Abstract: Aminoff suffering syndrome and decubitus ulcers in advanced dementia

Background: To study possible interrelations between Aminoff suffering syndrome and decubitus ulcers in advanced dementia. Our proposal 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. The MSSE that was developed by us and presented at world and regional congresses in Berlin (1999), Jerusalem (2000), Vancouver (2001), Stockholm (2002), Tokyo (2003), Las Vegas (2004), Rio de Janeiro (2005), Madrid (2006), Saint-Petersburg (2007), Trondheim (2008), Paris (2009).

Methods: A prospective study of 200 consecutive advanced dementia patients admitted to a general geriatric department of a tertiary hospital with a 6-month follow-up period. Interrelations between decubitus ulcers and scores on admission were evaluated.
The MSSE scale is available in English, Hebrew, Spanish and Dutch and covers 10 items (range 0-10). A high MSSE scale score with range 7-10 indicates a high level of suffering and reflects the severity of the medical condition in advanced dementia.
The MSSE scale was tested using the Cronbach  model, which demonstrated its significant reliability ( = 0.798). Validity of the MSSE scale was proven by Pearson correlation with Symptom Management in End-of-Life in Dementia (SM–EOLD) scale (r = 0.574, P < 0.0001), and Comfort Assessment in Dying with Dementia (CAD–EOLD) scale (r = -0.796, P < 0.0001). Results: On day of admission to the Geriatric Department, 40% of advanced dementia patients, of whom 63.8% (51/80) were male, suffered from decubitus ulcers (80/200). Patients with decubitus ulcers had a higher score (5.49 + 2.17) than those without bedsores (3.48 ± 2.22), with a significant difference (P < 0.0001). During a 6-month follow-up period, 71.2% (57/80) of end-stage patients with decubitus ulcers were diagnosed as having Aminoff suffering syndrome and subsequently died versus 45.8% (55/120) ESD patients who had not bedsores (P < 0.0001). Conclusions: Decubitus ulcers contribute to the development of Aminoff suffering syndrome in advanced dementia. Key words: advanced dementia, decubitus ulcers, Aminoff suffering syndrome