Functional Assessment Staging Test (FAST)

FACTS

• The Functional Assessment Staging Tool (FAST) is tool for health professionals to assess the level of cognitive function in a person with a primary degenerative dementia, such as Alzheimer’s disease. 

• It primarily focuses on the current level of functioning and ability to perform activities of daily living, which is useful for determining strategies to use to provide a calm, clean, safe, and loving environment. 

• Although useful, it is important to remember that no two people with dementia experience the disease the same way and the stages are used as a guide 

• In general, when dementia progresses, it does not skip FAST stages. Only functional decline that is felt to be related to the individual’s dementia should be taken into consideration.  

• The FAST scale is a 16 item scale divided into 7 stages. The stages of Alzheimer’s disease as defined by the FAST scale are: 

 

Stage 1: Normally functioning adult. No evidence of cognitive or functional decline.  

Stage 2: Age associated memory loss: Individual complains of forgetfulness, may have some increased difficulty performing various activities and tasks, such as misplacing objects or difficulties with work 

Stage 3: Mild cognitive impairment: Mild cognitive decline that begins to interfere with completion of complex tasks, such as bill paying, managing medications, traveling to new locations, cooking a meal, etc. Concentration, organization may become difficult. Decline may only be noticeable to close family, friends and co-workers. Average duration – 2 to 7 years 

Stage 4: Mild dementia: Signs of cognitive impairment become more noticeable. This is when most people are diagnosed with dementia. There is increased difficulty performing complex tasks, such as bill paying, managing medications, traveling, cooking a meal, cleaning, etc. Recent events may be forgotten. Average duration – 2 years  

Stage 5: Moderate dementia: Major memory deficiencies. Individuals can typically no longer live alone. They need help choosing proper clothing for the occasion, season. There may be issues with wandering. Average duration – 4 years 

Stage 6: Moderately severe dementia. The individual becomes more dependent in their care, needing increased assistance with activities of daily living. Individual requires care and supervision 24 hours a day. Average duration – 4 years. This stage is broken down into sub-stages: 

6a: Needs help dressing 

6b: Needs help bathing properly 

6c: Needs help toileting  

6d: Urinary incontinence 

6e: Bowel incontinence 

Stage 7: Severe dementia: The individual experiences a decline in speech, movement and level of alertness. They are generally dependent on others for their care. This stage is broken down into sub-stages. Average duration – 2 ½ years 

7a. Speech is limited to 6 or less words during the day 

7b. Speech is limited to 1 word which can be clearly understood 

7c. No longer able to walk without assistance 

7d. No longer able to sit upright without assistance 

7e. Loss of ability to smile 

7f. No longer able to hold head up without assistance