The Functional Assessment Staging of Alzheimer’s disease (FAST)

I recently became curious as to how a physician determines whether his patient with Alzheimer's Disease (AD) is in the six month widow for Hospice placement so I started to research the Functional Assessment Staging (FAST) of Alzheimer's Disease.

Staging methods are an essential tool in the assessment of disease severity in progressive dementing illness. The FAST system has been studied extensively and proven to be reliable and valid for staging dementia in Alzheimer’s disease. One of the major advantages of this system is that it spans and describes the entire course of normal aging and progressive AD until the final stages of the disease process. According to the National Hospice and Palliative Care Organization (NHPCO) FAST is used to determine hospice eligibility. The FAST identifies progressive steps and sub-steps of functional decline. NHPCO guidelines state that a FAST stage 7A is appropriate for hospice enrollment, based on an expected six month or less prognosis if the patient also exhibits one or more specific dementia-related co-morbidities. These co-morbidities are simultaneously existing conditions that make the diagnostic picture more complex, (i.e., aspiration, upper urinary tract infection, sepsis, multiple stage 3-4 ulcers, persistent fever, and weight loss greater than 10% within six months).

The FAST scale has seven stages:

1. Normal adult with no cognitive decline.

2. Normal older adult with very mild memory loss (forgetting location of objects and word finding difficulties).

3. Early dementia. Memory loss becomes apparent to co-workers and family. The patient may be unable to remember names of persons just introduced to them and may have difficulty in traveling to new locations with decreased organizational capacity.

4. Mild dementia. Persons at this stage may have difficulty with finances, counting money, planning dinner for guests, difficulty marketing. Memory loss increases. The person’s knowledge of current and recent events decreases.

5. Moderate dementia. At this stage the person needs more help to survive. They do not need assistance with toileting or eating but do need help choosing clothing. The person displays increased difficulty with serial subtraction. The patient may not know the date and year or where they live but do know who they are and the names of their family and friends.

6. Moderately severe dementia. The person may begin to forget the names of family members or friends. The person requires more assistance with activities of daily living, such as bathing, toileting, and eating. Patients in this stage may develop delusions, hallucinations, or obsessions. Patients show increased anxiety and may become violent. The person in this stage begins to sleep during the day and stay awake at night.

7. Severe dementia. In this stage, all speech is lost. Patients lose urinary and bowel control. They lose the ability to walk without personal assistance and the ability to sit up without assistance is lost. You may see individuals at this stage in nursing homes that will fall over if there are no lateral arm rests on the chair. Most will loose the ability to smile and will become bedridden and die of sepsis or pneumonia.

Although determining eligibility for an Alzheimer's dementia patient can be complex for physicians and clinicians, today, more patients than ever are now able to qualify for hospice care. To find out whether a family member is eligible for Hospice, speak to your physician or geriatric care manager for help and guidance in selecting the right Hospice agency for your loved one.