May 08, 2024 12:30:00

Why do memories and thinking abilities of patients with terminal dementia 'return' just before death?

Dementia slowly robs patients of their past memories and communication abilities, leading to them being unable to remember even the things and family members that were important to them, and is sometimes referred to as the 'long goodbye.' However, as far back as

the 19th century , there have been reports of some dementia patients suddenly regaining clarity, conversing with family and friends as they used to, remembering things from the past that they had lost, and eating meals. A psychologist explains the phenomenon in which patients appear to 'return' from their dementia state temporarily.

Terminal lucidity: why do loved ones with dementia sometimes 'come back' before death?
https://theconversation.com/terminal-lucidity-why-do-loved-ones-with-dementia-sometimes-come-back-before-death-202342

According to Yen Yin Lim, an associate professor of psychology at Monash University in Australia, and her colleagues, it is estimated that 43% of people returning home with dementia die within 24 hours, and 84% die within a week.

This phenomenon has long been known by patients' families and medical facility staff, but it was not the subject of scientific study for a long time until researchers coined the term 'terminal lucidity' in 2009.

Terminal lucidity is generally considered to occur just before death, but not all cases occur just before death. A 2024 study found that many patients with advanced dementia showed a little mental clarity more than six months before death. Cases of people with cognitive or memory disorders suddenly regaining mental clarity have also been reported in patients with meningitis , schizophrenia, brain tumors, and brain trauma.

The phenomenon of regaining mental clarity before death is sometimes called ' paradoxical lucidity ,' a name given to the phenomenon because it contradicts the expected course of neurodegenerative diseases such as dementia. Unfortunately, paradoxical lucidity is temporary and does not halt or reverse the progression of neurodegenerative diseases.

Although research into terminal lucidity has progressed in recent years, it is difficult to explain its mechanism. There are numerous case reports of terminal lucidity occurring in the presence of loved ones, and

research has shown that music can improve mental clarity, but most terminal lucidity does not have a clear trigger.

A 2023 study reported that changes in brain activity before death could cause terminal lucidity, but Lim and his colleagues say this alone doesn't fully explain why lost abilities suddenly return.

Another challenge is that research into paradoxical lucidity and terminal lucidity is itself difficult. Not all patients with advanced dementia experience terminal lucidity, and because the trigger is unknown, it is impossible to predict when lucidity will be regained.

Furthermore, terminal lucidity is a precious moment for those who are present to interact with the patient, and in some cases, a last chance to communicate with them. It would be unethical for researchers to use that time to interview the patient or to ask family members about their experiences after death.

In fact, people who have witnessed terminal lucidity in advanced dementia patients have a variety of reactions. Some feel it is a peaceful and warm moment, while others are deeply shaken by the sudden change. In some cases, they even request life-prolonging measures, thinking that 'maybe the patient is on the road to recovery.'

'Awareness of the phenomenon of terminal lucidity can help loved ones understand that it is part of the dying process, accept that the person with dementia will not recover, and make the most of the time they spend with their loved one who has regained lucidity,' said Lim et al. 'For those present, terminal lucidity may be one last precious opportunity to reconnect with the patient before the dementia progresses and the 'long goodbye' begins.'