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Expert reveals mystifying reason a third of dementia patients regain 'lost' memories in days before death
Experts have identified a fascinating feature of dementia, which can often give loved-ones false hope that the person's memory is improving.
They've found that around a third of dementia patients experience remarkable moments of lucidity that begin in their final few days of life.
The phenomenon, called terminal lucidity, sees the dementia patient sudden able to remember people’s names, loved one’s faces, and inside jokes.
And doctors say they often have to manage the family's expectations, as they see the sudden change as a sign their loved-one is improving.
Terminal lucidity is not well-studied or well-understood, however doctors believe it represents part of the brain’s last-ditch effort to keep itself 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 recover to their old selves
Dementia is a chronic, unstoppable disease, but the brief bouts of lucidity turn that standard orthodoxy on its head, with some doctors optimistic that this indicates the condition could, in fact, be reversed.
Dr Sam Parnia, a critical care physician at NYU Langone Health, said: ‘When you die, your brain is deprived of oxygen and nutrients, so it shuts down.
‘This shutting down process takes away the brakes…, and suddenly what seems to be happening is that it gives you access to parts of your brain that you normally can’t access.’
Normally, the ‘brakes’ allow us to filter out irrelevant information to help us carry out normal daily tasks.
But when the brain is deprived of oxygen, those inhibitory mechanisms weaken, and suddenly, people with dementia may have unfettered access to parts of their brains previously off limits.
Julie McFadden, a hospice nurse, said: ‘Sometimes we call it the surge, or the rally. It happens in about one-third of all dying patients.
‘It’s just like it sounds. [Patients] have been really bad, going downhill, it looks like they’re 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 for a few of hours to maybe a couple days and then they suddenly die.’
Julie McFadden, a hospice nurse, said the fleeting clarity lasts hours to just a couple of days and are almost always succeeded by death
Studies have shown that up to 90 percent of patients who experience this last bout of clarity die within a week.
Even if the moments of clarity are fleeting, they can be incredibly meaningful. An end-of-life doula wrote about a client who had been a highly successful intellect and owner of companies and 40 patents. But Alzheimer’s in his 80s forced him to stop working.
His wife had been sitting by his hospital bed for months, speaking with him, and saying good night in the same way every evening. One night, she went to say goodbye, holding each side of his face in her hands and whispering, ‘I love you.’
Suddenly, he woke 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-like state.
His wife said to the doula: ‘He looked directly into my eyes in such a knowing way. I know he knew me. I’ve been saying goodnight to him this same way for months without a response. I can’t believe what just happened.’
Dr Andrew Peterson, a 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 “old self” emerging.
‘There seems to be clear evidence that they’re aware not merely of their surroundings ... but additionally understanding what their relationships to other people are.’
There have been reports of terminal lucidity in medical literature dating back more than 250 years. While it’s most often seen in people with dementia and Alzheimer’s, it can happen to anyone nearing death.
Understanding the underlying mechanisms of these bouts of lucidity could usher in a new field of Alzheimer’s and dementia research.
The phenomenon suggests that the brain maintains some ability to form new neural connections even in the throes of dementia, which raises the possibility that bolstering the brain’s ability to do this with new medicines could lead to long-term improvements.
Dr Peterson said it suggests neural networks and/or helpful pathways may remain in the late stages of the illness, which could 'help potentially restore cognitive abilities to individuals we otherwise think are permanently impaired.’