Patient Name:                                                                                    Date:                             
 

FUNCTIONAL ASSESSMENT STAGING TOOL
(for Alzheimer's Disease)
1984 Barry Reisberg MD

Check if present

Stage

Assessment
(score is highest consecutive level of disability)

 

1

No difficulties, either subjectively or objectively.

 

2

Complains of forgetting location of objects; subjective word finding difficulties only.

 

3

Decreased job functioning evident to coworkers; difficulty in traveling to new locations.

 

4

Decreased ability to perform complex tasks (e.g., planning dinner for guests; handling finances; marketing).

 

5

Requires assistance in choosing proper clothing for the season or occasion.

 

6a

Difficulty putting clothing on properly without assistance.

 

6b

Unable to bathe properly; may develop fear of bathing. Will usually require assistance adjusting bath water temperature.

 

6c

Inability to handle mechanics of toileting (i.e., forgets to flush; doesn't wipe properly).

 

6d

Urinary incontinence, occasional or more frequent.

 

6e

Fecal incontinence, occasional or more frequent.

 

7a

Ability to speak limited to about half a dozen words in an average day.

 

7b

Intelligible vocabulary limited to a single word in an average day.

 

7c

Nonambulatory (unable to walk without assistance).

 

7d

Unable to sit up independently.

 

7e

Unable to smile.

 

7f

Unable to hold head up.