The MSSE scale, developed in 1999 and described by us, was
tested using the Cronbach’s a model, which demonstrated its
SIGNIFICANT RELIABILITY (a = 0.798).

A K AGREEMENT COEFFICINT of 0.791 between 2 observers was found.
Both observers found significant association between the 3 MSSE levels
and age (P = 0.02), hemoglobin (P = 0.02), albumin (P < .001), cholesterol (P =0.04), and use of analgesics or anti-psychotics (P = 0.04). CONVERGENT VALIDITY of the MSSE scale was proven by Pearson correlation with Symptom Management in End-of-Life in Dementia scale (r =0.574, P < 0.0001) and Comfort Assessment in Dying with Dementia scale (r =0.796, P < 0.0001). A high MSSE scale score with a range of 7 to 10 indicates a high level of suffering and reflects the severity of the medical condition in end-stage dementia. According to the MSSE scale, it has been confirmed that patients with end-stage dementia represent a heterogeneous group and have different levels of suffering and accordingly proved a significant CONCURRENT VALIDITY. The results of our research showed that care in the geriatric department fails to decrease the high level of suffering in patients with end-stage dementia. The total score of MSSE scale on the day of admission was 5.62 + 2.31 and increased to 6.89 + 1.95 on the last day of life with a SIGNIFICANT TEST-RETEST RELIABILITY (P < 0.0001). The group differences among the survival times of the 3 MSSE scale scores was evaluated by Kaplan-Meier analysis (log rank, P =0.0018, Breslow, P = 0.0027) and were significant. The results of the Cox proportional Hazard model of survival showed a high correlation between high MSSE scale score and high risk of mortality and short survival of patients with end stage dementia during the last 6 months of life with SIGNIFICANT PREDICTING VALIDITY (P = 0.013).