7 Stages of Dementia: Understanding the FAST Scale & Score Results

Dementia has different stages that signify how the disease has progressed in a patient and what is currently happening to their state of mind and body. 

Understanding the correct stage helps caregivers, family members, and medical professionals know what is happening to their loved ones and how they can prepare the patient for future challenges.

What is the FAST Scale?

 FAST stands for Functional Assessment Staging Tool, and it was developed by Dr. Barry Reisberg, a leading expert in Alzheimer’s disease. While other scales such as GSD focus on cognitive decline, FAST concentrates on a person’s ability to function normally and perform daily tasks.

Dementia is usually categorized into three stages: early or mild stage, middle stage, and late stage. The FAST scale explores each stage by delving deeper into them and breaking them down into detailed and comprehensible descriptions.

The FAST scale divides dementia into seven stages where each stage is associated with a label of function or the disease:

  • Stage 1: Normally functioning adult
  • Stage 2: Normally functioning senior adult
  • Stage 3: Early dementia
  • Stage 4: Mild dementia
  • Stage 5: Mid-stage dementia
  • Stage 6: Moderately severe dementia
  • Stage 7: Severe (final stages) of dementia

What does each stage in the FAST scale mean?

 At stage 1, an individual is free of any functional and cognitive decline. They are normal adults of any age who are mentally healthy.

At stage 2, an individual demonstrates ‘normal aged forgetfulness.’ This can be defined as memory lapses such as forgetting the name of acquaintances or misplacing items like glasses and house keys. Some may find it challenging to concentrate and focus at work, while others may sometimes struggle to find the right words. Experts believe that stage 2 can be considered normal for senior adults.

At stage 3, work issues progress to a higher level, and individuals may find it difficult to travel to new places. At this point, patients are often seen repeating a story over and over. Concentration becomes even more difficult, and the person may not be able to perform complex tasks like handling personal finances or planning dinner for guests.

By stage 4, most dementia patients are diagnosed because of their apparent cognitive impairment. The individual starts forgetting major or recent events or has trouble remembering what day or month it is. Although most individuals still have an adequate level of independence and can remember things like their address and phone number, patients have difficulty handling things like fixing meals or paying bills. At this point, the patient is in the early stages of dementia.

At stage 5, the patient has moved onto the middle stage and needs assistance for most tasks. They can perform some basic chores like feeding themselves, but someone else would have to prepare meals for them. Confusion, hallucination, suspiciousness, wandering, and other problematic behaviors begin at this stage. The person with dementia requires 24/7 attention and a full-time caregiver to tend to their needs.

Stage six can be divided into sub-stages that include:

  • Dressing difficulties
  • Difficulty in bathing
  • Inability to use the toilet without assistance
  • Urinary incontinence
  • Fecal incontinence

At stage 6, the person with dementia will require 24/7 supervision and become entirely dependent on their caregiver for assistance in everything they do. This stage is considered the beginning of severe dementia. Patients may develop severe mobility issues and start losing their ability to speak. At stage 6, many caregivers and family members find it necessary to transfer the patient to a specialized memory care community.

As the patient approaches the final stage, they start to lose the ability to move and speak. Stage 7 can be divided into these sub-stages:

  • Severely limited speech
  • Little or no intelligible speech
  • Inability to smile
  • Inability to walk
  • Inability to sit up without assistance
  • Inability to hold head up

Stage 7 is the final and last stage of cognitive disease. The patient’s ability to speak will eventually go away, and gradually they will lose their remaining abilities. Communication with others will become impossible. Finally, the body will stop responding and start to shut down.

Understanding the FAST Score Results

The FAST scale provides caregivers and family members a framework to assess and monitor the progress of a patient with dementia. Out of all the measures, the FAST scale has been accepted as the most accurate in identifying critical stages of this disease. Suppose an individual loses certain abilities that are listed at a later stage but still performs tasks from an earlier stage. In that case, it is possible that their mental issues are not due to Alzheimer’s disease. This information is very useful and helpful because it means that the patient can potentially be treated. If the patient has reached stage 7, caregivers can see that as an indication that they need respite care hospice.