Abstract; Aminoff Suffering Syndrome: a new pathological entity in end-stage dementia.

Aminoff Suffering Syndrome a New Pathological Entity in End-Stage Dementia

Aminoff B. Z., MD, PhD
Geriatric division, Sheba Medical Center, Tel-Hashomer, 52621; Human Suffering and Satisfaction Research Center, Israel, El-Ad; E-mail: bechorz@yahoo.com

Key words: end stage dementia, suffering syndrome, dying

Context: Patient suffering is a pathological syndrome traditionally viewed as a state encompassing psychological distress, spiritual concerns and various aspects of physical pain. There is insufficient clinical evidence for suffering in dying dementia patients and key criterions of irreversible medical condition, which may lead to inappropriate evaluation and insufficient palliative treatment.

Objective: To evaluate the suffering of terminal dementia patients (MMSE=0/30, FIM=18/126) over time, from admission to a geriatric ward and on during six months follow up.
Patients and methods: A prospective study of consecutive end-stage dementia patients, admitted to a general geriatric department of a tertiary hospital. Patients were evaluated weekly by the scale (MSSE) which developed by us and presented in world and regional congresses in Berlin (1999), Jerusalem (2000), Vancouver (2001), Stockholm (2002), Tokyo (2003), , Las-Vegas (2004), Rio-de-Janeiro (2005), Madrid (2006), the Committee for Labor, Social Services and Health of the Israeli Knesset (2005) and published in Journal Archives of Gerontology and Geriatrics (2004, 38, 2, 123-130) and Age and Ageing (2006, 35, 6, 597-601).

Results: Two hundreds patients have been studied. During six months follow up survived 88 (44%) and died 112 (56%) of end stage dementia (ESD) patients whom admitted to geriatric department. The MSSE scale score of six months survived ESD patients was low with MSSE=3.41±2.02 at day of admission and decreased during six months follow up to MSSE=2.77±1.90, P=0.003. In contrary, the MSSE scale score of died ESD patients was high with MSSE=4.97±2.46 at day of admission to geriatric department and increased until last day of life until MSSE=5.93±2.39, with significant difference P≤0.0001.

Conclusion: “Aminoff Suffering syndrome” in terminal dementia is the new pathological and geriatric symptomatology and entity which characterized by high MSSE scale score, irreversible and intractable aggravation of suffering and medical condition until death and less than six months survival. “Aminoff Suffering syndrome” could be key criterion for enrolling ESD patients for palliative treatment and new alternative setting approaches as Suffering Relief Units should be developed for end stage and dying dementia patients being in Aminoff Suffering syndrome.