The FAST scale helps medical professionals measure changes in how people with Alzheimer’s disease perform certain activities and functions. They can also use it to determine eligibility for hospice care.

The Reisberg Functional Assessment Staging (FAST) scale is a tool doctors use to diagnose and stage Alzheimer’s disease, the most common type of dementia.

Dr. Barry Reisberg, a leader in the field of Alzheimer’s, developed the FAST scale in the 1980s.

The scale measures a person’s changing abilities performing activities of daily living, such as working, paying bills, getting dressed, or walking.

The FAST scale helps medical professionals diagnose and assess the progressive stages of Alzheimer’s disease.

Alzheimer’s is a progressive disease, meaning the symptoms of dementia gradually increase over time. In the early stages, memory changes are mild. In later stages, people with Alzheimer’s can have significant difficulty responding to their environment or having a conversation.

By using the FAST scale during regular checkups, medical professionals can:

For people with Alzheimer’s who progress to severe stages of dementia, healthcare professionals can use the FAST scale to determine eligibility for hospice care.

The FAST scale is a tool that helps doctors assess the stages of Alzheimer’s specifically. It may not apply to other types of dementia.

The FAST scale is a 16-item scale divided into seven stages of dementia, from performing activities typically to severe dementia.

The following table shows each stage of the FAST scale, including functional changes and average duration.

StageStage nameFunctional changesAverage duration
1Typical adultThere’s no increased difficulty performing various activities and functions.N/A
2Typical older adultThe person has slightly increased difficulty performing various activities and functions, such as misplacing objects or difficulties with work.unknown
3Early dementiaThe person experiences increased difficulty performing job tasks evident to co-workers and difficulty traveling to new locations.2 to 7 years
4Mild dementiaThere’s an increased difficulty performing complex tasks, such as paying bills or preparing meals.2 years
5Midstage dementiaThe person requires assistance in choosing the proper clothing.4 years
6Moderately severe dementiaThe person experiences significantly increased difficulty dressing, bathing, and using the toilet independently.
6A: They need assistance getting dressed.
6B: They require help bathing properly.
6C: They could use support handling mechanics of toileting, such as flushing or wiping.
6D: They experience urinary incontinence.
6E: They have fecal incontinence.
4 years
7Severe dementiaThe person experiences a reduction of speech, movement, and consciousness.
7A: They have difficulty speaking (1 to 5 words per day).
7B: They have challenges using intelligible vocabulary.
7C: They need assistance walking.
7D: They require help sitting up.
7E: They have difficulty smiling.
7F: They could use support holding their head up.
2 1/2 years

The FAST scale is one of the most studied and most validated scales for tracking the progressive stages of Alzheimer’s. Validity refers to how close a staging score is to the actual stage of the disease. Medical experts note that the FAST scale produces reliable and consistent results over time.

However, the scale does have some limitations.

It may not be valid for people with other types of dementia. It also assumes dementia progresses from one stage to the next in numerical order without skipping any stages. However, some patients may skip stages due to secondary illnesses.

Hospice care is a type of medical care that focuses on comfort and quality of life for people with serious illnesses approaching the end of life.

Doctors use the FAST scale to determine whether a person with Alzheimer’s qualifies for hospice care. When dementia severity surpasses stage 7C (needing assistance walking independently), a person with Alzheimer’s qualifies for hospice care. At this stage, experts estimate survival to be 6 months or less, although many people with advanced Alzheimer’s live longer.

A 2021 research review suggested that hospice care or palliative care may offer a better quality of life for people with advanced Alzheimer’s than continued or difficult medical interventions.

Additional benefits of hospice care for people with advanced Alzheimer’s include a:

  • lower chance of hospitalization during the final 30 days of life
  • higher likelihood of receiving daily treatment for pain
  • greater satisfaction with care, which the person with Alzheimer’s and their caregiver can experience

The FAST scale is a tool doctors use to measure the severity and progression of Alzheimer’s disease. It’s a commonly used, well-validated, and reliable tool for diagnosing and staging Alzheimer’s.

Healthcare professionals also use the scale to determine whether someone with advanced Alzheimer’s qualifies for hospice care.

If you want to learn more about the FAST scale for dementia, talk with a doctor or healthcare professional.