Understanding the FAST Scale: How Dementia Progresses
Published July 10, 2020
The Functional Assessment Staging Tool, otherwise known as the FAST Scale, is used to evaluate the progression of dementia in patients with Alzheimer’s. It was designed by a leading expert in Alzheimer’s disease, Dr. Barry Reisberg.
In his research, Dr. Reisberg found that the symptoms of Alzheimer’s follow a certain pattern. This pattern is similar to normal human development but in reverse. He called this process “retrogenesis”.
His studies gave way to a documented description of dementia symptoms. All of which are contained in the FAST Scale. This makes it the most well-validated measure of dementia progression in scientific literature.
This is also why the FAST Scale is the most widely-used tool by nursing home professionals. It divides dementia into seven stages. This helps them determine the type of care and intervention an Alzheimer’s patient needs at every stage.
7 Stages of Dementia According to the FAST Scale
Stage 1: Normal Adult
Patients at this stage do not exhibit any type of cognitive decline. They are usually self-sufficient and can still do most of the activities they normally do.
Stage 2: Normal Older Adult
At this stage, Alzheimer’s patients start to show very mild memory loss. They tend to forget the location of everyday objects like keys, eyeglasses, etcetera. Some may also suffer from memory lapses like forgetting familiar words or names. These impairments are usually noticed by friends and family but may not show during clinical evaluations.
Stage 3: Early Stage Dementia
Mild cognitive impairments are usually observed in patients with early-stage dementia. Memory and concentration problems start to become obvious to family and coworkers. At this stage, patients tend to have difficulty with:
- traveling to new locations
- remembering names of people they just met
- planning or organizing things
- remembering the whereabouts of a valuable object
- remembering certain words
- retaining information they just read
Stage 4: Mild Dementia
It’s at this stage that patients start to show symptoms of moderate cognitive decline. Stage 4 patients are presumed to have a mental age of 8 to 12 years old. Their cognitive deficiencies are now apparent to everyone including medical professionals. Some of the activities they might find a challenge include:
- counting money
- remembering to pay bills
- remembering current events
- handling personal finances
- remembering personal information
The patient will also have difficulty performing complex tasks like planning dinner for guests. They may also appear withdrawn during mentally and socially challenging situations.
Stage 5: Moderate Dementia
Alzheimer patients at this stage may need some help performing day-to-day activities. They tend to exhibit major memory gaps and usually need help choosing the proper clothing. If left unsupervised, patients also tend to wear the same set of clothes for days.
Dementia symptoms at this stage may include:
- difficulty remembering important personal details like their current address and telephone number
- confusion as to the date, day of the week, and even the season
- difficulty with simple calculations
Stage 6: Moderately Severe Dementia
At this stage, the patient usually exhibits obvious severe cognitive decline. This is divided into five different substages:
- The patient has difficulty putting clothing on without assistance.
- The patient needs help with bathing.
- The patient needs help with using the toilet.
- Urinary incontinence
- Fecal incontinence
The patient may also start to exhibit significant personality changes. As their condition declines, they may also:
- lose awareness of their surroundings and recent experiences
- recall their personal history inaccurately
- forget the names of people they know so well like their spouse or children
- have an irregular waking/sleeping cycle
- tend to wander and become lost
Stage 7: Severe Dementia
During this final stage, patients experience very severe cognitive decline. Like the previous stage, it is also divided into the following substages:
- Limited speaking ability (patients can only speak an average of 5-6 words a day).
- Speech ability is reduced to a single unintelligible word per day which the patient repeats over and over again.
- Loss of walking ability.
- The patient can no longer sit up on their own.
- Loss of ability to smile.
- The patient can no longer hold their head up.
This stage is also characterized by slow and abnormal reflexes. Their muscles usually grow stiff and some may have difficulty swallowing their food.
How Long Does Each Stage Last?
The answer differs for each person. There are a lot of factors that affect the progression of dementia. The scale is only used to predict what happens next but it cannot tell how long a patient will stay at what stage. It usually depends on their overall health condition and the environment they are in.
Treatments also play a huge role in the progression of dementia. Proper medication and intervention can significantly slow down the disease’s progression.
On average, people live 8 years after being diagnosed with Alzheimer’s. But they can survive anywhere from 3 to 20 years.
Dementia symptoms do not skip a stage in the FAST scale. If the patient’s condition accelerates or skips one or few stages in the scale, it might be due to factors other than Alzheimer’s.
For example, a patient who is manifesting early-stage dementia may suddenly need help with bathing or using the toilet. This means they jumped from stage 3 to stage 6, thereby skipping stages 4 and 5. In cases like this, the patient may have an underlying condition that accelerated their dementia. Or there might be changes in their living situation that makes it difficult for them to do certain things.
About The Author
Judy Ponio is a firm believer in the power of knowledge when it comes to whole body donation and she wants to share her experience with the world. She also loves to write about food and art.