WHEN YOU’VE MOVED a loved one suffering from dementia or Alzheimer’s disease to memory care you will hear mention of the Fast Scale, or Reisberg Functional Assessment Staging (FAST) scale at some point during their care. This scale assists doctors, hospice providers, patients and their loved ones in discussing and understanding the progress of Alzheimer’s disease and dementia. We believe knowledge is power, so here we acquaint you with the scale and break down the different stages. 


FAST includes a seven-stage system that is based on the patient’s level of functioning and daily activities. It should be noted that FAST focuses more on an individual’s level of functioning and activities of daily living rather than cognitive decline. It is possible for someone to be at a different cognitive stage (referred to as Global Deterioration Scale for Assessment of Primary Degenerative Dementia) and have a different FAST stage. 


The FAST scale is the most well-validated measure of the course of Alzheimer’s disease in published scientific literature. The scale is comprised of the following seven categories, with the first five being: 

  1. No cognitive impairment; normal function. 
  2. Possible mild cognitive impairment. 
  3. Mild cognitive impairment; interference with complex tasks. 
  4. Mild dementia, affecting everyday tasks such as cooking and banking. 
  5. Moderate dementia, whereby the person needs assistance choosing appropriate clothing, for example. 

Category six is divided into sub-stages and involves difficulties with everyday activities such as dressing and bathing. Those sub-stages include: 

  1. Difficulty dressing. 
  2. Difficulty bathing. 
  3. Inability to use the toilet without assistance. 
  4. Urinary incontinence. 
  5. Fecal incontinence. 

Once stage seven hits, the patient starts to lose the ability to speak and move. Those sub-stages are: 

  1. Severely limited speech. 
  2. Little to no intelligible speech. 
  3. Inability to walk. 
  4. Inability to sit up without assistance. 
  5. Inability to smile. 
  6. Inability to hold head up without assistance. 


Alzheimer’s disease always follows a clear progression through the FAST scale, with all steps typically occurring in order, although some stages may overlap. In the case of other forms of dementia, patients can skip stages. For Alzheimer’s patients, the FAST scale offers doctors an average expected duration for each stage, but it’s important to note that there is no exact science to the timing. The treatments a patient undertakes can affect the time it takes them to go through each stage. On average, a person with Alzheimer’s lives about four to eight years post-diagnosis, but can live as long as 20 years, according to the Alzheimer’s Association. 


By the time a patient is in hospice care they are usually in stage seven— the final stages of the disease. This is where there is significant difficulty communicating and moving independently. They typically: 

  • Require round-the-clock assistance with daily activities and personal care. 
  • Lose awareness of recent experiences and surroundings. 
  • Experience changes in physical abilities, with difficulty walking, sitting and swallowing. 
  • Have more difficulty communicating. 
  • Are vulnerable to infections, particularly pneumonia. 

In the final stages, individuals have trouble responding to their environment, carrying on conversations and controlling movement. They may still utter words or phrases, but communicating the pain they’re in or the needs they have can become very difficult. As memory and cognitive skills decline, big personality changes can occur, with patients requiring extra help with daily activities. 

Being equipped with knowledge of the FAST stages, whether at home, in a skilled nursing facility or hospice care, can help families cope, plan and come to terms with the days ahead. 

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