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Moments of Clarity in Dementia; an Opportunity for New Research and Hope

Wednesday, July 24th, 2019

People living with advanced dementia can experience remarkable moments of spontaneous clarity near the end of their life. An interdisciplinary workgroup is calling for a closer examination into this unusual phenomenon, called terminal or paradoxical lucidity; proposing that it may give clues to there being a reversible component to this otherwise assumed irreversible, degenerative condition.

The group recently published an article outlining what is known and not known about paradoxical lucidity, the possible mechanisms by which it might occur, and the ethical and methodological considerations involved in such investigation. The review describes earlier work whereby most collected instances of this meaningful connection with the world occurred within the last one or two days of the individual’s life, and ranged from minutes to several days.

The researchers do not know what is behind this unexpected lucidity. They suggest that it could share elements of the neural activity seen in near death experiences during heart attacks. Else, observations of dying rats implicate that surges of electrical activity or neurotransmitter release in the brain might enable access to some sort of functional network configuration.

The authors acknowledged that studying paradoxical lucidity will be challenging because of the fleeting nature of the event, and that new technology and methods will need to be designed to capture it. The team recognise important ethical implications of the work, including the ability of the person with dementia to provide consent and an awareness that it might impact caregivers’ interactions with their loved one.

It is hoped that the data generated by such research might inform end-of-life opportunities for the person with the dementia and their family, as well as identify novel avenues for therapeutic intervention.

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The University of Sydney

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