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How To Use The Fast Scale For Dementia

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If your loved one has dementia, you probably already know that the disease progresses in stages. The different stages signify different levels of cognitive decline and what’s happening in the patient’s mind and body. One of the tools medical professionals use is the Functional Assessment Staging Test (FAST) scale. Did you know that many family members also use it to assess a loved one’s dementia progression?

The best way to use the FAST scale for dementia is to understand how the scale divides the dementia journey. The scale groups dementia progression into seven stages. Comprehending what each stage means will make it easier to track your loved one’s cognitive decline and know which action to take.

Caring for a dementia patient isn’t easy. It is time-consuming and sometimes emotionally draining. The FAST scale for dementia is a screening test that helps caregivers assess the patient’s condition more easily, so they know what to do next according to their needs.

If you’re interested in using the FAST scale for dementia care, this blog post is for you. We’ve outlined everything you need to know about the scale below.

What is the Functional Assessment Staging Test?

FAST stands for Functional Assessment Staging Tool, also known as the Fast Scale. This is a screening tool that caretakers can use to measure the level of functional impairment in a loved one who has been diagnosed with dementia. 

The scale is a useful tool that quantitatively assesses how well the person functions and documents change over time. However, the scale should not be used as the sole criterion for diagnosing dementia or differentiating between various forms of dementia.

Dr. Barry Reisberg, a leading expert in Alzheimer’s disease, invented the Fast Scale. This scale is primarily used by healthcare professionals, doctors, and family members to understand, discuss, and follow the progression of dementia and Alzheimer’s patients.

Read our article, Does Medicare Cover Dementia Testing?.

How Does The Fast Scale Work?

The Fast Scale is used to measure the changes in a person’s ability to function over time.

This scale is different from other assessment tools that focus primarily on cognitive decline, such as the Global Deterioration Scale (GDS). It is also different than evaluation tests, such as the clock drawing test or the Mini-Mental State Examination (MMSE).

To assess the different stages of dementia or Alzheimer’s, the Fast functional scale focuses on an individual’s ability to perform tasks of everyday activities of daily living, such as bathing, dressing, and grooming.

How the Fast Scale Breaks Down Dementia Stages

There are primarily three overarching stages of dementia:

  • Early or mild stage
  • Middle stage
  • Late stage

The Reisberg Functional Assessment staging scale digs a little deeper into these three stages, breaking them into a 16-item scale with more detailed and comprehensible categories.

These include the following characteristics:

Stage 1 (Normally Functioning Adult)

Individuals in this stage are considered healthy and free of cognitive and functional decline. If your family has a history of dementia, and you’ve not shown any signs of the disease, you are considered to be a normal adult in this stage.

Stage II (Normally Functioning Senior Adult)

The second stage in the FAST scale is often defined as “normal aged forgetfulness.” For most individuals, this manifests as simple memory lapses, such as forgetting where you put your keys or what you were going to say in the middle of a conversation. Experts consider this stage “normal” for senior adults.

Stage III (Early Dementia)

In the third stage, the person begins showing mild signs of dementia that may only be noticeable among close relatives and friends. For instance, the person may start telling the same story repeatedly.

If the person is still working, they may start having challenges coping with their job responsibilities. Furthermore, concentrating becomes a challenge, and the individual may find it hard to complete complex tasks like doing their own taxes.

Stage IV (Mild Dementia)

Most individuals get a dementia diagnosis in this stage because their cognitive loss is more severe and noticeable. For example, the person may struggle with financial issues or forget important dates such as birthdays or anniversaries.

At this stage, the individual has difficulties performing tasks that require following multiple steps at once. For instance, cooking a complicated meal becomes challenging because they have to simultaneously keep track of too many things.

However, the person still has a good level of independence in this stage.

Stage V (Mid-Stage Dementia)

In stage five, the individual’s cognitive impairment has progressed to the “middle” stage, and they can no longer live independently. While they can still perform basic tasks like feeding themselves, someone else has to prepare the meals.

It’s also at this moderate dementia stage that problematic behaviors like paranoia, hallucinations, and wandering begin manifesting. The person needs a full-time caregiver to help them with everyday tasks and daily activities of living. 

Read our helpful tips for how to talk to a parent with dementia without belittling them.

Stage VI (Moderately Severe Dementia) 

This stage is considered the beginning of severe or late-stage dementia. In the two final stages of the Fast scale seven-stage system, the stages are broken down further into subsets within the stage. Examples for Stage VI include 6d – urinary incontinence or 6e – fecal incontinence.

In Stage VI, the patient has experienced severe cognitive decline. They are entirely dependent on their caregiver and require 24/7 supervision and assistance in just about everything.

The person may also start experiencing challenges with ambulatory ability and speaking ability. Most families decide to take their loved ones into a memory care facility at this stage.

Read about ways to make the transition from home to memory care easier.

Stage VII (Severe/End stages) of Dementia)

This is the final stage of dementia.

The person’s ability to function and perform tasks declines to become nonexistent. They are approaching end of life and now require full-time care, including assistance with eating and toileting.

Furthermore, they lose their speech ability and can no longer communicate. Their cognitive function continues going on a downward spiral. Their body follows and within a short time they pass away.

When Should A Fast Score Be Used? 

The Fast Scale is mainly used for patients with dementia or Alzheimer’s disease and a prognosis of 6 months of life expectancy or less. It’s especially crucial to help you know when to call hospice for those patients who have advanced into the later stages of the disease.

However, it’s not uncommon for family members and caregivers to use the scale from early stages to keep track of the disease progression.

What Fast Scale Qualifies For Hospice?

A patient’s hospice eligibility won’t be met until they are in stage seven or greater on the Fast Scale.

This is because hospice care is a form of care for those near the end of their life. It focuses on comfort and pain management rather than curative treatments to prolong life.

Read more about the hospice criteria for dementia in our article.

Wrapping Up

Whether you’re a patient, caregiver, or family member of someone with dementia or Alzheimer’s disease, it’s crucial to understand how the FAST scale works and what it measures. This way, you’ll be able to get the most accurate diagnosis and treatment possible.

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