Abstract: End stage dementia and entropy definition of suffering.

Background: A new definition of human suffering according to the entropy hypothesis may facilitate comprehension of health, Alzheimer disease and the aging process.

Methods: A cohort study of 71 patients (28 females, 43 males) with very advanced dementia who died in our ward during the study period. The intense of the suffering level of end-stage dementia patients was evaluated by the (MSSE) scale.
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 a model, which demonstrated its significant reliability (a = 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: Our research concluded that 63% and 30% of dementia patients died with a high and intermediate level of suffering, respectively. Only 7% died with a low level of suffering. On day of admission the total score of the MSSE scale was 5.62± 2.31, and increased to 6.89±1.95 on the last day of life, with a significant difference (P < 0.0001). Suffering level in advanced dementia has a significant correlation with short survival, advancing age, more severe illness, malnutrition, the existence of decubitus ulcers and the administration of medications. Established correlations could be explained by the enhanced level of the patients’ body entropy. Conclusions: Suffering and satisfaction are functional levels of human entropy. We believe that human suffering may be defined as a complexity of negative sensations, perceptions, emotions or human thoughts that arise due to an increasing level of entropy of a person’s organism and are affected by relationships with others, or germane surroundings in the past, present, or of a future threat. An elevated level of human entropy is a measure of disorder, a process of ageing and torment of the advanced dementia patient.