Having a loved one with Alzheimer’s disease can come with a lot of uncertainty. In the early stages, you might mistake your loved one’s cognitive symptoms for typical signs of aging.

As symptoms like confusion progress, knowing more about your loved one’s stage of Alzheimer’s can help you meet their needs and your own. That’s where the Functional Assessment Staging (FAST) scale comes in.

What Does the FAST Scale Measure?

The FAST scale has seven levels of Alzheimer’s disease progression. This assessment evaluates functional abilities and daily living skills as Alzheimer’s progresses.

Each of the seven stages of Alzheimer’s disease has specific criteria, stage 1 indicating the earliest phase and stage 7 representing the most advanced. Stages 6 and 7 have 11 substages between the two for a total of 16 FAST levels.

Stage 1

Stage 1 on the FAST scale indicates no changes in function. People perform daily tasks normally and show no signs of memory loss, even though changes in the brain may already be happening but aren’t yet noticeable.

Stage 2

A score of stage 2 on the FAST scale is consistent with normal aging. In this stage, your loved one might have trouble remembering names and places, or they may frequently misplace items. This stage may come with a sense of difficulty at work if your loved one is still working, although others may not notice it.

Stage 3

In stage 3 on the FAST scale, other people begin to notice your loved one’s struggles at work or in social settings. Your loved one becomes less organized and may have trouble traveling to new places.

Stage 4

Stage 4 on the FAST scale indicates mild Alzheimer’s disease. In this stage, complex tasks become more challenging for a person with Alzheimer’s. For example, they may have trouble planning events or paying bills.

Stage 5

Stage 5 on the FAST scale indicates moderate Alzheimer’s disease. In this stage, your loved one needs a little more assistance with independent functioning. They may have trouble choosing appropriate clothing for the weather or occasion, have trouble driving, or struggle to keep up with personal hygiene.

Stage 6

At stage 6, Alzheimer’s disease is moderately severe. Stage 6 lasts for around two and a half years in an otherwise healthy person. In this stage, your loved one might experience major emotional and behavioral changes as they lose independence. Stage 6 on the FAST scale has five substages:

• Stage 6A — Basic activities become more difficult without supervision and your loved one might need help getting dressed.
• Stage 6B — Bathing, dressing, and other daily self-care activities become more difficult without help from a loved one or caregiver.
• Stage 6C — Using the restroom independently becomes difficult as a person may forget to flush, wipe, or dispose of toilet paper.
• Stage 6D — Your loved one might experience urinary incontinence.
• Stage 6E — Your loved one might experience fecal incontinence, and caregivers may need to take them to the restroom often.

Stage 7

During stage 7, your loved one needs help throughout the day. Physical and neurological changes become more apparent. Stage 7 on the FAST scale is severe Alzheimer’s disease. There are six substages:

• Stage 7A — Speech becomes more challenging in this substage, and your loved one might say no more than six words or short phrases in a day.
• Stage 7B — Speech continues to worsen, and your loved one may be limited to one intelligible word a day.
• Stage 7C — Your loved one loses the ability to move independently.
• Stage 7D — Sitting up independently is no longer possible, and your loved one may fall over without armrests or other support.
• Stage 7E — Your loved one loses the ability to smile and may grimace in place of a grin.
• Stage 7F — Your loved one loses the ability to hold their head up without support in this final stage.

In the early stages of Alzheimer’s, friends and family might notice mental or behavioral changes first. As your loved one progresses through the stages of Alzheimer’s, they may start to notice the changes themselves and experience anxiety as a result.

One myALZteam member described their experience using the FAST scale to measure their son’s Alzheimer’s progression. “My son has also acknowledged that he’s sometimes more juvenile. The FAST Scale shows that as the stages progress, the cognitive ages become progressively lower. I find it very interesting that our loved ones sometimes have a sense of this happening.”

How the FAST Assessment Is Performed

Health care providers use FAST as a tool to assess a person’s Alzheimer’s disease progression and determine the next steps in treatment. In the early stages, the person may report their own symptoms and changes. As Alzheimer’s progresses, doctors will rely on input from caregivers and family members.

The FAST scale is only a guideline, and people may not progress in an exact order. Still, although Alzheimer’s has no cure, doctors can use the FAST scale stages to guide treatment. They might prescribe or adjust medications to control symptoms, modify the home care plan, or recommend interventions.

Determining Hospice Eligibility With the FAST Scale

As a caregiver for someone with Alzheimer’s, you might wonder when to consider hospice or end-of-life care. The FAST scale is a useful tool for determining the best time for your loved one to enter hospice.

Generally, hospice offers care to people with a life expectancy of six months or less. This care involves managing symptoms and improving quality of life.

Typically, when a person with Alzheimer’s reaches stage 7 on the FAST scale, they qualify for hospice care because of how much their physical and mental abilities have declined. The FAST scale doesn’t account for other diagnoses that could affect a person’s eligibility for hospice care.

Consult your loved one’s health care providers to decide on the best time to consider hospice based on their overall health.

What Caregivers Should Know

The FAST scale helps you better understand your loved one’s disease progression. This information can help you communicate more effectively with physicians and other caregivers and help you plan for the future.

Scoring on the FAST scale can also help build understanding and support among Alzheimer’s caregivers. One myALZteam member noted, “The FAST stages are very useful for carers to compare their cases in a neutral framework because it’s the day-to-day issues that weigh us down and make us seek contact with other carers to support each other. And the stages facilitate communication.”

Knowing your loved one’s current stage of Alzheimer’s according to the FAST scale can help you prepare for future changes. Based on their stage, you might consider:

• Modifying the home for accessibility
• Purchasing medical supplies your loved one might need, like a wheelchair
• Exploring options for hospice or palliative care (relieves pain and symptoms of serious illness to improve quality of life)
• Considering an assisted living facility
• Scheduling counseling for your loved one to cope with the changes

It’s easy to focus on your loved one’s changing needs as they progress through the FAST scale stages of Alzheimer’s disease. However, caregivers’ needs also change through the process. Take care of yourself, and don’t neglect your own physical, emotional, and financial needs. Consider joining an Alzheimer’s caregiver support group, establishing a support network of friends and family, or exploring self-care tips for Alzheimer’s caregivers to avoid burnout.

Talk With Others Who Understand

On myALZteam, the social network for people with Alzheimer’s disease and their loved ones, more than 86,000 members come together to ask questions, give advice, and share their stories with others who understand life with Alzheimer’s disease.

Have you used the FAST scale to measure a loved one’s Alzheimer’s progression? Share your experience in the comments below, or start a conversation by posting on your Activities page.