Terminal Lucidity Explained: How Does a Person With Dementia Experience Mental Clarity Before Death?

There are so many feelings, incidents that can occur unexpectedly as the patients reach the end of their life. Terminal lucidity is one example of the end-of-life phenomenon which puzzles so many families and caregivers.

What Is Terminal Lucidity?

Terminal lucidity refers to the phenomenon where a person who was unable to communicate or perform any other meaningful behaviors briefly regains clear consciousness or mental cognizance.

Also known as end-of-life rallying, this phenomenon is commonly observed among terminally ill patients, where they experience a sudden influx of energy, alertness, and awareness before death. Accounts of terminal lucidity have had people overcome disease and brain injuries such as stroke, brain abscesses, and tumors to recall memories and people.

Terminal lucidity does not only mean that a terminally ill person bounces back but sometimes also entails people with mental illness who become asymptomatic of their particular condition shortly before dying. The condition has seen even people who had been living with dementia return to their former cognitive function, to the surprise of all, to die sometime after.

Terminal lucidity means that, at times, individuals are able to do a number of things they previously could not: recognize the people around them, remember who or where they are, remember their past, and request their favorite food. They may also speak in full and lucid sentences, answer questions, stand up and move about, and sing.

The gap between terminal lucidity and the time of a person's death has created controversy about the naming of the phenomenon. Other research refers to it as "paradoxical lucidity" because the state of mental clarity can occur hours, days, weeks or even months prior to death.

Terminal lucidity is a little-investigated field of research, and few real studies have been published on it. Under these circumstances, it is correspondingly difficult for experts to say how common these episodes of lucidity really are.

In a 2018 study, researchers investigated terminal lucidity cases in patients who were admitted to a teaching hospital. Of the 338 reported deaths, there were only six episodes of terminal lucidity; all patients died within nine days of the episode.

Terminal lucidity can be an emotional experience since there is no way to predict if or when it might happen or how long it might last. A 2022 study found that 72% of caregivers surveyed had a positive attitude toward witnessing episodes of lucidity, while 17% of caregivers found the experience actually stressful.

What Causes Terminal Lucidity?

Currently, science cannot explain why these episodes of short-term lucidity occur. It is actually a very baffling phenomenon to decipher since it relates to individuals whose brain function is thought to be irreversibly damaged due to disease, for example, Alzheimer's disease, or other dementia-causing conditions.

According to a 2009 study, historical cases of terminal lucidity were explained as consequences of the way the brain physiology changes when a person is dying, although detailed explanations to support this claim were lacking.

Other experts believe that the momentary changes in cognition occur due to alterations in some brain functions. Some other studies indicate that unexplained changes in the brain and body may occur moments before death, and this could be responsible for changing memory and behavior.

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