FAST — Functional Assessment Staging Tool (Reisberg)
7-stage functional staging of Alzheimer-type dementia (Reisberg 1988). Stages 1–7 reflect cognitive and functional decline; stages 7a–7f delineate end-stage dementia. FAST 7a–c is commonly used to determine hospice eligibility (US criteria) but is widely cited internationally for prognostication.
Score interpretation
→ Confirm diagnosis (memory clinic). Address vascular risk; lifestyle interventions. Cholinesterase inhibitor only when functional impairment present (Stage 4).
→ Cholinesterase inhibitor (donepezil / rivastigmine / galantamine — NICE TA217). Assess driving (DVLA). Power of attorney; advance care planning. Carer support.
→ Memantine considered (NICE TA217). Address behavioural and psychological symptoms (BPSD) non-pharmacologically first; risperidone short-term only if severe distress / risk. Continence care, falls prevention. Begin advance/palliative care discussions.
→ Palliative-focused care (hospice referral; FAST 7c with ≥1 medical complication = US hospice eligibility). Comfort feeding rather than artificial nutrition (NICE NG97 / RCP 2021). PAINAD for non-verbal pain assessment. Family bereavement support.
Interpretation bands for the FAST. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Donepezil · Acetylcholinesterase inhibitor (AChEI) — dementia
- Memantine · NMDA receptor antagonist — dementia
- Rivastigmine · Dual AChEI and BuChEI inhibitor — dementia
- Quetiapine (Elderly — Dementia Caution) · Atypical Antipsychotic
- Memantine · NMDA Receptor Antagonist — Dementia
- Rivastigmine · Acetylcholinesterase Inhibitor — Dementia
- Falls Assessment in Older Adults · NICE CG161 2013
- Delirium Outside ICU · NICE CG103
- Comprehensive Geriatric Assessment (CGA) · BGS / NICE
- Delirium Assessment and Management · NICE CG103 2010
- Frailty Recognition and Management · BGS Frailty Framework / NHS NHSE
- Polypharmacy and Medicines Optimisation · STOPP/START v2 2014 / NICE NG5
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.