Experts have identified a fascinating feature of dementia, which can often give loved ones false hope that the person’s memory is improving.
They have found that about a third of dementia patients experience notable moments of lucidity beginning in the last days of their life.
The phenomenon, called terminal lucidity, causes the dementia patient to suddenly be able to remember people’s names, the faces of loved ones and inside jokes.
And doctors say they often have to manage family expectations, seeing the sudden change as a sign that their loved one is getting better.
Terminal lucidity is neither well studied nor well understood; However, doctors believe it represents part of the brain’s last-ditch effort to stay alive while other physiological processes slow or stop.
The final bout of lucidity can be distressing for the patient’s loved ones, who may experience a false glimmer of hope that they will regain their old selves.
Dementia is a chronic, unstoppable disease, but brief bouts of lucidity turn that standard orthodoxy on its head, and some doctors are optimistic that this indicates the condition could, in fact, be reversed.
Dr. Sam Parnia, a critical care physician at NYU Langone Health, saying: ‘When you die, your brain is deprived of oxygen and nutrients, so it shuts down.
“This shutdown process takes the brakes off… and all of a sudden what seems to be happening is it gives you access to parts of your brain that you normally can’t access.”
Typically, ‘brakes’ allow us to filter out irrelevant information to help us perform common day-to-day tasks.
But when the brain is deprived of oxygen, those inhibitory mechanisms weaken, and suddenly people with dementia can have unlimited access to parts of their brain that were previously off-limits.
Julie McFadden, palliative care nurse, saying: ‘Sometimes we call it an increase or a rebound. It occurs in approximately one third of all dying patients.
‘It’s just what it sounds like. (The patients) have been very bad, they are going downhill, it seems like they are going to die. And suddenly they get better…they start talking, their personality comes back, maybe they’re walking, maybe they’re eating. It usually only lasts a few hours or maybe a couple of days and then they die suddenly.’
Julie McFadden, a palliative care nurse, said the fleeting clarity lasts from hours to just a couple of days and is almost always followed by death.
Studies have shown that up to 90 percent of patients Those who experience this last bout of clarity die within a week.
Even if the moments of clarity are fleeting, can be incredibly meaningful. A doula at the end of her life wrote about a client who had been a highly successful intellect and owner of businesses and 40 patents. But Alzheimer’s at age 80 forced him to stop working.
His wife had been sitting next to his hospital bed for months, talking to him and saying goodnight the same way every night. One night, she went to say goodbye to her, holding each side of her face in her hands and whispering, “I love you.”
Suddenly, he woke up from his coma, looking at her with full recognition of who she was and said, “I love you too” before falling back into his coma.
His wife told the doula: ‘He looked me straight in the eyes with great knowledge. I know he knew me. I’ve been saying goodnight in this same way for months without getting a response. I can’t believe what just happened.’
Dr. Andrew Peterson, professor of philosophy and bioethics at George Mason University, said, “One thing that seems to be quite profound for family members who observe lucidity is something we call the emergence of the ‘old self.’
“There seems to be clear evidence that they are not only aware of their surroundings… but also understand what their relationships are with other people.”
There have been reports of terminal lucidity in medical literature dating back more than 250 years. While it is most commonly seen in people with dementia and Alzheimer’s, it can happen to anyone who is near death.
Understanding the underlying mechanisms of these attacks of lucidity could open a new field of research into Alzheimer’s and dementia.
The phenomenon suggests that the brain maintains some ability to form new neural connections even in the midst of dementia, raising the possibility that boosting the brain’s ability to do so with new medications could lead to long-term improvements.
Dr. Peterson said this suggests that useful neural networks and/or pathways may remain in the later stages of the disease, which could “potentially help restore the cognitive abilities of individuals we otherwise think are permanently impaired.” .
