BioPsychoSocial Assessment Tools for the Elderly - Assessment Summary Sheet Test: Functional Assessment Staging Test (FAST) Year: 1984 Domain: Biological, Psychological, Social Assessment Tool Category: Dementia/Alzheimer’s Variations/Translations: N/A Setting: Clinical, in-patient or community-based Method of Delivery: Individual is assessed by a primary care-giver or by a person with a high level of familiarity with the patient. Description: The FAST was developed for use with Alzheimer’s disease (AD) patients to stage a patient’s level of disability with respect to AD. The FAST is comprised of 7 major levels of functioning (from normal adult to severe AD); levels 6 and 7 are additionally divided into substages (11 total). The FAST is derived from Axis V of the Brief Cognitive Rating Scale (BCRS) (Reisberg et al., 1983), which itself is derived from the Global Deterioration Scale (GDS) (Reisberg et al., 1982). The stages and substages are thus designed to correlate with the GDS global level of cognition and functional capacity measures (Sclan & Reisberg, 1992). Scoring/Interpretation: The FAST stages AD from levels 1 to 7, with level 1 representing a normal adult and level 7 representing severe AD. Thus, the higher the stage, the higher the disability level of the patient with respect to AD. Scoring is based on the highest level of consecutive disability (Sclan & Reisberg, 1992). Time to Administer: Variable, depending on the rater’s familiarity with the patient and the time required to determine disability. Availability: Available from Dr. B. Reisberg (Langone Medical Center, NYU) at no cost. Software: N/A Website: N/A Quantitative/Qualitative: Quantitative Validity (Quantitative): Concurrent validity of FAST with other psychometric and mental status assessments, including the GDS, has been established (Reisberg et al., 1984; Sclan & Reisberg, 1992). Pearson correlations between FAST and ten independent psychometric test measures ranged from 0.59 to 0.73. The Pearson correlation between FAST and the Mini-Mental State Exam (MMSE) was 0.87 (Reisberg et al., 1984). Correlation between FAST and the Ordinal Scales of Psychological Development (OSPD) was reported to be -0.60 to -0.79 for individual subtests and -0.79 overall. Ordinality of the FAST scale was determined by calculating the coefficients of reproducibility and scalability, which both demonstrated that the scale had strong validity. The coefficient of ordinality, which measures the degree to which a sample of responses approximates a unidimensional scale, was reported to be 0.9933 (>0.9 indicates a valid scale). The coefficient of scalability was reported to be 0.9827 (>0.6 indicates a truly unidimensional and cumulative scale) (Sclan & Reisberg, 1992). Reliability (Quantitative): Rater consistency (fixed effect) and rater agreement (random effect) were calculated using the intraclass correlation coefficient (ICC); excellent reliability was reported (fixed effect ICC = 0.86; random effect ICC = 0.87) (Sclan & Reisberg, 1992). References: Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24, 653-659. Reisberg, B., Ferris, S. H., Anand, R., de Leon, M. J., Schneck, M., Buttinger, C., & Borenstien, J. (1984). Functional staging of dementia of the Alzheimer's type. Annals of the New York Academy of Sciences, 435, 481-483. Sclan, S.G., & Reisberg, B. (1992). Functional Assessment Staging (FAST) in Alzheimer’s disease: reliability, validity, and ordinality. International Psychogeriatrics, 4(Suppl. 1), 55-69. Comments: Used in conjunction with the Global Deterioration Scale.