Serial killer Angus Sinclair died alone in a prison cell, a court has been told.
The 73-year-old was incontinent and bedbound following a series of strokes when he died in March last year.
Sinclair was in Glenochil Prison, Clackmannanshire, after being convicted of four killings including the World's End murders in 1977.
His death was the subject of a fatal accident inquiry at Stirling Sheriff Court because he died in jail.
The inquiry was told that Sinclair had suffered from deteriorating health for about 18 months prior to his death.
Karon Rollo, fiscal depute at the Scottish Fatalities Investigation Unit, said that for a year before he died, Sinclair had required "assistance with personal hygiene and dressing".
She said: "He had an increased frequency of falls, decreased dietary and fluid intake, increased episodes of incontinence, and a DNA CPR (do not attempt cardiopulmonary resuscitation notice) was in place."
For the last five days of his life he was "unable to mobilise", was confined to bed, and was cared for by prison medical and nursing staff.
He was last seen alive by nursing staff at about 01.40 hours on 11 March 2019, locked in his cell in the jail's Abercrombie wing.
When nursing staff checked on him at 03:50, he was not breathing.
Ms Rollo said: "Cause of death was certified as bronchopneumonia, ischaemic heart disease and cerebrovascular disease."
The court heard earlier that Sinclair's next of kin were aware of the inquiry but had opted not to attend or participate, and no criticism of his care at the hands of either the Scottish Prison Service or the NHS had been made.
Sinclair had been in prison since 1982 after being convicted of a series of rapes and indecent attacks on children.
In 2014 he was found guilty of murdering teenagers Helen Scott and Christine Eadie who were last seen at the World's End pub in Edinburgh in October 1977.
Despite the biggest hunt in Scottish police history, the identity of their killer remained a mystery for decades.
He was also convicted of the murders of Catherine Reehill, seven, and 17-year-old Mary Gallacher, but he was suspected of killing four more women.
Who was Angus Sinclair?
The words "evil" and "monster" are inadequate ones to describe a "dangerous predator capable of sinking to the depths of depravity".
Those were the damning remarks of the judge who sentenced Angus Sinclair for the murders of teenagers Christine Eadie and Helen Scott.
It had taken 37 years and a change to Scotland's double jeopardy law before the killer was brought to justice for these two deaths.
But the Glasgow-born painter and decorator had killed before.