Dementia
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Table 8. Functional Assessment Staging Scale (FAST) – 7 stages
1. No difficulty, subjectively or objectively.
2. Complains of forgetting location of objects. Subjective work difficulties.
3. Decreased job functioning evident to coworkers. Difficulty in traveling to new
locations. Decreased organizational capacity.
4. Decreased ability to perform complex tasks (i.e. planning dinner for guests,
handling personal finances, forgetting to pay bills).
5. Requires assistance in choosing proper clothing to wear for the day, season or
occasion (i.e. patient may wear the same clothing repeatedly, unless supervised).
6. Occasionally or more frequently over the past weeks
a. Improperly putting on clothes without assistance or cueing.
b. Unable to bathe properly (not able to choose proper water temperature).
c. Inability to handle mechanics of toileting (i.e. forgets to flush the toilet, does
not wipe properly or properly dispose of toilet tissue).
d. Urinary incontinence.
e. Fecal incontinence.
7. a. Ability to speak limited to approximately <6 intelligible different words in the
course of an average day or in the course of an intensive interview.
b. Speech ability is limited to the use of a single intelligible word in an average day
or in the course of an intensive interview.
c. Ambulatory ability is lost (cannot walk without personal assistance).
d. Cannot sit up without assistance (i.e. the patient will fall over if there are not
lateral rests on the chair).
e. Loss of ability to smile.
f. Loss of ability to hold up head independently.
STEP 13: Assess for behavioral and psychological
symptoms of dementia (BPSD)
➤ These symptoms can include agitation, anxiety, confusion, psychosis
(delusions and hallucinations), resistance to care, disinhibition, and
changes in sleep pattern.
➤ There is significant overlap with depression and delirium.
➤ Of note, dementia residents are medically stable during these
behavioral episodes.
➤ Always consider medication side effects in the evaluation of new
behaviors.
