8th International Conference on Alzheimer Disease and
Related Disorders, Stockholm, Sweden, 2002
Neurology of Aging 2002; 23 (1S):S153
The First Objective Tool for the Evaluation of Suffering in End-Stage Dementia: Reliability and Validity
B.Z.Aminoff, E.Purits, A.Adunsky
Geriatric Division and Memory Clinic, and Stuchynsky Alzheimer Research Treatment Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel
The purpose of this study was to assess the reliability and validity of the (MSSE), an objective scale for the evaluation of suffering in ESD. The MSSE was initially introduced at the IVth European Congress of Gerontology, Berlin, 1999, and the 17th World Congress of Gerontology, Vancouver, 2001 (Aminoff). One hundred and three dementia patients with severe cognitive (MMSE-0/30) and functional decline (FIM-18/126) were independently examined by two physicians (Ph-1 and Ph-2). The reliability of the MSSE questionnaire (10 items, range 0-10) was found to be significant, with Cronbach alpha values of 0.735 (Ph-1) and 0.718 (Ph- 2). The Kappa agreement coefficient of the two sets of examinations to the whole scale was 0.791. There was an almost perfect agreement rate between Ph-1 and Ph-2 for seven items (Kappa 0.882-0.972) and a substantial agreement rate for three items (Kappa 0.621-0.682) in the MSSE scale. The total MSSE score for Ph-1 and Ph-2 was 4.8±2.54 and 4.42±2.42, respectively, with a strong Pearson correlation (r=0.929). The EDS patients were divided into three levels of MSSE (low range 0-3: Ph-1 – MSSE=2.19±0.94;Ph-2 – MSSE=2.14±0.90;intermediate range 4-6: Ph-1 – MSSE=4.95±0.93;Ph-2 – MSSE=4.83±0.81;high range 7-10: Ph-1 – MSSE=8.31±0.93;Ph-2 – MSSE=8.19±0.81, with significant differences between the groups [P <0.0001])). Negative Pearson correlations were found between the levels of MSSE and the levels of total protein, albumin, hemoglobin, cholesterol and a positive correlation was found using analgesics (Ph-1, Ph-2;P <0.0001). Significant differences were found in the survival curves of the groups of patients in the three MSSE levels. A much shorter survival was observed in patients with high MSSE levels with the Kaplan-Meier method using Log Rank and Breslow tests. The MSSE scale is recommended for the diagnosis of the severity of the patient’s condition and the level of suffering in ESD.