Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias

George A Mashour; Lori Frank; Alexander Batthyany; Ann Marie Kolanowski; Michael Nahm; Dena Schulman-Green; Bruce Greyson; Serguei Pakhomov; Jason Karlawish; Raj C Shah

doi:10.1016/j.jalz.2019.04.002

Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias

Alzheimers Dement. 2019 Aug;15(8):1107-1114. doi: 10.1016/j.jalz.2019.04.002. Epub 2019 Jun 19.

Authors

Affiliations

¹ Center for Consciousness Science, Neuroscience Graduate Program, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. Electronic address: gmashour@umich.edu.
² RAND Corporation, Arlington, VA, USA.
³ International Academy of Philosophy, University in the Principality of Liechtenstein, Viktor Frankl Chair, Mauren, Principality of Liechtenstein.
⁴ College of Nursing, Pennsylvania State University, University Park, PA, USA.
⁵ Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany.
⁶ Yale School of Nursing, West Haven, CT, USA.
⁷ Department of Psychiatry, University of Virginia, Charlottesville, VA, USA.
⁸ Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, MN, USA.
⁹ Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
¹⁰ Department of Family Medicine, Rush Medical College, Chicago, IL, USA.

PMID: 31229433
DOI: 10.1016/j.jalz.2019.04.002

Abstract

Unexpected cognitive lucidity and communication in patients with severe dementias, especially around the time of death, have been observed and reported anecdotally. Here, we review what is known about this phenomenon, related phenomena that provide insight into potential mechanisms, ethical implications, and methodologic considerations for systematic investigation. We conclude that paradoxical lucidity, if systematically confirmed, challenges current assumptions and highlights the possibility of network-level return of cognitive function in cases of severe dementias, which can provide insight into both underlying neurobiology and future therapeutic possibilities.

Keywords: Alzheimer's disease; Cognition; Consciousness; Dementia; End-of-life care; Lucidity; Recovery.

Publication types

Review

MeSH terms

Alzheimer Disease*
Cognition / physiology*
Dementia*
Humans