE or CDR?

The FAST Scale focuses specifically on functional abilities and the progression of Alzheimer’s disease, rather than cognitive function alone. In contrast:
MMSE (Mini-Mental State Examination): Assesses cognitive function and is commonly used for screening and monitoring cognitive impairment.
CDR (Clinical Dementia Rating): Assesses cognitive and functional performance in six areas to stage dementia severity.
Compared to the above scales, the FAST Scale is particularly useful for mapping functional decline and planning long-term care needs.

Who is qualified to administer the FAST Scale, and do they need any special training?

The FAST Scale can be administered by healthcare professionals such as doctors, nurses, and trained caregivers who are familiar with the patient’s history and daily functioning. While no special certification is required, the administrator needs to have a good understanding of the scale and experience in assessing dementia to ensure accurate staging.

How can the FAST Scale be helpful for families caring for a loved one with dementia?

The FAST Scale can help families understand the current stage of their loved one’s dementia and anticipate future changes. This understanding enables families to:
Plan for appropriate levels of care and support.
Communicate effectively with healthcare providers.
Make informed decisions about interventions, living arrangements, and services.
By tracking changes over time, families can better manage the caregiving process and ensure the patient receives the best possible care tailored to their stage of dementia.

What support does Melodia Care Hospice offer for families?

Melodia Care Hospice provides comprehensive support, including:
Assessing the functional status of dementia patients using the FAST scale.
Creating personalized care plans.
Offering emotional and practical support to families.
Providing grief counseling and ongoing support.