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FAST Scale

Functional Assessment Staging of Alzheimer’s Disease. (FAST)

Normal Aging

1. No difficulties, either subjectively or objectively.

Possible Mild Cognitive Impairment

2. Complains of forgetting the location of objects. Subjective word finding difficulties.

Mild Cognitive Impairment

3. Decreased job function evident to co-workers;
difficulty in traveling to new locations. Decreased organizational capacity.

    • expected duration for this stage 84 months approximant mental age 12+ years.

Mild Dementia

4. Decreased ability to perform complex tasks (e.g., planning dinner for guests), on occasion, handling personal finances (forgetting to pay bills), difficulty shopping, etc.

    • expected duration for this stage 24 months approximant mental age 8-12 years.

Moderate Dementia

5. Requires assistance in choosing proper clothing to wear for day, season, occasion.

    • expected duration for this stage 18 months approximant mental age 5-7 years.

Moderately Severe Dementia

6a. Difficulty putting clothing on properly without assistance.

    • expected duration for this stage 4.8 months approximant mental age 5 years.

6b. Unable to bathe properly; (e.g., difficulty adjusting bath water temperature)
occasionally or more frequently over the past weeks.*

    • expected duration for this stage 4.8 months approximant mental age 4 years.

6c. Inability to handle mechanics of toileting (e.g., forgets to flush the toilet, does not wipe properly or properly dispose of toilet tissue) occasionally or more frequently over the past weeks.*

    • expected duration for this stage 4.8 months approximant mental age 4 years.

6d. Urinary incontinence, occasional or more frequent. 

    • expected duration for this stage 3.6 months approximant mental age 3-4 years.

6e. Fecal Incontinence, (occasional or more frequently over the past week).

    • expected duration for this stage 9.6 months approximant mental age 2-3 years

Severe Dementia

7a. Ability to speak limited to approximately a half dozen different words or fewer, in the course of an average day or in the course of an intensive interview.

    • expected duration for this stage 12 months approximant mental age 1.25 years

7b. Speech ability limited to the use of a single intelligible word in an average day or in the course of an interview (the person may repeat the word over and over.)

    • expected duration for this stage 18 months approximant mental age 1 years.

7c. Ambulatory ability lost (cannot walk without personal assistance).

    • expected duration for this stage 12 months approximant mental age 1 years.

7d. Ability to sit up without assistance lost (e.g., the individual will fall over if there are no lateral rests [arms] on the chair).

    • expected duration for this stage 12 months approximant mental age 0.5-0.8 years.

7e. Loss of the ability to smile.

    • expected duration for this stage 18 months approximant mental age 0.2-0.4 years.

7f. can no longer hold up their head

    • expected duration for this stage 12 months approximant mental age 0-0.2 years.
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Clock Test For Measuring Dementia.

There is a fairly simple at home test that can be used to measure a loved one who is suspected of dementia. It is the Clock Test.

The basics are to ask the person to draw an analog clock with the time at 11:10, be sure that it is complete with all of the numbers. This test is extremely easy to administer at home and only requires a pencil and paper. Yet it measures a number of things. First it measures the verbal understanding.  Does the tested understand what you are asking them to do? Or do you have to further explain and may even need to show a picture or draw a clock yourself. Second it measures their short-term comprehension.  While a normal adult could draw the clock within less than a minute. A dementia sufferer may require several minutes to complete the task. Sometimes asking what are they supposed to do.  Third longer term memory, does the tested remember what a clock looks like or did it require a picture or looking at a clock?  Fourth an understanding of spatial relationship are they able to put the number in the correct location or are they skewed all on one side, not evenly spaced or perhaps not in the correct order.  Can they draw a good circle, is the circle closed. Did it start and end at the same place. It could be open or over lapping.  Perhaps the circle does not meet or finishes above or below the starting location. Did they put the hand on the clock? Do they both start in the center? Are they pointing to the correct time or did it require a reminder. Since the hands are often the last thing to be drawn is not uncommon for them to forget what time they were asked to draw on the clock. Fifth critical thinking, planning and thinking ahead how did the tested set about to draw the clock? A rational thinker will first draw a circle then put 12 at the top then 6 at the bottom the three in the right quadrant and the 9 in the left. After that they will fill in the rest of the numbers. And the hands last the hands may be simple lines or elaborate ornate hands.

I am not going to get into testing on this post. This is just a preliminary guide to help the layperson identify a possible dementia sufferer.

The instructions should be “I would like you to draw a clock, put in all the numbers, and set the hands for 10 after 11.”


If you administer this test I would love to hear from you. I would also like to share a photo the clock drawing.

Clifton

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Holiday Food for Thought

Every year at this time my home is transformed into a warm and cozy Holiday Haven. The furniture is moved to accommodate the Christmas tree. Festive centerpieces and bowls of candy and nuts are added to every table. There are blinking lights, candles and a fire in the fireplace to set the house a glow. Looks wonderful to me….. But to someone Living with Alzheimers or Dementia, it could be very unsettling. If we reside with someone Living with Alzhemeirs…How can we minimize their stress? Which will undoubtingly minimize yours. 

First and foremost, plan ahead. You know your loved one better than anyone else. Second, use common sense. Don’t plan a six-course meal for ten people, knowing your loved one is unable to sit for an extended length of time without getting agitated. Thirdly, be flexible. Any Holiday festivity set in stone is no fun anyway. Take your cues from your loved one.

Set your loved one up for success by making a few adjustments to your Holiday grandeur. Remember, the Christmas tree may get knocked down or ornaments may be pulled from its branches. So, shatterproof ornaments usually work the best. Also, keep any heirlooms in places they can be seen but not touched. Don’t forget all the edible items we use as tree ornaments. The strings of popcorn and cranberries, candy canes and cookie dough ornaments are all very tempting. Depending on the “stage” of Alzheimer’s your loved one is currently in, you might want to skip the tree altogether. 

There are some other unedible and potentially harmful items you need to keep in mind….. Holiday plants. At some stages of Dementia and Alzheimer’s, items in the hand, go straight to the mouth, this can be very concerning. A few plants that come to mind are poinsettias, mistletoe, holly berries, yew, the Christmas Rose, Jerusalem Cherry, and Amaryllis. All vary in toxicity depending on plant and amount consumed. If in doubt, call Poison Control at 1-800-222-1222

Now on to one of my favorite Holiday traditions….. Food, food and more food. For starters, maybe that communal bowl of candy or nuts might need to be put out of reach before it all disappears. Back to that six-course meal. Besides the normal finger food appetizers, try modifying your recipes to finger food status. Stuffing in a square pan and cut into bitesize pieces would be great. How about potatoes cut into bite-sized pieces instead of mashed?  You and I both know anything wrapped in bacon or puff pastry is scrumptious and easy to eat. Oh, one more thing. Remind your family and friends that if they leave their plate unattended, it may be invaded by the fingers of a passerby enjoying a quick bite.

Most of you who have a loved one living with Alzheimer’s or Dementia understand the dangers of an unattended candle or fireplace. What about the house lights being turned down low to enhance the twinkle of the Holiday lights? Have you ever noticed how things look vastly different in the dusk and dawn? This may be the same effect inside lighting changes have on your loved one. Their visual perception is already compromised by the Alzheimer’s. Reducing the lighting can cause things to seem stranger than they already appear. Now add to that, blinking lights and spotlights of large figures dancing on the walls. That could be terrifying.  Calm and soothing routine lighting is usually the best. So, try to keep the lighting distractions to a minimum for a much more comfortable experience. 

You know your loved one better than anyone else. Trust your instincts. Remember to them, you are their safe place. So, enjoy all your loved ones this Holiday season. You are not alone….. You can do this.   

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The Last Holidays

Awwwwwww…… the Holidays are upon us. What do the Holidays mean to you? What is your first thought when you flip that calendar page and November stares you in the face?

My mind turns to the dreadful rush of shopping, food preparation and the gatherings of family and friends. Then it pleasantly goes back to a simpler time. Memories of our big Thanksgiving dinners at my childhood home pop into my mind. Suddenly it is flooded with the memories of my Last Thanksgiving spent with loved ones who are no longer physically on this earth. There my mind stays savoring the nostalgia and then the sadness washes over me. Of course, there are many Thanksgiving memories in between now and then. Those are not forgotten, just overshadowed by the absence of those precious family members.

After Thanksgiving, we quickly move to the Christmas festivities. For me Christmas has not been the same since my little children became young adults. The magical moments of children’s excitement are long gone. Santa. reindeer, decorating the tree and opening presents, all lose their magic. I try to concentrate on planning gatherings with family and friends. Then, of course, my mind wonders once again to the Last Christmas memories of those special loved ones who are no longer able to celebrate with us.

Those of you who have Loved Ones Living with Alzheimer’s or Dementia may also struggle with the wonderful memories of past Holiday celebrations. Then, possibly your mind wanders to, “This may be my last holiday them”. The Alzheimer’s or Dementia continues to progress and other illnesses can set in at any time. You say to yourself, “How can we make great holiday memories with the daily challenges we face?” Here are some ideas to help you and your loved ones plan a celebration to remember.

Keys to Having a Happy Holiday

  1. Change your expectations.
  2. Build on past traditions that were most meaningful to Your Loved One with Alzheimer’s or Dementia
  3. Involve your loved one as their abilities allow
  4. Prepare your friends and family of the changes the two of you are going through
  5. Decrease the size of the gathering. Encourage them to visit at different times or even different days for short periods of time.
  6. Have visitors wear name tags (this may help, depending on the stage of Alzheimer’s)
  7. If people ask about gift giving. Suggest useful gifts like favorite foods, comfortable clothing or soft cuddly items ( stuffed animals or small blankets). Don’t forget yourself. If asked, suggest gift certificates for self-care or help with household responsibilities.
  8. If you receive invites  and your loved one is not able to attend, ask a friend or family member to sit with your loved one and go by yourself
  9. Stick to your loved ones routine as much as possible. 
  10. Follow your instincts. No one knows your loved one like you do.  

Hopefully, these few tips will help you and your loved ones celebrate the best possible Holidays this season. Making memories to share for years to come. Remember, you are not alone….. You can do this. 

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A Difficult Time

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Loss and Grief

The middle of July through the end of the year is a difficult time for my family and me. We are reminded that the world continues to spin and time keeps moving forward even after a great loss. Although this difficult time does not directly pertain to Alzheimer’s and Dementia it may hit home with some of you. My thoughts are unorganized and the words don’t flow smoothly together. My lack of focus can leave my mind foggy and my body exhausted. I guess grief can do that to you.

Experts say there are seven stages of grief. I’ve found that these stages do not go in any particular order and are often repeated. These stages are Shock and Disbelief, Denial, Pain, Anger, Bargaining, Depression and Acceptance/Hope. There are also different types of losses that we grieve. Of course, the loss of a Loved One to death’s door is the one most people associate with grief. Some other losses we mourn are Loss of Relationships, Employment, and Health.

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Grief is exhausting and can become very overwhelming. I’ve learned that you need to feel your feelings and talk about them. As painful as that may sound, and it is painful, you have to give space to them. If not, that emotion will begin to fester and intensify until the blister finally pops. Leaving an uncontrollable ooze of negativity that can push you into a very dark place.

In that first year of my journey with grief, I stuffed my many painful emotions into a “closet”. Struggling every day to keep those “monsters” hidden behind that bulging “closet door”. I was so very afraid to confront those monstrosities of soul-shattering pain. I was using all my strength and every ounce of energy to forcefully keep that “door” shut. I found myself in a very dark place. I was very fortunate to find a safe place to allow those “monsters” out of the “closet” and talk about my shattered heart, lost hope and disappearing dreams.

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Don’t Let Grief Guide Your Path

The old adage “Time heals all wounds”, is not completely true for me. Time does not heal all wounds. Even when the wounds appear to heal, there are scars left behind. These scars are a reminder of our brokenness and the strength it took to gather those pieces and put ourselves back together. Time does not heal, but using that time to learn to feel our feelings does somewhat in time ease the pain just a little. This allows us to cope with these scars without allowing them to define who we are.

Grief is difficult. Give yourself permission to talk about it. Talking about it takes away its power to consume you. Don’t let grief guide your path. Find a comfortable balance that allows grief to walk with you through this thing we call life.

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Must See Movie About Feeling Your Feelings

 

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