We studied 183 patients with advanced dementia who had been admitted to the Geriatric-Internal Medicine Department of a general hospital, with a 1 year follow-up evaluated by Mini-Suffering State Examination (MSSE) scores on first days after admission.The not calm compared to calm patients with advanced dementia had a high suffering level (6.12 + 2.16 versus 3.21 + 1.71) with a statistically significant difference (P ¼ 0.001). The not calm patients were sicker, a higher percentage had fever (P ¼ 0.005), elevated levels of white blood cells WBC (P ¼ 0.003) and C-reactive protein (CRP) (P ¼ 0.020). The Kaplan–Meier function analysis showed a shorter survival of not calm versus calm advanced dementia patients, with a statistically significant difference (Log Rank [Mantel– Cox] P ¼ 0.002). Not calm in advanced dementia patients is the first item of the MSSE and is a very important symptom of Aminoff Suffering Syndrome.