Most Dementia Patients ‘Return’ Before Death And It’s Unclear Why : ScienceAlert

Dementia is often described as “a long goodbye.” Even if the person is still alive, dementia slowly and irreversibly destroys their memories and the qualities that make someone “them.”

Dementia eventually robs the person of their ability to communicate, eat and drink on their own, understand where they are, and recognize family members.

Since the 19th century, accounts from relatives, caregivers and health workers have described people with dementia suddenly becoming lucid. They described the person engaging in meaningful conversation, sharing supposedly lost memories, making jokes, and even asking for meals.

An estimated 43 percent of people who experience this brief lucidity die within 24 hours and 84 percent within a week.

Why does this happen?

Terminal lucidity or paradoxical lucidity?

In 2009, researchers Michael Nahm and Bruce Greyson coined the term “terminal lucidity” because these episodes of lucidity often occurred shortly before death.

But not all lucid episodes indicate that death is imminent. A study has found that many people with advanced dementia will show brief glimmers of themselves more than six months before they die.

Lucidity has also been reported in other conditions affecting the brain or thinking skills, such as meningitis, schizophrenia, and in people with brain tumors or brain injury.

Moments of lucidity that do not necessarily indicate death are sometimes called paradoxical lucidity. It is considered paradoxical because it defies the expected course of neurodegenerative diseases such as dementia.

But it is important to note that these episodes of lucidity are temporary and unfortunately do not represent a reversal of the neurodegenerative disease.

Why does terminal lucidity occur?

Scientists have struggled to explain why terminal lucidity occurs. Some episodes of lucidity have been reported in the presence of loved ones. Others have reported that music can sometimes improve lucidity. But many episodes of lucidity do not have a distinct trigger.

A New York University research team hypothesized that changes in brain activity before death could cause terminal lucidity. But that doesn’t fully explain why people suddenly regain abilities previously thought lost.

Paradoxical and terminal lucidity are also very difficult to study. Not everyone with advanced dementia will experience episodes of lucidity before death. Lucid episodes are also unpredictable and usually occur without a particular trigger.

And since terminal lucidity can be a moment of joy for those who witness the episode, it would be unethical for scientists to use this time to conduct their research. At the time of death, it is also difficult for scientists to question caregivers about lucid moments that may have occurred.

Explanations for terminal lucidity go beyond science. These moments of mental clarity can be a way for the dying person to say their final goodbyes, turn the page before death, and reconnect with family and friends. Some believe that episodes of terminal lucidity are representative of the person connecting to an afterlife.

Why is terminal lucidity important?

People can have a variety of reactions when they see terminal lucidity in a person with advanced dementia. While some will experience it as peaceful and bittersweet, others may find it deeply confusing and upsetting. There may also be a need to change care plans and seek life-saving measures for the dying person.

Being aware of terminal lucidity can help loved ones understand that it is part of the dying process, recognize that the person with dementia will not recover, and allow them to make the most of the time they spend with them. the lucid person.

For those who witness it, terminal lucidity can be a last, precious opportunity to reconnect with the person who existed before dementia took hold and the “long goodbye” began.

Yen Ying Lim, Associate Professor, Turner Institute for Brain and Mental Health, Monash University and Diny Thomson, PhD Candidate (Clinical Neuropsychology) and Provisional Psychologist, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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