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Clinical Manifestations.

Brant Mittler1, Ying Wang2, Joel Reisman3

  • 1Geriatric Research Education & Clinical Center, VA South Texas Healthcare System, San Antonio, TX, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

The Functional Assessment Screening Tool (FAST) may underestimate Alzheimer's disease severity compared to the Montreal Cognitive Assessment (MoCA). However, FAST offers a practical alternative for tracking disease progression in clinical settings.

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Area of Science:

  • Neurology
  • Geriatrics
  • Clinical Assessment

Background:

  • Alzheimer's disease (AD) diagnosis and staging rely on cognitive and functional assessments.
  • The Functional Assessment Screening Tool (FAST) measures functional changes in AD.
  • The Montreal Cognitive Assessment (MoCA) is a standard cognitive screening tool for AD.

Purpose of the Study:

  • To determine the correlation between FAST scores and MoCA-defined cognitive stages in patients with mild cognitive impairment (MCI) or AD.
  • To establish FAST score thresholds that align with different stages of cognitive impairment.

Main Methods:

  • Paired FAST and MoCA scores were analyzed from 405 patients within the Veteran's Affairs Healthcare System (2020-2024).
  • Statistical analyses included calculating means, standard deviations, medians, and ranges for FAST scores at different MoCA-defined stages.
  • Linear and repeated measures mixed-effects models were employed, adjusting for patient demographics.

Main Results:

  • MoCA cut-offs identified stages: Normal (≥29), MCI (26), Mild (18), Moderate (11), and Severe (≤10).
  • Corresponding mean FAST scores indicated stages: MCI (3.3), Mild (3.8), Moderate (4.8), and Severe (5.8).
  • FAST scores showed a tendency to underestimate disease severity compared to MoCA, with over half of patients scoring in the normal/preclinical FAST range (1 or 2) while only one patient scored normal on MoCA.

Conclusions:

  • This study established FAST score thresholds that correspond to cognitive stages from normal to severe AD, based on a crosswalk with MoCA scores.
  • While FAST is a valuable global functional assessment tool, it may not capture the full extent of cognitive decline indicated by MoCA.
  • FAST remains a useful and widely utilized clinical instrument for monitoring AD progression.