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FAST Scale for Dementia: Functional Assessment Staging (Stages 1-7)

The FAST (Functional Assessment Staging) is a clinician-rated scale that stages Alzheimer's disease by the everyday abilities a person has lost, from stage 1 (no difficulty) to stage 7 (very severe decline). Stages 6 and 7 are split into substages 6a to 6e and 7a to 7f, and the stage is the highest consecutive level of disability.

For professional reference, research, and education only. Not for diagnosis or medical advice.

FAST Stage Reference

  • Enter a total score to see its range.

  • Pick the highest stage the person has reached in consecutive order; stages 6 and 7 are recorded with their substage (for example 6c or 7a). Deficits that appear out of order are noted separately. Stage descriptions are paraphrased, not the wording of the form.

    FAST stageInterpretation
    7+Stage 7: very severe declineSubstages: 7a speech limited to about six words or fewer in a day; 7b only one intelligible word; 7c can no longer walk without personal help; 7d can no longer sit up without support; 7e can no longer smile; 7f can no longer hold up the head unaided.
    6Stage 6: severe declineSubstages: 6a needs help or cues to dress correctly; 6b cannot bathe properly without help; 6c cannot manage the mechanics of toileting; 6d urinary incontinence; 6e bowel incontinence.
    5Stage 5: moderately severe declineNeeds help choosing clothing suited to the day, season or occasion.
    4Stage 4: moderate declineReduced ability to carry out complex tasks such as planning a meal for guests, managing money and bills, or shopping.
    3Stage 3: mild declineDecline at work noticed by colleagues, difficulty travelling to unfamiliar places and reduced ability to organize.
    2Stage 2: very mild declineSubjective complaints only, such as misplacing objects or difficulty finding words.
    1Stage 1: no difficultyNo functional difficulty, either reported or observed.

    Reisberg B. Functional assessment staging (FAST). Psychopharmacol Bull. 1988;24(4):653-9. Seven stages, with substages 6a to 6e and 7a to 7f.

The FAST (Functional Assessment Staging) stages Alzheimer's disease by the everyday abilities a person has lost, across 7 stages and 16 levels from normal function to very severe decline [1] [2]. It is the functional companion to the Global Deterioration Scale, by the same author [4].

What does the FAST measure?

The FAST measures functional decline: the order in which a person with Alzheimer's disease loses the ability to work, manage complex tasks, dress, bathe, use the toilet, speak, walk and finally hold up their head [1]. Barry Reisberg developed it at the New York University Aging and Dementia Research Center, and it was published in 1988 [1] [2].

It was built to cover the whole course of the disease, including the severe stages where cognitive screens such as the MMSE reach their floor and can no longer separate one person from another [2] [8]. Because it rates what a person can still do rather than test answers, it is described as relatively free of the education and cultural biases that affect mental status tests [7] [9].

The FAST and the Global Deterioration Scale

The FAST was derived from the Global Deterioration Scale (GDS), Reisberg's 1982 seven-stage scale of overall cognitive decline [3] [5]. The two are used together as the GDS/FAST staging system [4]. FAST stage numbers line up with GDS stage numbers, and the FAST divides GDS stages 6 and 7 into substages to describe late-stage decline in more detail [5]. The GDS rates overall cognitive decline; the FAST rates function alone, and its substages keep tracking change after a person reaches GDS stage 6.

Note that the Global Deterioration Scale is not the same as the Geriatric Depression Scale, which is also abbreviated GDS.

Terms of use

Published copies of the FAST carry the notice "copyright 1984 by Barry Reisberg, M.D. All rights reserved." No general licence terms from the copyright holder were found. The stage descriptions on this page are paraphrased; use the form itself from an authorized source.

How do you give the FAST?

  • Who rates it. A clinician or trained member of the care team. It is a rating, not a test the person completes.
  • Sources of information. An interview with the person, observation, and a knowledgeable informant or caregiver. The form marks several stages as scored mainly from informant report [1].
  • Time window. Several stage 6 items ask whether the difficulty has occurred occasionally or more often over the past weeks [1].
  • Repeat ratings. Because the stages are ordered, re-staging over time shows the course of decline [2] [4].
  • Who it is for. Adults with known or suspected Alzheimer's disease. It stages severity; it does not diagnose dementia.

How do you score and interpret the FAST?

  1. Work up from stage 1 and find the highest stage the person has reached in consecutive order. That is the FAST stage [1].
  2. For stages 6 and 7, record the substage (for example 6d or 7c).
  3. Note separately any losses that appear out of order. In one hospice study, 41% of people with dementia could not be staged because their losses were not in order [10].
FAST stageParaphrased descriptionMatching GDS stage
1No functional difficulty, reported or observed1, no cognitive decline
2Subjective complaints, such as misplacing objects or word-finding difficulty2, very mild cognitive decline
3Decline noticed at work, difficulty travelling to new places, reduced ability to organize3, mild cognitive decline
4Reduced ability with complex tasks such as finances, shopping or planning a meal for guests4, moderate cognitive decline
5Needs help choosing appropriate clothing5, moderately severe cognitive decline
6a-6eNeeds help dressing (6a), bathing (6b), toileting (6c); urinary (6d) then bowel (6e) incontinence6, severe cognitive decline
7a-7fSpeech limited to a few words (7a) then one word (7b); loses walking (7c), sitting up (7d), smiling (7e), head control (7f)7, very severe cognitive decline

The FAST stages come from Reisberg (1988) [1]; the GDS stage names come from Reisberg et al. (1982) [3]. The FAST and GDS share stage numbers [4] [5], but they rate different things, so a person can be staged differently on each. Because functional loss in Alzheimer's disease follows a characteristic order, the developers describe the FAST as an aid to diagnosis and differential diagnosis [2].

The FAST stages describe the typical course of Alzheimer's disease [2]. A stage is a description of current function, not a prediction for any one person.

Psychometric properties

  • Reliability, validity and ordinality. Three investigations reported by the scale's developers found the FAST reliable and valid across the entire course of Alzheimer's disease, and found that function declines in the characteristic order the stages describe [2].
  • Correlation with cognition. In 464 Korean adults with probable Alzheimer's disease, the FAST correlated with the Korean MMSE (r = -0.71) and with the Clinical Dementia Rating and activities of daily living scales (all p < 0.001) [6].
  • Separating normal cognition, MCI and Alzheimer's disease. A Persian version tested in 219 older adults had a sensitivity of 92.2% and specificity of 98.0% for separating normal cognition from mild cognitive impairment, and 99.0% and 93.7% for separating Alzheimer's disease from mild cognitive impairment (areas under the curve 0.952 and 0.982) [7].
  • Severe stages. In 70 people with severe Alzheimer's disease, MMSE scores were at or near the floor, but a cognitive battery for severe dementia correlated with the 11 FAST substages present in the sample (Spearman rho = -0.77) [8].
  • Sensitivity to treatment. In pivotal trials in moderate to severe Alzheimer's disease, the FAST showed a significant medication effect where the MMSE did not [9].
  • Hospice survival. In hospice cohorts, people who had reached stage 7c at enrolment lived a mean of 3.2 months [10] and 4.1 months [11].

Limitations

  • Not a diagnosis. The FAST stages severity once Alzheimer's disease is suspected or diagnosed; it does not diagnose dementia or tell dementia types apart on its own.
  • Not everyone declines in order. In one hospice study, 41% of people with dementia could not be staged because their losses were not ordinal [10]. Physical illness, stroke or other dementias can cause functional losses out of sequence.
  • Hospice use. People who could not be staged lived longer than those at stage 7c, and the authors warned that relying on the FAST alone could reduce access to hospice care [10] [11]. The Medicare hospice guideline for Alzheimer's disease and related disorders lists stage 7 or beyond as one of several required characteristics, not as a criterion on its own [12].
  • Informant-dependent. Several stages are scored mainly from a caregiver's report [1], so accuracy depends on how well the informant knows the person's daily life.
  • Coarse in early stages. Stages 1 to 5 each rest on a few broad abilities; use cognitive tests such as the MoCA or SLUMS to describe early cognitive change in more detail.
  • Copyrighted form. No general licence terms from the copyright holder were found, so care teams should source the form appropriately.

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

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FAQ

  • What are the 7 stages of the FAST scale?

    Stage 1 is no functional difficulty and stage 2 is subjective forgetfulness. Stage 3 brings decline noticed at work and in travelling to new places, and stage 4 trouble with complex tasks such as finances. In stage 5 the person needs help choosing clothes, in stage 6 help with dressing, bathing and toileting, and stage 7 is the loss of speech, walking and finally head control.

  • What do the FAST substages 6a to 7f mean?

    Stage 6 has five substages (6a to 6e) that track loss of dressing, bathing, toileting and then bladder and bowel control. Stage 7 has six substages (7a to 7f) that track loss of speech, then walking, sitting up, smiling and holding up the head. Together with stages 1 to 5 the FAST describes 16 levels.

  • How does the FAST relate to the Global Deterioration Scale?

    Both were developed by Barry Reisberg and are used together as the GDS/FAST staging system. The FAST stages carry the same numbers as the seven Global Deterioration Scale stages, but the FAST rates function only and divides the last two stages into substages, so it keeps tracking change after cognitive tests reach their floor.

  • How is the FAST used in hospice care?

    Hospice studies in the United States have used FAST staging to identify people with advanced dementia. In one study, people who had reached stage 7c lived a mean of 3.2 months after hospice enrolment, but 41% could not be staged because their losses did not follow the expected order. The authors cautioned against relying on the FAST alone. In the Medicare hospice guideline for dementia due to Alzheimer's disease and related disorders (local coverage determination L34538), stage 7 or beyond on the FAST is one of several characteristics a person must show, and a progressive decline from stage 7A or beyond counts as a decline in clinical status. The guideline says it is not meant for other dementias such as multi-infarct dementia.

References

    1. 1.Reisberg B. Functional assessment staging (FAST). Psychopharmacol Bull. 1988;24(4):653-9.
    2. 2.Sclan SG, Reisberg B. Functional assessment staging (FAST) in Alzheimer's disease: reliability, validity, and ordinality. Int Psychogeriatr. 1992;4 Suppl 1:55-69.
    3. 3.Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982;139(9):1136-9.
    4. 4.Auer S, Reisberg B. The GDS/FAST staging system. Int Psychogeriatr. 1997;9 Suppl 1:167-71.
    5. 5.Kayhan Koçak FO, Kumral E. The relationship between dementia staging scales, cognitive-behavioral scales and functionality in patients with cognitive impairment. PLoS One. 2025;20(5):e0322572.
    6. 6.Na HR, Kim SY, Chang YH, et al. Functional assessment staging (FAST) in Korean patients with Alzheimer's disease. J Alzheimers Dis. 2010;22(1):151-8.
    1. 7.Noroozian M, Reisberg B, Farhadi A, et al. Translation and psychometric evaluation of a Persian version of the functional assessment staging scale (I-FAST) in older patients with mild cognitive impairment and Alzheimer's disease in Iran. Acta Neurol Belg. 2022;122(4):987-996.
    2. 8.Auer SR, Sclan SG, Yaffee RA, Reisberg B. The neglected half of Alzheimer disease: cognitive and functional concomitants of severe dementia. J Am Geriatr Soc. 1994;42(12):1266-72.
    3. 9.Reisberg B. Global measures: utility in defining and measuring treatment response in dementia. Int Psychogeriatr. 2007;19(3):421-56.
    4. 10.Luchins DJ, Hanrahan P, Murphy K. Criteria for enrolling dementia patients in hospice. J Am Geriatr Soc. 1997;45(9):1054-9.
    5. 11.Hanrahan P, Raymond M, McGowan E, Luchins DJ. Criteria for enrolling dementia patients in hospice: a replication. Am J Hosp Palliat Care. 1999;16(1):395-400.
    6. 12.Centers for Medicare & Medicaid Services. Local Coverage Determination L34538: Hospice Determining Terminal Status (CGS Administrators). Revision effective 2026-08-06.

  • Copyright 1984 Barry Reisberg, MD. All rights reserved (notice printed on published copies of the form). No general licence terms from the copyright holder were found; this page describes the stages in its own words and does not reproduce the form.

HiBoop does not offer this scale. This page is reference material.

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